You can still live a long life
Fortunately, most women treated for breast cancer will never experience a recurrence. After successfully treating the original cancer, a patient is considered “in remission.” With breast cancer, women must be diligent about follow-up since breast cancer can return months or even many years later. This is called recurrent breast cancer and it can appear in the breast after a lumpectomy, the chest area after a mastectomy, or in more distant parts of the body.
The likelihood of a recurrent case depends on many factors, including the specific type of cancer including hormone receptors, the stage at diagnosis, and your genetic makeup.
“There are a number of reasons this can happen,” said Dr. Rosemary Leeming, MD, breast surgeon and chief medical officer at Geisinger Medical Center in Danville, “but the recurrent cancer develops from the original breast cancer and typically has the same features, although there may be some differences.”
How cancer returns
Surgical treatment for breast cancer can include a mastectomy to remove the entire breast, or a lumpectomy, which removes only the cancerous lump. A lumpectomy is typically followed by radiation which reduces the risk of cancer returning in the breast. Surgical treatment only removes the tumors that can be seen or felt, which is why patients are typically advised to take “systemic” treatment which included medications that get into the whole system. Studies have shown that lumpectomy with radiation and mastectomy are equivalent in treating breast cancer. Systemic treatment is often recommended after both surgeries.
“Currently, our technology can’t identify all cancerous cells in the body, and we assume that some are outside the breast even with early breast cancer,” said Dr. Leeming. Because of this, many doctors recommend a course of systemic treatment with chemotherapy, antibodies to cancer proteins, anti-estrogens or a combination of these.
Types of recurrence
There are several types of breast cancer recurrence, all of which have a different prognosis and require a different treatment.
- Local recurrence happens when the cancer comes back in the same area it originally appeared. After a lumpectomy, cancer can reappear in the same breast, usually in the same location. This happens less than 5 percent of the time and is more common with younger patients or more aggressive cancers. Making sure the edges are clear of cancer (“clean” margins) and adding radiation are the most effective ways to reduce the risk of local recurrence.
“In the case of local recurrence, most doctors will recommend a full mastectomy if a patient has already had radiation therapy,” Dr. Leeming said.
In addition, additional systemic treatment may be indicated.
- Regional recurrence happens when the cancer is found in the lymph nodes near the armpit or collarbone.
“The lymph nodes are a filter within our immune system,” said Dr. Leeming. “They remove waste and toxins in our tissue, similarly to how the kidneys cleanse our blood. With cancers, some of the cells can be trapped which leads to pain and swelling.” Initial treatment usually included removal of a few of the nodes under the arm to see if any cancer cells are present. This information is used to determine if additional treatment is required.
Regional recurrence is usually treated with surgery to remove the involved nodes and may require additional radiation plus systemic treatment.
- Metastatic recurrence is marked by the spread of breast cancer outside the breast and regional nodes to other areas of the body. This occurs when cancer cells travel through our lymph system or bloodstream. Metastatic breast cancer (MBC) is considered stage IV and although it is not curable it is often controlled for many years. The most common site of spread is to the bones and less commonly the lungs, brain and liver. The most effective way to reduce metastatic breast cancer is to take systemic treatment in which anti-cancer medication such as chemotherapy or anti-estrogens is given.
- Opposite breast cancer is not considered recurrent cancer but it is of concern to most women. The risk of getting a second, unrelated breast cancer depends on whether you carry a genetic mutation which caused the first cancer as well as the age at which the first cancer developed. Patients who carry a BRCA mutation are 10 times more likely to experience a second opposite breast cancer. The risk for most women is about 0.3-0.5 percent per year or 3-5 percent in 10 years. This risk is reduced in women who take anti-estrogen medications.
Talk to your doctor about ways to reduce your risk of recurrent or opposite breast cancer. The risks are probably less than you think but completing recommended treatment including radiation following a lumpectomy and any recommended systemic treatment is essential.
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