The scary stuff!!!

[PinkGirl]

In Ceese's thread Do you ever wonder WHY, Debbie posted this:

In my research I have found that most BC patients do recurr at some point in their life, be it 5 years or 20 years. It always come back.


How come we never talk about this????

[dlaxague]

How come we never talk about this????

Probably we don't talk about it because it's not true. I'm surprised that it slipped thru unchallenged in the other thread.

Another Debbie

[mts]

Here is a link to some info regarding dormant tumor cells.
This was also a subject of great interest at the Era of Hope...
The DoD has funded a study that so far is showing dormant cells in mice that "wake-up" after being in their sef induced sleep. The overall take is that we have these dormant cells and have yet to find the trigger that perks them up. The cells are somehow immune to chemo agents. I will try to find the Era of Hope study and post later.

Here is some aditional info not related to the Era of Hope study:

http://cancerres.aacrjournals.org/cg...ract/67/9/4491

Maria

[mts]

Although many of us will recur I think it notes mention that many of us will not. I, for one -don't plan to.
Staying informed and aware of the risk is important for everyone regardless of how we perceive what cancer may or may not do to us in the future.
During the dormant cancer cell presentation, I asked if it was studied where chemo was given to healthy women to kill the dormant cells and the response was that these cells are highly resistant to current chemo agents and still the healthy tissue was additionally damaged. So, the scientists are trying to develop an agent that will cause cell apoptosis without causing harm to healthy cells. Isn't that what a lot of science is trying to do anyway ?
Here is the Era of Hope study regarding dormant tumor cells:
http://cdmrp.army.mil/bcrp/era/abstr...045699%2D1.pdf


If you want to deluge yourself with additional Era of Hope abstracts- log on to: http://cdmrp.army.mil/bcrp/era/abstracts2008

maria

[Becky]

I meant to comment and didn't. I should have. Depending on your stage, far more women will NOT recur. Even women who are diagnosed at Stage 4 have almost a 50% shot of not recurring after initial successful therapy.

There are many theories in regard to cancer in general. I am sure ALL are true -

One is that chemo completely anniliates everything and you are cured. I am sure this is true for many people.

Another is that some cells become dormant. They may awaken or they may not. We know this is true, especially for those who recur much further out from treatment (years and years).

Another is the stem cell theory which can hold true for upfront recurrences and later ones.

Regardless, taking good care of yourself results in a strong immune system that helps prevent recurrence and completely new cancers. This is what you should dwell on - good health to live your life to the fullest (being disabled by any disease state will really screw up any future plan).

By the way - in my local support group we have many, many 20+ yr survivors. Those that did pass away died from something else.

[lilyecuadorian]

Becky , I love how you explain things !!!!

[goops]

Becky -

Even women who are diagnosed at Stage 4 have almost a 50% shot of not recurring after initial successful therapy.

What do you base that on? I thought it was very rare for a stage 4 person to get (and stay) cancer free. Since I have just be diagnosed as stage 4, I would love it if what you say is correct.

Becky,

I think what you said regarding the stage 4 recurrence rate must be a typo. Almost all people diagnosed as stage 4 will recur.

Jill

[Jackie07]

[Abstract]

Risk factors for late relapse and death in patients with early breast cancer.

C GK, M B, B Z.
Adjuvant treatments reduce the risk for recurrence and death from breast cancer; but even 10-15 years after diagnosis, these risks persist. The aim of our study was to identify prognostic factors for relapse and death in the second decade after primary surgery. Patients with early breast cancer treated from 1983-1987 (n=1035) were included. Patients' characteristics, tumor prognostic factors, treatments, data on recurrence and death were obtained from patients' charts and our cancer registry. Median follow-up was 17 (1-23) years. At 10 years after surgery, 515 (49.8%) patients were alive and of them 432 (41.7%) were relapse-free. Of the 432 patients being alive and relapse-free at 10 years 153 (35.4%) had an event thereafter, of them 38 (25%, 9% of all) had a relapse of breast cancer. For this period only the presence of lymphovascular invasion (LVI) and positive estrogen receptors (ER) were found as independent unfavorable prognostic factors for relapse-free (HR 2.09, p=0.007; HR 1.50, p=0.021, respectively) and overall survival (HR 2.15, p=0.006; HR 1.41, p=0.05, respectively) while tumor size, grade and nodal status had no prognostic significance. Positive ER and LVI are independent prognostic factors for relapse and death in the second decade after surgery in patients with early breast cancer. Key words: breast cancer, estrogen receptors, late relapse, lymphovascular invasion

[Jackie07]

Overview of resistance to systemic therapy in patients with breast cancer.

