The Myth And Stigma Of The 5
Many people still believe that breast cancer, even hormone-positive disease, is essentially cured after five years this can lead to misunderstandings in families. Loved ones who dont understand late recurrence may downplay your feelings, or criticize you when you think brain tumor each time you get a headache.
Until information on late recurrence becomes more widely known, and even though its frustrating, you may need to educate loved ones about the risk, and why you should be concerned when you develop new or unexplained symptoms.
Vaginal Estrogen Therapy May Increase Risk Of Recurrence In Breast Cancer Patients Treated With Aromatase Inhibitors
Hormone therapy does not increase the risk of death in postmenopausal survivors of estrogen receptor-positive breast cancer, according to research published in the Journal of the National Cancer Institute.
The study also showed no increase in the risk of breast cancer recurrence in the overall cohort, but patients who received vaginal estrogen therapy and aromatase inhibitor treatment had an increased risk of recurrence.
The study was conducted in a cohort of postmenopausal women in Denmark who were diagnosed with early-stage, invasive, ER+ nonmetastatic breast cancer from 1997 through 2004. Patients underwent complete resection and received either no subsequent treatment or adjuvant endocrine therapy for 5 years.
The analysis included 8461 patients 1957 who received VET, 133 who received menopausal hormonal therapy , and 6371 who received no hormone therapy. Patients who received both MHT and VET were included in the MHT group. Patients who had received VET or MHT prior to their breast cancer diagnosis were not included in the study.
At a median follow-up of 9.8 years, 16% of patients experienced breast cancer recurrence. There was no significant difference in the risk of recurrence for patients who had received MHT and those who had never received hormone therapy .
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Tool Predicts Risk For Late Breast Cancer Recurrence
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An online prognostic tool accurately determined the risk for late distant recurrence among women with ER-positive breast cancer, according to a single-arm, prospective study.
The Clinical Treatment Score post-5 years tool could be used to determine whether patients should continue endocrine therapy 5 years after initial treatment.
Hormone-sensitive breast cancer is one of the few cancers where late recurrence is common, and predicting who is at high risk is particularly important so that they can continue hormone treatment,Jack Cuzick,PhD, director of the Wolfson Institute of Preventive Medicine and head of the Centre for Cancer Prevention Centre for Cancer Prevention at Queen Mary University of London, said in a press release. While our ability to predict this type of cancer is highly likely to improve in the future, were providing a simple tool which is available now, and is easily used and well tested.
To develop CTS5 a web-based calculator researchers used the Arimidex, Tamoxifen, Alone or in Combination, or ATAC, dataset to determine rates of delayed metastasis 5 to 10 years after endocrine therapy.
The tool defines the risk for distant recurrence within the next 5 to 10 years as low , intermediate or high .
The tool appeared significantly prognostic for late distant recurrence in the ATAC cohort and the BIG 1-98 validation cohort .
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How Does This Breast Cancer Recurrence Risk Calculator Work
This health tool evaluates recurrence risk in the case of patients with a recurrence of breast cancer or metastatic disease.
The risk factors accounted for in this breast cancer recurrence calculator are:
Grade of tumor the higher the grade, the more likely a recurrence is. For instance, grade 4 contains increasingly abnormal and rapid growth cancer cells that are more likely to recur
Lymph nodes inflammation of lymph nodes is indicative of higher risk
Lymphatic or vascular invasion presence or absence of breast cancer cells in the lymphatic or vascular system.
Breast cancer recurrence can take place at the original site or spread to other parts of the body, indicating metastasis or distant recurrence .
Most recurrences occur within the first five years after first treatment with average risk rates of about 11%. This percentage increases in the case of patients with cancer family history or BRCA gene mutations.
Diagnosis of localized recurrence takes place through physical exam and mammogram while diagnosis of metastasis depends on types of symptoms and available testing.
Recurrence cancer treatment depends on the initial treatment, for example in the case of a lumpectomy, local recurrence is treated with mastectomy while in case the initial treatment was mastectomy, an attempt to remove the second tumor surgically is made, followed by radiation therapy.
What Are The Signs Of Breast Cancer Recurrence
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:
- Unexpected weight loss or change in appetite
- Severe or ongoing headaches
However, symptoms will vary depending on where the secondary cancer presents, and some primary and secondary cancers may not present any obvious symptoms. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.
If you have any health concerns or symptoms that are new or persistent, speak with you GP or treating physician.
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What Women Can Do Themselves
There are some things women can do themselves to lower their risk of late recurrence:
- Regular exercise is associated with a lower risk of death from breast cancer as well as death from all causes.
- Its important for everyone to have their vitamin D level tested, although the role of vitamin D is still uncertain. Vitamin D deficiency is associated with bone loss, a concern for most people who have coped with breast cancer.
