Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
Treatment For Breast Cancer Recurrence
If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.
Treatment options depend on where the cancer has recurred and what treatment youve had before:
- Local recurrence is likely to be treated surgically first with a mastectomy if you didnt have one already or a surgical removal of the tumor if you did. After surgery, chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
- Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
- Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.
Circulating Tumor Cells At 5 Years Post
In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.
In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.
Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.
That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.
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How Is A Local Recurrence Or Metastasis Found
Breast cancer can recur at the original site . It can also return and spread to other parts of the body .
Local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.
Metastasis is usually found when symptoms are reported to a provider.
If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.
Learn about follow-up care after breast cancer treatment.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic the cancer has come back not in the breast , but elsewhere in the body as well. Thats a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a new cancer, and is treated as such.
Be aware that many people talk about recurrence and metastasis in the same breath. But they are not the same thing. If you have had a local recurrence, when the cancer remains confined to your breast, the good news is that your prognosis is not necessarily any worse than it was the first time.
Whether its a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume were dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation, says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.
If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer would be treated largely as an entirely new problem.
That woman will not only undergo surgery, but may well receive additional therapy that doesnt ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent, says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
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Should I Have Regular Routine Scans Or Blood Tests To Check For Distant Breast Cancer Recurrence
No. Routine scans to check for the presence of distant disease recurrence are not recommended in the absence of symptoms
Given the ominous nature of stage 4 disease, the obvious question is, why dont we scan for spread regularly after a first diagnosis, so that we can detect it early if it does return? The reason we dont scan or test for metastasis is that there really is no early stage 4 disease, and thus no real opportunity to intervene earlier and increase the chance of cure. Its also important to know that with recurrence, one does not progress from one stage to the next: a woman who was originally diagnosed with stage 1 breast cancer does not recur as stage 2, because once cells have taken up residence elsewhere, she is immediately considered to have stage 4 disease. And with stage 4 disease, either you respond well to treatment and the disease regresses, or you dont and it doesnt. Studies have shown that getting frequent scans after a first cancer diagnosis does not lead to improved survival, which is why we dont scan for stage 4even if we wish we could.
Current guidelines and evidence therefore recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on.
If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.
Treatment For Local Recurrence
Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.
If you had breast-conserving surgery then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.
If you previously had a mastectomy, surgery may be possible to remove the affected areas.
Nearby lymph nodes may also be removed.
Radiotherapy is usually only an option if you havent previously had radiotherapy in the same area.
The way radiotherapy is given for a recurrence is similar to how its given to someone newly diagnosed.
Radiotherapy may be offered if surgery isnt possible.
Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.
Its not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases.
If you have previously had chemotherapy then different chemotherapy drugs may be used.
The most widely used targeted therapies are for HER2 positive breast cancer.
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Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
Getting Support And Information
It can be very difficult to cope with the news that your cancer has come back. At first, you are likely to feel very upset, frightened and confused. Or you may feel that things are out of your control.
It is very important to get the right information about your type of cancer and how it is best treated. People who are well informed about their illness and treatment are more able to make decisions and cope with what happens. Your doctor or breast care nurse can give you information.
It can help to talk to family and friends about how you feel.
You can also contact one of the breast cancer organisations. They have free factsheets and booklets they can send to you. They might also be able to put you in touch with a support group.
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Treatment Type And Breast Cancer Survival
Overall survival is the same for lumpectomy plus radiation therapy and mastectomy. This means both treatments lower the risk of dying by the same amount.
For a summary of research studies on lumpectomy plus radiation therapy and mastectomy in the treatment of early breast cancer, visit the Breast Cancer Research Studies section.
Introduction To Breast Cancer Recurrence
Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment. Breast cancer can come back as a local recurrence or as a distant recurrence somewhere else in the body. The most common sites of recurrence include the lymph nodes, the bones, liver, or lungs.
What Factors Determine The Likelihood Of A Recurrence
- Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence.
- Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
- Hormone receptors. About two-thirds of all breast cancers contain significant levels of estrogen receptors, which means the tumors are estrogen receptor positive . ER-positive tumors tend to grow less aggressively and may respond favorably to treatment with hormones.
- Histologic grade. This term refers to how much the tumor cells resemble normal cells when viewed under the microscope the grading scale is 1 to 4. Grade 4 tumors contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater chance of recurrence.