Gonzalez-Angulo AM, Morales-Vasquez F, Hortobagyi GN.
Department of Breast Medical Oncology, Unit 424, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, USA.
Breast cancer is the most common cancer and the second leading cause of cancer death in American women. It was the second most common cancer in the world in 2002, with more than 1 million new cases. Despite advances in early detection and the understanding of the molecular bases of breast cancer biology, about 30% of patients with early-stage breast cancer have recurrent disease. To offer more effective and less toxic treatment, selecting therapies requires considering the patient and the clinical and molecular characteristics of the tumor. Systemic treatment of breast cancer includes cytotoxic, hormonal, and immunotherapeutic agents. These medications are used in the adjuvant, neoadjuvant, and metastatic settings. In general, systemic agents are active at the beginning of therapy in 90% of primary breast cancers and 50% of metastases. However, after a variable period of time, progression occurs. At that point, resistance to therapy is not only common but expected. Herein we review general mechanisms of drug resistance, including multidrug resistance by P-glycoprotein and the multidrug resistance protein family in association with specific agents and their metabolism, emergence of refractory tumors associated with multiple resistance mechanisms, and resistance factors unique to host-tumor-drug interactions. Important anticancer agents specific to breast cancer are described. Breast cancer is the most common type of cancer and the second leading cause of cancer death in American women. In 2002, 209,995 new cases of breast cancer were registered, and 42,913 patients died of it. In 5 years, the annual prevalence of breast cancer will reach 968,731 cases in the United States. World wide, the problem is just as significant, as breast cancer is the most frequent cancer after nonmelanoma skin cancer, with more than 1 million new cases in 2002 and an expected annual prevalence of more than 4.4 million in 5 years. Breast cancer treatment currently requires the joint efforts of a multidisciplinary team. The alternatives for treatment are constantly expanding. With the use of new effective chemotherapy, hormone therapy, and biological agents and with information regarding more effective ways to integrate systemic therapy, surgery, and radiation therapy, elaborating an appropriate treatment plan is becoming more complex. Developing such a plan should be based on knowledge of the benefits and potential acute and late toxic effects of each of the therapy regimens. Despite advances in early detection and understanding of the molecular bases of breast cancer biology, approximately 30% of all patients with early-stage breast cancer have recurrent disease, which is metastatic in most cases. The rates of local and systemic recurrence vary within different series, but in general, distant recurrences are dominant, strengthening the hypothesis that breast cancer is a systemic disease from presentation. On the other hand, local recurrence may signal a posterior systemic relapse in a considerable number of patients within 2 to 5 years after completion of treatment. To offer better treatment with increased efficacy and low toxicity, selecting therapies based on the patient and the clinical and molecular characteristics of the tumor is necessary. Consideration of these factors should be incorporated in clinical practice after appropriate validation studies are performed to avoid confounding results, making them true prognostic and predictive factors. A prognostic factor is a measurable clinical or biological characteristic associated with a disease-free or overall survival period in the absence of adjuvant therapy, whereas a predictive factor is any measurable characteristic associated with a response or lack [cont'd on next posting]

[Jackie07]