- Losing weight if you are overweight, or maintaining a healthy weight is important as well.
Tumor Size And Lymph Node Status
The risk of recurrence is linked to the size of the original tumor as well as the number of positive lymph nodes, although these factors alone can’t explain all recurrences. In the 2017 study noted earlier, for women who were cancer-free after five years of hormonal therapy, the risk of recurrence was highest for those who had large tumors that had spread to four or more lymph nodes , and lowest with small, node-negative tumors.
The risk of recurrence of these small, node-negative tumors, however, remains significant at roughly 1% per year until at least 20 years post-diagnosis. Due to the life expectancy of metastatic breast cancer , the risk of death lags somewhat behind recurrence.
|Late Recurrence Rate and Lymph Node Status|
|Years After Diagnosis|
Within these ranges, the risk of recurrence was greater in women who had larger tumors than smaller tumors . Tumor grade and Ki-67 had only moderate predictive value, and progesterone receptor status and HER2 status had no predictive value in this study.
It’s noteworthy that women who had one to three positive lymph nodes were twice as likely to have their cancer recur at distant locations between five years and 20 years post-diagnosis than in the first five years, and those who have node-negative tumors were roughly four times more likely to have a late than an early recurrence.
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Risk Of Late Recurrence Is Underestimated
A survey led by the Canadian Breast Cancer Network found that women often underestimate their risk of late recurrence. In the survey, only 10% were aware of the risk of recurrence after five years of tamoxifen therapy, and 40% felt that they were cured after hitting the five-year mark.
Many breast cancer survivors underestimate their risk of late recurrence.
How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
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What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Less common but serious side effects of hormone therapy drugs are listed below.
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
The Oncotype Dx Breast Recurrence Score
Oncotype Dx® is a genomic laboratory test that helps guide treatment decisions for people with early-stage invasive breast cancers. Genomic tests look at the genes in tumors. This can tell us more about your risk of the cancer coming back. Genomic tests are not the same as genetic tests. Genetic tests look for a single-gene mutation in your body . Genomic tests look at the genes in the tumor.
Genomic tests are a way to look specifically at your tumor to help guide your treatment options. There are several genomic tests available. This article focuses on the Oncotype DX® breast recurrence score test. This test helps decide if having chemotherapy along with endocrine therapy after surgery will lower your risk of the cancer coming back .
The Oncotype DX® test is endorsed by all major cancer organizations, including the National Comprehensive Cancer Network and the American Society of Clinical Oncology . It can help you choose a treatment plan if you have early-stage breast cancer.
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What Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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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.
Can Hormone Therapy Be Used To Prevent Breast Cancer
Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.
A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .
As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.
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Be Mindful Of Your Environment Including Household Chemicals
Its long been suspected that environmental exposures, including the chemicals we are exposed to in everything from household cleaners to cosmetics, may play a role both in breast cancer risk and recurrence. While its difficult to study , we are learning that practicing caution is wise.
A 2017 review looked at the evidence to date connecting breast cancer and the environment. Some compounds, such as PCBs , may raise the risk of recurrence. Others may alter the regulation of genes involved in cell growth, apoptosis , and much more. Endocrine disrupting chemicals can mimic the function of hormones in our bodies, and its well known that the hormone estrogen should be avoided to reduce breast cancer recurrence, at least for people with hormone positive tumors.
There is a great amount of information out there of varying degrees of concern, but the important thing to note is that its relatively easy to avoid concerning chemicals . Most household cleaners can easily be replaced with baking soda, lemon juice, and vinegar .
The environmental working group has a website where you can search on thousands of personal care products . And adding a few houseplants to your home can help to absorb many indoor air carcinogens with indoor air thought to be more of a concern that outdoor air pollution.
What Is The Likelihood Of Breast Cancer Recurrence Chances Of Breast Cancer Returning
Many factors contribute to whether breast cancer will recur. According to the study by O’Rourke and colleagues , some risk factors that can predict local recurrence rate include:
- Grade of tumor The cell appearance in tumors.
- Lymph node status Whether lymph nodes contain cancer cells or not when lymph nodes contain cancer cells, it is reported as node-positive. When cancer cells have not spread to the lymph nodes, it is said to be node-negative.
- Lymphatic or vascular invasion Cancer cells moving into lymphatic or blood vessels.
Usually, a higher grade tumor, node-positive lymph node status, and presence of lymphatic or vascular invasion are associated with the higher risks of local recurrence. On the other hand, a first-grade tumor, with node-negative lymph node status, with the absence of lymphatic or vascular invasion, is associated with lower risks of local recurrence.
According to your data input, the Omni breast cancer recurrence rate calculator determines the likelihood of breast cancer recurrence. Keep reading to learn how to use the breast cancer recurrence risk calculator, and visit Omni breast cancer risk calculator to explore the risk factors for breast cancer development.
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