- Nuclear grade. This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade are usually more aggressive .
- Oncogene expression. An oncogene is a gene that causes or promotes cancerous changes within the cell. Tumors that contain certain oncogenes may increase a patient’s chance of recurrence.
Breast Cancer ‘can Return 15 Years After Treatment Ends’
Breast cancer can resurface after remaining dormant for 15 years following successful treatment, a study has found.
Women with large tumours and cancer that had spread to the lymph nodes had the highest 40% risk of it coming back.
Researchers writing in the New England Journal of Medicine said extending treatment with hormone therapy could reduce the risk of it recurring.
Scientists analysed the progress of 63,000 women for 20 years.
All had the most common form of breast cancer.
This is a type fuelled by the hormone oestrogen which can stimulate cancer cells to grow and divide.
Every patient received treatments such as tamoxifen or aromatase inhibitors which block the effects of oestrogen or shut off the hormone’s supply.
Although after five years of treatment their cancers had gone, over the next 15 years a steady number of women found that their cancer spread throughout their body – some up to 20 years after diagnosis.
Women who originally had large tumours and cancer that had spread to four or more lymph nodes were at highest risk of the cancer returning the next 15 years, the study said.
Women with small, low-grade cancers and no spread to the lymph nodes had a much lower 10% risk of cancer spread over that time.
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Check On Whether You Need Medications
After you complete your cancer treatment, if you have a high chance of your cancer returning, your doctor may prescribe you certain drugs to reduce your risk.
Tamoxifen and raloxifene are two such drugs. These drugs are approved for use in the U.S. and doctors usually prescribe them to lower the chances of estrogen-related breast cancer. Both drugs block estrogen hormone in breast cells. Studies show that they reduce your chances of getting breast cancer again by about 40%.
Tamoxifen. You take this once a day by mouth as a pill or liquid. It may make it less likely for you to get cancer in parts of your breast that werenât affected earlier. You may have side effects like hot flashes, vaginal discharge, irregular periods, loss of sexual interest, memory loss, fatigue, and joint pain.
Raloxifene. Itâs a pill you take once a day. Itâs usually given to women who are post-menopausal those who stopped having their periods. It may also help you avoid or treat osteoporosis, when your bone density thins, putting you at risk of fractures.
While rare, these drugs can also cause blood clots in your leg veins or lungs. This can be a serious side effect that may need immediate medical attention. Contact your doctor as soon as possible if you think you have a blood clot.
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Local Breast Cancer Recurrence
Local breast cancer recurrence is when the cancer has reoccurred close to or in the same place the first tumor was found within the breast. If you were treated with lumpectomy and radiation for your first occurrence, the breast tissue cannot be treated with radiation again. In that case, the standard of care for surgical treatment is mastectomy.
If radiation was not part of your original treatment when lumpectomy was performed, then another lumpectomy followed by radiation may be recommended. If there is not adequate breast volume remaining for lumpectomy, mastectomy may be recommended. Depending on the medical oncologists evaluation, which is based on the prognostic factors of the tumor, he or she may recommend chemotherapy and/or hormonal therapy.
How Will My Prognosis Affect My Treatment
Following surgery or radiation, your treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with your surgeon, may advise the use of tamoxifen or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
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Treatments And Recurrence: Early And Late
Treatments also play a role in both early and late recurrences. While chemotherapy can significantly reduce the risk of recurrence in the first five years, it has much less influence on the risk of late recurrence.
Hormonal therapy reduces the risk of recurrence in the first five years , but can also reduce the risk of late recurrences. It is this reduction in risk that has led to recommendations to extend hormonal therapy for people at high risk beyond five years.
Extending hormonal therapy from five years to 10 years has been shown to reduce the risk of late recurrence, but the risk of recurrence needs to be weighed against the side effects of continued therapy.
A 2019 study found that people with luminal A tumors continued to have significant benefit from tamoxifen therapy for 15 years post-diagnosis.
The addition of bisphosphonates to an aromatase inhibitor in post-menopausal women with early-stage breast cancer may improve survival, but it’s too early to determine the effect on late recurrences. Bisphosphonates reduce the risk of bone metastases, but the most common sites of distant late recurrence are the brain, liver, and lungs.