Questions for your Breast Cancer Doctor:
- What is my chance of distant metastasis in the next 5 years?
- What is my chance of local or regional recurrence in 5 to 10 years?
- What is the chance of a new breast cancer in the next 10 years?
- Why is cancer recurrence such a worrisome problem?
TYPES OF BREAST CANCER RECURRENCE:
The most important recurrence is distant metastasis. This is when cancer grows back in other organs of the body such the bone, brain, or liver. If this happens, it is a major threat to your life. If you are diagnosed with distant metastasis, it means you have Stage IV cancer.
Think of distant metastasis as tiny cells that have spread to other organs before you were initially diagnosed and treated. If these cells survive in those organs despite chemotherapy and/or endocrine therapy, they can grow larger over time and threaten your life. If someone dies of breast cancer, it is usually due to this type of recurrence.
Local or Regional Recurrence:
Local or regional recurrence is when the cancer grows back in the breast, the skin, or the regional lymph nodes after surgery, endocrine therapy, chemotherapy, or radiation. It is a serious threat, but less so than distant metastasis.
Usually more surgery, chemotherapy, and possibly radiation therapy is needed when cancer recurs locally or regionally. These can be very challenging problems for your breast cancer team. You benefit most when you have a multidisciplinary team of specialists working together to determine the best approach to your breast cancer recurrence.
Entirely New Breast Cancer: (not a true recurrence)
Most patients use the term “recurrence” when referring to the chance of developing a completely new breast cancer in the future. A new cancer is not a true “recurrence.” It is really a new problem and not a reflection of your prior breast cancer coming back.
Your initial breast cancer treatment choices can lessen the chance of developing a recurrent breast cancer. If you have a mastectomy rather than a lumpectomy/radiation your chance of local recurrence in the same breast is less. Taking hormonal therapy (anti-estrogen medications) has a “good side effect” of lessening your risk of developing new breast cancer in either breast after a lumpectomy. In general, a new breast cancer is less threatening than local or regional recurrence or distant metastasis.
Why is recurrence so life-threatening?
An early stage breast cancer is usually removed with surgery, and often requires radiation, chemotherapy, and hormonal therapy. If cancer grows back in the breast, the lymph nodes, or in other parts of the body, it means that some of the original breast cancer cells survived the initial treatment. Think of “recurrent cancer cells” as more resistant, aggressive cells. They require more aggressive surgery and usually chemotherapy when they recur.
A recurrent breast cancer is often considered more threatening than the original breast cancer situation years before. This is why we strongly recommend a team approach to breast cancer recurrence to make sure no stone is left unturned in deciding your treatment options.
Common Scenarios about Recurrence:
“I have a favorable, early stage (I or II) breast cancer and will be treated with a lumpectomy, radiation, and hormonal therapy. What is my chance of recurrence?”
- The risk of distant metastasis is 5 to 15 percent over 5 – 10 years.
- Local or regional recurrence occurs in about 5 to 10 percent of patients over 5 years.
- A new breast cancer can develop at a rate of about one-half a percent a year.
“What is my risk of recurrence when choosing between a mastectomy or a lumpectomy for a small, early stage breast cancer?”
- The risk of distant metastasis and death are exactly the same at 10 years.
- The risk of local or regional recurrence is slightly higher for patients with a lumpectomy (5-8% over 10 years) when compared with a mastectomy (3% over 10 years). If this occurs, you will need a surgery to remove the recurrent cancer and possibly more treatment like chemotherapy, endocrine therapy, or radiation. When all’s said and done, the same number of women are alive and cancer free if they have a lumpectomy (and radiation) or a mastectomy (without radiation) for early stage breast cancer.
- The risk of an entirely new breast cancer is slightly higher if one preserves their breast with a lumpectomy and radiation versus removal of the breast with a mastectomy. This is solely because there is more breast tissue remaining after a lumpectomy.
Patient Friendly References:
This page detailing (here) “Recurrent and Metastatic Breast Cancer” is a good source of information. This non-profit organization provides excellent online and printable patient resources about breast cancer.
This section (here) on “Breast Cancer Recurrence” also has resources for patients with recurrence. The Susan G. Komen organization is a leading advocacy group dedicated to assisting patients, funding research and ensuring quality breast cancer care.
This is a detailed outline (here) about all types of cancer, “When Cancer Comes Back: Cancer Recurrence.” The American Cancer Society is an organization that supports patients with cancer and funds research for cancer of all types.
Any evidence of distant metastasis is considered Stage IV Breast Cancer. This detailed patient booklet about Stage IV Breast Cancer (here) is excellent resource for any patient with metastatic breast cancer. This “NCCN Quick Guide: Stage IV Breast Cancer” (here) is also an excellent resource. The NCCN is a consortium of organizations and governmental agencies to promote quality breast cancer care.
More Detailed References:
This page (here) “Why you should receive care at an NAPBC Breast Center” outlines the benefits of being treated in a dedicated and accredited breast center. The National Accreditation Program for Breast Centers is a group of national, professional organizations dedicated to improving breast cancer care.
If you want to get deep into the details, this free 200-page pdf document (here) has guidelines to help clinicians to make treatment recommendations about nearly all aspects of breast cancer. You can easily register (here) as a non-professional to get access and more information about breast cancer. The National Comprehensive Cancer Network is the leading organization in developing clinical guidelines.