lack of a response to a specific treatment. The main prognostic factors associated with breast cancer are the number of lymph nodes involved, tumor size, histological grade, and hormone receptor status, the first two of which are the basis for the AJCC staging system. The sixth edition of the American Joint Committee on Cancer staging system allows better prediction of prognosis by stage. However, after determining the stage, histological grade, and hormone receptor status, the tumor can behave in an unexpected manner, and the prognosis can vary. Other prognostic and predictive factors have been studied in an effort to explain this phenomenon, some of which are more relevant than others: HER-2/neu gene amplification and protein expression, expression of other members of the epithelial growth factor receptor family, S phase fraction, DNA ploidy, p53 gene mutations, cyclin E, p27 dysregulation, the presence of tumor cells in the circulation or bone marrow, and perineural and lymphovascular space invasion. Systemic treatment of breast cancer includes the use of cytotoxic, hormonal, and immunotherapeutic agents. All of these agents are used in the adjuvant, neoadjuvant, and metastatic setting. Adjuvant systemic therapy is used in patients after they undergo primary surgical resection of their breast tumor and axillary nodes and who have a significant risk of systemic recurrence. Multiple studies have demonstrated that adjuvant therapy for early-stage breast cancer produces a 23% or greater improvement in disease-free survival and a 15% or greater increase in overall survival rates. Recommendations for the use of adjuvant therapy are based on the individual patient's risk and the balance between absolute benefit and toxicity. Anthracycline-based regimens are preferred, and the addition of taxanes increases the survival rate in patients with lymph node-positive disease. Adjuvant hormone therapy accounts for almost two thirds of the benefit of adjuvant therapy overall in patients with hormone-receptor-positive breast cancer. Tamoxifen is considered the standard of care in premenopausal patients. In comparison, the aromatase inhibitor anastrozole has been proven to be superior to tamoxifen in postmenopausal patients with early-stage breast cancer. The adjuvant use of monoclonal antibodies and targeted therapies other than hormone therapy is being studied. Interestingly, some patients have an early recurrence even though they have a tumor with good prognostic features and at a favorable stage. These recurrences have been explained by the existence of certain cellular characteristics at the molecular level that make the tumor cells resistant to therapy. Selection of resistant cell clones of micrometastatic disease has also been proposed as an explanation for these events. Neoadjuvant systemic therapy, which is the standard of care for patients with locally advanced and inflammatory breast cancer, is becoming more popular. It reduces the tumor volume, thus increasing the possibility of breast conservation, and at the same time allows identification of in vivo tumor sensitivity to different agents. The pathological response to neoadj uvant systemic therapy in the breast and lymph nodes correlates with patient survival. Use of this treatment modality produces survival rates identical to those obtained with the standard adjuvant approach. The rates of pathological complete response (pCR) to neoadjuvant systemic therapy vary according to the regimen used, ranging from 6% to 15% with anthracycline-based regimens to almost 30% with the addition of a noncross-resistant agent such as a taxane. In one study, the addition of neoadjuvant trastuzumab in patients with HER-2-positive breast tumors increased the pCR rate to 65%. Primary hormone therapy has also been used in the neoadjuvant systemic setting. Although the pCR rates with this therapy are low, it significantly increases breast conservation. Currently, neoadjuvant systemic therapy is an important tool in not only assessing tumor response to an agent but also studying the mechanisms of action of the agent and its effects at the cellular level. However, no tumor response is observed in some cases despite the use of appropriate therapy. The tumor continues growing during treatment in such cases, a phenomenon called primary resistance to therapy. The use of palliative systemic therapy for metastatic breast cancer is challenging. Five percent of newly diagnosed cases of breast cancer are metastatic, and 30% of treated patients have a systemic recurrence. Once metastatic disease develops, the possibility of a cure is very limited or practically nonexistent. In this heterogeneous group of patients, the 5-year survival rate is 20%, and the median survival duration varies from 12 to 24 months. In this setting, breast cancer has multiple clinical presentations, and the therapy for it should be chosen according to the patient's tumor characteristics, previous treatment, and performance status with the goal of improving survival without compromising quality of life. Treatment resistance is most commonly seen in such patients. They initially may have a response to different agents, but the responses are not sustained, and, in general, the rates of response to subsequent agents are lower. Table 1 summarizes metastatic breast cancer response rates to single-agent systemic therapy.
PMID: 17993229 [PubMed - indexed for MEDLINE]

[Jackie07]

Please note the pCR rate has increased to 65% with Herceptin. The statistics we see these days includes most patients who did not receive Herceptin. With Herceptin, Her-2 positive have become the most treatable breast cancer. We have become the lucky ones.

But just like all the advertisement would say, past performance is no guarantee and individual result may vary...

[StephN]

Hi -
Goops, being stage IV and NED for over 6 years now, I also wonder what the stats are for STAYING NED under the new drug treatments.

The nurses at my cancer center tell me that there are several women there like myself, as well as many who are stage IV active disease and fighting well.

I only know personally two others like myself who have remained NED for a long period. Althought there are a few on this site like Christine, Andi and a couple of others.

They must be still collecting current information from trial studies for stage IV. I know I am followed after being on a trial.

[mts]

This post only exemplifies how so much is known yet how little we understand cancer...

One more reason to make cancer a national priority that our elected officials have to bring to the level of attention equal to global warming... we all know that.

maria

[Vi Schorpp]

and thanks for bringing this up PinkGirl.

