Early versus late treatment affects
 

Debbie,

Dr. Radvin made the following comments in a Breast Cancer Update issue in 2003:

"Impact of therapy on early versus late relapses

The divergence of curves with effective adjuvant therapy has not been adequately studied, and I think there is an enormous hidden story there. Some curves begin to diverge within the first year, continue to diverge for the first five years and then parallel each other. Curves like this tell me the therapy is killing the rapidly progressive, early relapsing clones.

The last overview showed that the proportional benefits for chemotherapy emerged entirely because of impact on relapses within the first five years. There was no impact at all on relapse from the average chemotherapy after five years — a fascinating result. (emphasis added)

With chemotherapy, we are not yet touching the late, slowly proliferating population, which accounts for perhaps one-third of all relapses, particularly in ER-positive disease. This is where vaccines may be of particular benefit. In contrast, there was a curve for a particular therapy presented at San Antonio that showed no difference in the first five years, but the advantage accumulated in the second five years. The curve suggested the therapy showed no advantage against the rapidly progressive clones in the early relapsers, but that the advantage emerged in the late relapsers.

Hormone therapy is more balanced than chemotherapy in the impact on the second five years. In NSABP P-1 and B-14, the curves actually slightly diverge. The therapy is probably acting on the slower and stalled clones. This has not been adequately studied, and I think it’s worth some additional research."

link: http://www.breastcancerupdate.com/bcu2003/2/ravdin.htm


Hopeful

Data on early stagers who were treated with herceptin/
and chemo plus herceptin is not in. I believe this will have an important impact on recurrence stats.

When I had my lumpectomy surgery at Cornell there was a study being done on patients that were early stage bc, node negative. The dr. were performing bone marrow biopsies to study dormant bc cells.

The mechanisms underlying tumor dormancy in breast
cancer remain poorly understood and this presents significant challenges to both experimental investigation and clinical management.

What makes the cancer sleep and what wakes it up?

In any event....as Maryann has proved "The stats can be /and will/be wrong..while we all share this nasty disease, we each live in our own DNA...and as Becky said, anything can happen any day of the week, so
enjoy each day and live it to the fullest. We are lucky in a sense, for we have learned through our bc dx. not to sweat the small stuff and most of all a deeper understanding of "What is really important" from day to day.

Hopefully the near future will bring us more details and answers.

"Each Day We Get A Little Bit Closer"
Jean

What a wonderful thread!

My own experience on 'recurrence' was that by definition, cancer is the kind of disease that is hard to be completely rooted out of one's system. Either the surgeon missed the cancer cells (in my case, a big chunk) or the cells are hard to kill (the 'dormant' ones?)
But that is why they are called 'cancer' - something that is hard to treat; something that could spread, recur, and become fatal.

In the old days, they were called 'incurable' diseases. These days, they are viewed more as chronic illnesses.
In my own experience, it became chronical because of 'human error' ... But, according to our mechanic friend who survived both Vietnam and skin cancer: "Everybody is terminal..."

So, I just take it as God's special arrangement for me to understand life and its important ingredience: living, loving, and laughing.

I finally got around to reading the article which I found to be very interesting. Thank you Ann.
Working to understand the relationship between delayed recurrences and the significance of dormant cells could very likely result in many more lives saved in the future.
It was 2 yrs after I ended my 5 yrs on Tamoxifen that I had this last recurrence.
It was also a few months after I started using the Premarin cream (sparingly) that I had this past recurrence.

Just took my head out of the sand and brushed it off..............hmmmmmm, still an interesting topic.

Hey, I forgot to say something the other day too...while in for my 6 month check up last week I told my nurse and onc. about her2support. They never heard of it. I told them all about it and they were going to check it out for themselves and then, possibly, refer this site to other her2 patients.

Ok - back underhttp://her2support.org/vbulletin/ima...ons/icon12.gif

Mary Jo

goops,

We've taken into our home four (rescued) aged fur-babies over these past yrs since dx. and mets. Two are romping where all good doggies go... and one of them died from maglignant melanoma.

The 'kids' are the only thing that get me going on the days where nothing else will. Our need for eachother is symbiotic.

Losing one... well I don't have to go there, I'm sure you know. But, GIVING them a second chance, a loving 'forever' til the end home, these are more meaningful to me in the big picture.

As to the main topic here! I find value in all that's been said and reported, yet hold firmly to the 'crap shoot' theory.

Inflammatory and Invasive 6-26 pos. nodes MRM Jan. 2000. Stage IIIb er+pr- not Her tested until:

Mets to mediastinal nodes/spots on lung/pelvis July 2002. Her2+++

Mets to brain (first time) Sept. 2002.
Mets to brain (2nd time) March 2003.
Mets to brain (3rd time/current) March 2005.

So, my by my count, that's nearing 9 yrs from the beginning and close to 6 for brain mets... and I've done practically no 'standard' of treatment throughout.

I had the MRM first, then A/C and no rads.
Did just two months of Tamoxifen, then nothing.

On body mets dx: Navelbine/Herceptin til 'NED' - 3mos. that's it.

Brain mets dx: have had no WBR, but many focalized. And have responded in one way or another to Xeloda/Temodar since 8/05.

Part of what I'm trying to say is that I did not do the 'right' thing as far as known standards of care. So those things have not been the reason for my extended expiration date... thus the 'crap shoot' theory. And I do know it applies to many others, too.



just my veiw...
pattyz and fur-kids (ages: almost 59, 12 and 7)
Lyle (just turned 71, on Tamoxifen, feeling good)

Goops - Just remember, a super healthy person could adopt a puppy and then get hit by a bus. When I was younger, it never occurred to me to make arrangments for my dog in case something happened to me. I'm older and wiser. I don't have a pet now, but with my last old buddy I got a commitment from my brothers to care for him if something happened to me. And that was several years before I was diagnosed!!

As for the article, it's very interesting and sobering. Another reminder that life is precious and we need to enjoy every minute. Maybe I'll adopt a dog!

Practical suggestions
 

Likely this is where any proactive practices could make the most difference on an individual basis:

RB's suggestions on balancing fats
Regular exercise
Obtaining and maintaining proper body mass index
Getting good skin exposure regularly to the sun (not too much and not too little)
RobinP's tea consumption
Anti-inflammatory use like aspirin or curcumin
Using glass and such instead of plastic for microwaving
Diet (like organic food and more fruits and vegetables)
Avoiding parabens
Starting or staying on any preventive medication

A.A.

Another one who beat the odds...lance armstrong. If you have not read his book, recommend it.

Ann,

This is my first post and it was your post that spurred me on to register. I have been quietly listening for over a year to everyone. The information on recurrence for me is something I find very useful. While I can understand that not everyone feels that way. Thanks for the post.

Ann, how nice of you to join us! And what a great picture of you and your 2 handsome young men!
Maryanne

Barbra,

Your message gave me a great deal of satisfaction that someone appreciates what I have done here. I thank you for joining this group and am flattered by your remark that my sharing of info is the key point for your decision. There are many others who frequently post relevant bc researach findings and many of us benefited from their postings.
Welcome.

Ann