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.
Limit Or Avoid Alcohol
Studies show that there is a link between moderate and heavy alcohol use and breast cancer. Alcohol is known to raise estrogen levels in your blood. This makes it more likely for you to get cancer again. If youâre a cancer survivor, itâs best to avoid alcohol altogether.
If you do choose to drink, make sure to limit it to only one drink a day to lower your chances of your cancer coming back.
Can I Lower My Risk Of Getting A Second Cancer
There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen after breast cancer.
To help maintain good health, breast cancer survivors should also:
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Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
Palb2 Gene Mutation Could Raise Risk Of Developing Breast Cancer By As Much As 60 Percent
In 1997, during a routine mammogram, I learned I had breast cancer. I left my job at Saks and had a lumpectomy, six months of chemo, six weeks of radiation and later 10 years of the drug tamoxifen. During the months of chemotherapy, I saw an ad in the Chicago Tribune they needed a freelance journalist. I had only ONE published clip to my name, but I applied.
I still remember the phone call from Andy Gottesman, the editor at the Tribune who hired me. We are going to give you a chance. Indeed, they did. My first story was to interview a woman who had a tree fall on her house during a snowstorm. I went out into the blizzard following a chemo treatment.
That year, I had 35 stories published in the Chicago Tribune. Later I would go on to be a staff writer at a local paper, the Pioneer Press and since 2003 have been an independent journalist writing for Chicago Tribune, New York Times, Washington Post and more.
This April, one of my daughters learned she had the PALB2 mutation during genetic testing. I had genetic testing in 2009 and was relieved to learn I did not have the more known BRCA mutation. I thought that my daughters and I were in the clear.
The PALB2 mutation, which could raise the risk of developing breast cancer as much as 60 percent, was discovered in 2014.
How was it possible that I, a 24-year breast cancer survivor and a journalist who for the last 10 years specialized in health reporting, knew NOTHING about PALB2?
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How Does Distant Recurrence Occur
Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?
In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.
While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.
If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.
Changes To The Breast Or Chest Area
After breast-conserving surgery or a mastectomy, with or without reconstruction, be aware of any changes to either side, such as:;
- swelling on your chest, in your armpit or around your collarbone
- a change in shape or size
- a change in skin texture, such as puckering or dimpling
- redness or a rash on or around the nipple or on the skin
- liquid that comes from the nipple without squeezing it
- the nipple has become inverted or looks different, for example changed its position or shape
- swelling in the arm or hand
- a lump or thickening that feels different
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Can Breast Cancer Return After A Double Mastectomy
During the course of breast cancer treatment, a woman may decide, after discussion with her doctors, to have both of her breasts removed.
She might choose to have a double mastectomy in the hope that it will reduce the risk of breast cancer recurring in the remaining tissue or a new cancer developing in the opposite, unaffected breast.
A woman who has had breast cancer does not inherently or automatically face an increased risk of being diagnosed with another type of cancer, says Ellis Levine, MD, Chief of Breast Medicine at Roswell Park Comprehensive Cancer Center.
Unless they have an underlying hereditary genetic mutation, I do not consider them at exquisite risk to develop another type of cancer, he says. The cancer that is most often genetically linked to breast cancer is ovarian, due to mutations in the BRCA 1 or BRCA 2 genes.
When mastectomies are performed, surgeons will remove as much of the cancerous tissue as possible. If a woman, in consultation with her doctors, decides to have a skin-sparing or nipple-sparing mastectomy, a small amount of healthy breast tissue may be left behind on the skin to allow for reconstruction of her breasts.
Even if the full breast is removed, surgeons will not have removed 100% of the breast cells, explains Jessica Young, MD, a breast surgeon at Roswell Park. The risk of cancer recurring is lower if the whole breast is removed, but it is not zero percent.
Breast Cancer Treatment
Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status; and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a;single vs. double mastectomy.
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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.
Side effects can include vaginal discharge, muscle and joint pain, hot flashes, and night sweats. These drugs may also speed up osteoporosis and may raise your cholesterol.
Treatment Of Local Recurrence After Previous Mastectomy
Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.
Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.
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Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
Breast Cancer Survivors Fear Of Cancer Returning Linked To Genomic Test Results Psychological Factors
Modifiable Factors Such as Anxiety and Emotional Response to Cancer Are Strongest Predictors of Fear
Breast cancer survivors with a higher risk of cancer recurrence based on genomic testing may experience greater fear of their cancer returning, according to a new study led by researchers at NYU Rory Meyers College of Nursing. However, psychological factors such as anxiety are the best predictors of survivors fear of their cancer recurring.
Although genomic test results were associated with fear of cancer recurrence, our findings highlight that distressing, but treatable, psychological factors fuel cancer survivors fear of recurrence, said Maurade Gormley, PhD, RN, an assistant professor and faculty fellow at NYU Meyers and the lead author of the study, which was published in the journal Psycho-Oncology.;; ;
For breast cancer survivors, fear and worry that their cancer will return is a significant, unmet psychological need. Over half of breast cancer survivors experience moderate to severe levels of fear of cancer recurrence; this grows to up to 70 percent among younger breast cancer survivors.
We wanted to address the question of whether women with a history of breast cancer have greater fear of recurrence when they are told they are at high risk from genomic testing, said Gormley.
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How Is Breast Cancer Recurrence Managed Or Treated
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
- Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
- Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
- Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
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.
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How Do I Know There Is A Recurrence
If you’ve been treated for breast cancer, you should continue to practice breast self-examination, checking both the treated area and your other breast each month. You should report any changes to your doctor right away. Breast changes that might indicate a recurrence include:
- An area that is distinctly different from any other area on either breast
- Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
- A change in the size, shape, or contour of the breast
- A mass or lump, which may feel as small as a pea
- A marble-like area under the skin
- A change in the feel or appearance of the skin on the breast or nipple, including skin that is dimpled, puckered, scaly, or inflamed
- Bloody or clear fluid discharge from the nipples
- Redness of the skin on the breast or nipple
In addition to performing monthly breast self-exams, keep your scheduled follow-up appointments with your healthcare provider. During these appointments, your healthcare provider will perform a breast exam, order lab or imaging tests as needed, and ask you about any symptoms you might have. Initially, these follow-up appointments may be scheduled every three to four months. The longer you are cancer-free, the less often you will need to see your healthcare provider. Continue to follow your healthcare provider’s recommendations on screening mammograms .
Prognosis Of Late Vs Early Cancer Recurrence
Late recurrence is associated with a better prognosis than early recurrence in estrogen receptor-positive breast cancer. A 2018 study in Clinical Breast Cancer found that survival after recurrence was significantly longer in people with a late versus early recurrence . In this study, the lungs were the most common site of late distant recurrence.
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