Breast Cancer Recurrence

There are some excellent on line resources such as the NIH.
Web MD features a breast cancer health center. Cancer Connect has up to date information. The American Cancer Society is a reliable source. The Web can be wonderful tool.

Recurrence and survival statistics are based on historical studies as well as more current clinical trial results. It is important for an individual patient to realize that they are not a statistic, and that recurrence and survival rates can never be predicted with complete accuracy in a given patient. My recommendation is to be aware of the statistics as they pertain to your individual case, but do not hang all your hopes and fears on those numbers.

Usually after mastectomy and reconstruction, imaging such as mammogram is not performed as all or almost all of the breast tissue is removed. MRI is sometimes performed every few years, but primarily to assess the integrity of silicone implants, if they were used for the reconstruction.

There are no standard recommendations for imaging in a patient that has undergone mastectomy and implant reconstruction - usually careful physical exam every 6 months is recommended as a recurrence will most often present as a palpable lump (able to be felt). In cases where it is difficult to differentiate scar tissue from recurrence, biopsy is usually performed.

If reconstruction is performed using a muscle flap, MRI or ultrasound are probably the most helpful tests to rule out recurrence, but again there are no standard recommendations for post-mastectomy imaging.

The options for such patients have never been greater. They include continuing trastuzumab (Herceptin™) as the chemotherapy is switched, the substitution or addition of lapatinib for or with trastuzumab, and enrollment on clinical trials testing a large and growing number of HER2 directed novel therapies.

A key issue would be whether or not your cancer was estrogen receptor (ER) or progesterone receptor (PR) positive. The standard recommendation (which I'm sure you have heard) is that HRT is not given after a diagnosis of breast cancer.

If an anti-estrogen therapy, such as tamoxifen or one of the aromatase inhibitors, has been recommended for you to reduce recurrence, then administration of oral HRT would counteract the treatment.

Vaginal estrogen, such as Vagifem, is often given to women who have had breast cancer and have symptomatic vaginal dryness. The absorption of estrogen from the vagina is relatively small.

Data have been reported by Craig Jordan and Matthew Ellis of cases of cancer to longer sensitive to anti-estrogen treatment (hormone-resistant), which can be rendered hormone sensitive again after administration of estrogen. So the estrogen question in a complex one.

The time since diagnosis should also be considered. If a patient is cancer free for many years after diagnosis, and had poor quality of life from estrogen lack, then estrogen may be recommended after full discussion of the pros and cons.

Risk of recurrence will depend in staging (tumor size and presence or absence of nodal metastases).

Your chance of developing a new primary breast cancer has been greatly reduced by having a bilateral mastectomy.

A study by El-Tamer et al Ann Surg Oncol. 2004 Feb;11(2):157-64 found no difference in overall survival and breast-cancer specific survival between BRCA mutation carriers and non-carriers.

You choice to have bilateral mastectomy has certainly reduced the likelihood of a new cancer in the same breast and vastly reduced the chance of a cancer in the opposite breast. Adjuvant chemotherapy (and hormonal therapy when indicated) has reduced your chance of recurrence. Oophorectomy has diminished your chance of ovarian cancer.

It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.

I strongly recommend regular exercise, which has been shown to reduce recurrence rates.

When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good.

I was originally diagnosed with IBC in Aug 2008, with breast, axillary and supraclavicular node(above the collarbone) involvement making me a stage 3, my frist recurrence 5 months after initial treatment was in my internal mammary lymph node - a loco-regional recurrence still a stage 3. this year it has gone to my liver as Dr Ueno states above this is considered a distant metastasis there for stage 4. So I would be the exception to the in general rule as my first recurrence was still within stage 3 parameters

In general, surgery is not indicated for a recurrent inflammatory breast cancer. However, there is always an exception depending on the clinical situation. This case is something that we should not be commenting based on the information provided on the net. I recommend to see a multidisciplinary team with a experience in inflammatory breast cancer.

The following information is from the site Facing Our Risk: http://www.facingourrisk.org/index.php - a national nonprofit organization devoted to hereditary breast and ovarian cancer.

"Women with a BRCA mutation or other hereditary breast cancer who choose breast conservation to treat their breast cancer are at higher risk for another cancer in either breast than women with sporadic breast cancer. Although the exact risk depends on a woman’s age and other factors, one study found that BRCA carriers diagnosed with breast cancer have a 14% chance within ten years of developing the disease in the same breast, and a 37% chance within ten years of developing the disease in the opposite breast. Another study found a 40% chance for BRCA carriers to develop cancer in the opposite breast within ten years of their initial diagnosis. The risk for a second breast cancer among women who develop sporadic cancer is about 10%."

If there's one thing that can comes up time and time again for risk reduction in breast cancer survivors it is exercise; moderate, daily exercise. This, most recently on ABC World News Tonight 10/3/11: http://abcnews.go.com/WNT/video/breast-cancer-awareness-hit-gym-14659881

I took up cycling following treatment not necessarily to prevent recurrence, but because exercise in and of itself helped reduce symptoms brought on by treatment, especially tamoxifen. Other helpful strategies: I eat a largely vegetable based diet, little if any red meat; I avoid situations that do nothing but cook up stress for me; and when possible, I laugh long and hard. There's everything to be said for surrounding yourself with loving, open people.

The other caveat I believe all of us understand is that there are certain kinds of breast cancer that are more amenable to these kind of interventions. Mine happened to be one, even though I was diagnosed at a later stage, it was ER/PR positive.

Biologically speaking, there are also breast cancers that are so aggressive no amount of self-propelled activity is going to change the outcome. I don't want any woman with advanced disease to blame herself for not doing enough. We all must do what we can by understanding our cancer and what helps make us tick.

When experiencing fear of a post-treatment recurrence, I tell my friends that the best thing they can do for me is pray and meditate. It's important to find friends who can handle your expression of fear without judgment or emotion. A loved one may be too close to you to listen to those fears without panicking. A volunteer from the American Cancer Society can be an objective source of support, there just to listen and affirm any anxiety. For breast cancer the ACS offers Reach to Recovery volunteers. I've benefited from this program and now volunteer in that capacity.

A recurrence of the original primary tumor or a new tumor can be devastating psychologically - while many women understand that cancer can come back, no one expects it, just like most don't expect the original diagnosis. Take some deep breaths, and as noted above, face it head-on. Try not to let your emotions and fears get the best of you, and realize that science and treatment advances may mean better and more effective treatment options than were available to you previously.

that's very interesting and i don't know that particular statistic. this may be true in areas of the country that are less populated and there are less specialist doctors. however, the risk of recurrence depends a lot on margins, and if a margin is positive or close, this will be made clear in the pathology report from surgery. so if a reexcision is needed, that particular surgeon will know.