12 January 2021

12 January 2021

The National Cancer Institute (NCI) recently announced that they will start tracking breast cancer recurrence. Currently, initial cases of breast cancer are reported, but local / regional (in the breast or underarm lymph nodes) or metastatic (elsewhere in the body, most commonly lungs, liver bones and brain) breast cancer recurrences are not. It is unclear how many patients with early stage breast cancer experience a recurrence, although it has been reported to be approximately 30%.

It will be several years before we see meaningful data, but this is most certainly a step in the right direction. Patients and physicians alike are frustrated by the lack of reliable data on recurrence rates. Patients who develop metastatic cancer are frustrated that they are not “counted.” And much credit to Katherine O’Brien, a woman in Chicago who is living with metastatic breast cancer – she led the creation of a petition, which collected nearly 12,000 signatures, requesting that federal and state registries begin collecting this information.

This most certainly is a step in the right direction to ensure that all cases of breast cancer, both initial and recurrent diagnoses, are captured. It’s also a testament to the power of the patient advocate!

Medscape article

9 November 2017

In patients with a common form of breast cancer, known as estrogen receptor (ER) “positive”, endocrine therapy is often recommended after other treatments such as surgery, chemotherapy, and radiation are complete. Tamoxifen, most commonly used in pre-menopausal women, blocks the estrogen receptor on the breast cell, so estrogen cannot impact cell growth. In post-menopausal women, aromatase inhibitors (AI) are commonly used – these medications block the production of estrogen in the fat cells – a primary source of estrogen after menopause. Historically, these medications have been used for 5 years after completion of other treatment, although there are some studies suggesting longer courses may benefit certain patients. However, longer courses of therapy are associated with a higher incidence of side effects.

A study just published in the New England Journal of Medicine demonstrated that after 5 years of endocrine therapy, patients have an increasing risk of breast cancer recurrence with long term follow up. The authors evaluated individual patient data from a large database of randomized trials. They found that in patients with stage I tumors (tumor less than 2 centimeters and no lymph node involvement) the 20 year risk of recurrence was approximately 13%. In patients with 4-9 involved nodes, the risk ranged from 34-41% depending on the size of the main tumor.

This study is important as it confirms what many of us see in our practices – that breast cancer can and does recur, even many years after therapy. However, it also raises an important discussion point about our treatments. Studies have estimated that as many as 30% of women prescribed endocrine therapy stop treatment due to side effects which significantly interfere with quality of life such as menopausal symptoms, bone and joint pains, bone loss (osteoporosis) and fracture, and mental status changes (“chemobrain”). Patients should discuss any of these symptoms, especially if they are considering stopping their medication, with their physicians. Lifestyle changes, exercise programs, and medications may be of benefit. It is also important to understand that despite all appropriate treatment, cancer can and does come back – so health maintenance and surveillance are important even long after cancer therapy has ended.