From Jackie's information, ....the presence of lymphovascular invasion (LVI) and positive estrogen receptors (ER) were found as independent unfavorable prognostic factors for relapse-free (HR 2.09, p=0.007; HR 1.50, p=0.021, respectively) and overall survival (HR 2.15, p=0.006; HR 1.41, p=0.05, respectively) while tumor size, grade and nodal status had no prognostic significance...

that's interesting because I had LVI and positive ER, and had no Herceptin. For those who had Herceptin, it appears to be more favorable.

[dlaxague]

Vi said: From Jackie's information, ....the presence of lymphovascular invasion (LVI) and positive estrogen receptors (ER) were found as independent unfavorable prognostic factors for relapse-free (HR 2.09, p=0.007; HR 1.50, p=0.021, respectively) and overall survival (HR 2.15, p=0.006; HR 1.41, p=0.05, respectively) while tumor size, grade and nodal status had no prognostic significance...

that's interesting because I had LVI and positive ER, and had no Herceptin. For those who had Herceptin, it appears to be more favorable.

Vi, the above is talking specifically about LATE relapse, after 10 years of no recurrence. The factors that increase risk for late relapse are not necessarily the same as the ones that increase risk for early relapse and early relapse is more common. Note that in the above article, they started with 1038 women diagnosed with primary cancer and based the ending stats that you reference on 38 women who recurred after 10 years. Not a very big number. Less than 4% (I am not strong in math). Plus, they are saying that "early treatment" (ie: chemo and I assume Herceptin) has no effect on late recurrence. 'Still trying to get my head around that one but this was discussed recently in another thread and made sense when I read the explanation.

Anyway, just wanted to make sure you saw the distinction between risk for "regular" recurrence within the first 10 years, when risk is highest for all of us, and "late" recurrence or relapse, when there are fewer women recurring but the risk factors affecting that have changed a bit.

Sorry no time right now to find that thread. Does anyone else remember what it was called?

Debbie Laxague

[madubois63]

Here is my two cents - I hope I don't upset anyone. Remember my history,n ho much I have over come, and that I am very upbeat and will fight this disease until the bitter end.

As of today, there is NO CURE FOR CANCER. End of story. I look forward to the day there is and I'll lead the parade. I know we re getting closer all the time. I believe the cancer will come back some time in the future, BUT it may not happen until after you have passed on from natural causes, heart disease, a car accident, whatever...Or like me, it comes back just after I reach some sort of normalcy - bamb! I think we can do things to help keep it at bay and should never forget that it lurks, but don't let it control you or take over your thoughts. Tell your doctor of all changes and take good care of yourself. Jmo

[PinkGirl]

Thanks for your thoughtful replies. I, too, don't want to offend anyone with my beliefs and I'm hoping that this is a place where I can be honest about how I feel.

I don't personally know anyone who has lived a long life after
being dx. with breast cancer. I have known friends and acquaintances
who had breast cancer and they all lived from 5 to 7 years. My
oncologist told me that he could give me a lot of statisitics but he
could not tell me what my outcome would be. I have read a lot about
the disease and have come to believe that it "usually comes back".
I hope I am wrong.

I enjoy your posts Madame DuBois. You always make me smile. I
so admire you for how you live with and fight this crappy disease and
manage to almost always stay in your "happy place". Thanks for the
reminder to not keep my shoulders up by my ears!

[Jackie07]

I personally know 4 women in my mid-size town (50,000) who had breast cancer treatment and are still alive and well. One is my former supervisor in the local public library. She found cancer a couple of years (1993?) after she had retired at the age of 63 in 1991. The other three are my church members: one is my sunday school teacher who had the surgery during her early 40's. She worked 20 more years after that and retired several years ago as the high school librarian. Another church member who had treatment in her 40's is also a retired school librarian.

I often wondered if the dust in the library or chemicals emited from the processed books or (?) had caused breast cancer to the 4 of us. But the third church member is a housewife all her life. Did she get it from the household chemicals? We don't know.

I think I've been optimistic because all these 4 ladies I've known for 22 years are all still alive and well...

[dhealey]

I have been a nurse for 25 years and all of my patients that were diagonsised with BC and many other cancers always at some point no matter the stage when diagnosised have a recurrence. That being said, that does not mean they die. Do to the many new drugs available now many continue to lead very active lives. But as I stated before at some point it will come back. As Mary anne states there is no cure. I did not mean to upset anyone by my comment, but I have done extensive research over the past twenty-five years following these patients and I do not know a one who did not have a recurrence. One woman was diagnosised a stage I and recurred 20 years later in the other breast and now has mets to her lungs. Sorry to have upset anyone.