Surviving Breast Cancer, Embracing Life

The following is an Editorial Resource from YourTotalHealth.

Will My Breast Cancer Come Back?

Reviewed by: Martin E. Liebling, M.D., FACP

From the moment a woman is diagnosed with breast cancer, she focuses on treating and curing it. Even after successful treatment, she’s bound to wonder, “Will it come back?”

The chances that cancer will return can be difficult to judge accurately, but medical researchers are getting better at predicting—and in some cases preventing—recurrence. .

A 2008 study provides a good overview of long-term recurrence risk. Researchers at the M.D. Anderson Cancer Center in Houston studied breast cancer patients over 15 years. The study began with women who were cancer-free after five years of treatment with either chemotherapy or hormone therapy. The findings:

1. Overall risk of recurrence was 11 percent at 10 years after diagnosis.
2. At 15 years after diagnosis, recurrence risk was 20 percent.
3. Likelihood of recurrence increased with the cancer’s stage at original diagnosis. For instance, women whose cancer was stage III at diagnosis were nearly twice as likely to experience recurrence (13 percent) as women who were diagnosed in stage I (7 percent).

Although the study provides an overall map about breast cancer recurrence, each case is different. Breast cancer can recur locally, in the same area where breast tissue was removed, or in the skin, chest wall or lymph nodes nearby. Distant recurrence, or metastasis, may occur in the bones, lungs, liver or brain. In addition to recurrence, women can also develop a completely new cancer in the same breast or the untreated breast.

The good news: For many women, the risks of breast cancer recurrence can be determined during their initial surgery and treatment can be planned to minimize that risk.

Minimizing Risk through Treatment

Most breast cancer patients begin treatment with surgery, either lumpectomy or mastectomy, to remove the tumor. The next step in a treatment plan may include some combination of chemotherapy, radiation, hormone therapy and targeted therapies. Each type of therapy fights the remaining cancer cells, by killing the tissue directly or affecting specific parts of the cancer cell so it cannot reproduce.

Doctors can now determine which treatment will work best for a specific tumor by identifying certain tumor characteristics in the pathology report and other tests on tumor tissue. These tests also help predict how likely the tumor is to recur.

Some of the tumor characteristics include:

1. Size.
2. Stage. How far it has spread.
3. Nuclear grade. How fast tumor cells divide.
4. Histologic grade. How abnormal the tumor cells are.
5. Estrogen or progesterone receptor positive. Whether or not the tumor responds to hormones.
6. HER2 positive. Whether or not it has certain gene abnormalities.

Each characteristic can help guide doctors to use specific treatments. For example, if a tumor responds to estrogen (ER positive), it should respond to hormonal therapy designed to reduce the effects of estrogen in the body.

About 25 percent of women with breast cancer have HER2-positive tumors, which are aggressive cancers with abnormal HER2 genes. These tumors can be treated with combinations of chemotherapy or hormone therapy with trastuzumab (Herceptin), a newer targeted therapy that works on HER2-positive tumors, but not other tumors.

Other tools are also available to help doctors predict recurrence. For example, the Oncotype DX test can be used by women who have localized breast cancer (not spread to the lymph nodes) that is ER-positive. The test looks at a number of genes associated with the tumor and creates a score that indicates the likelihood that the cancer will recur within 10 years. A high score on the test would indicate that chemotherapy would be beneficial. A low score would indicate less likelihood of recurrence and probably no need for chemotherapy.

The possibility that breast cancer can return years or even decades after apparently successful treatment is one of the most troublesome aspects of this disease. But as doctors get better at identifying the most effective treatments for each kind of breast cancer, they are also getting better at reducing the risk that breast cancer will recur.

What's Next:  Recurrence: 7 Ways to Protect Yourself

• Prevent Breast Cancer 
• Your Stories: Diagnosis
• Your Stories: Treatment

Review date: 9-16-2008