Prognosis Can Be Better Than Thought When Breast Cancer Returns

But study outlines who may be at a higher death risk

WEDNESDAY, May 22, 2002 (HealthDayNews) -- Women who have a local recurrence of breast cancer have a better prognosis and more treatment options than they might think, a new study says.

However, the outlook depends on their age at first diagnosis, how aggressive the initial tumor was, and how long they were cancer-free.

The small study, appearing in the June 1 issue of the journal Cancer, says the prognosis was better for women whose initial cancer came before they reached age 60 and for those whose cancer hadn't returned for at least eight years.

Recurrences are a very real risk for women who have had breast cancer. Local recurrences occur in or near the site of the original tumor, and are generally thought to be a re-growth of the first tumor. Recurrences in other parts of the body, or distant metastases, mean the cancer has spread.

In this study, women who had had a local recurrence had a 10-year survival rate of 56 percent versus just 9 percent for women who had had a distant metastases. The median survival length for women with a local recurrence was 12.9 years, and only 2.2 years for women with cancer that had reappeared elsewhere.

The study authors also found the risk of death was not affected by whether the woman had initially had a mastectomy or breast-conserving surgery (a lumpectomy followed by radiation).

"It's a small study, but an important one," says Dr. Clifford Hudis, chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York City. He was not involved in the research.

Local recurrences of breast cancer are the subject of much discussion among doctors because it's not always clear when the tumor is indeed a recurrence of the original cancer and when it's a completely new one.

"We struggle all the time with the clinical meaning of local recurrence," Hudis says. "If the tumors are new, you would expect a better prognosis and that's what they see here."

The authors analyzed data from 105 patients who had experienced a local recurrence of breast cancer. Fifty-five of these patients had had a lumpectomy followed by radiation, and 50 had undergone a mastectomy.

A second group of 335 patients had had a recurrence, but in sites far removed from the original tumor.

The authors then identified seven factors that might have an impact on survival: the initial size of the first tumor; the tumor grade (how abnormal the cells appear under a microscope); whether the cancer had spread to the lymph nodes; the date of the initial diagnosis; the age at the time of the initial diagnosis; the time elapsed between tumors; and the type of treatment for both the initial cancer and the recurrence.

Only tumor grade, age at the time of diagnosis of the first tumor, and the time elapsed between tumors seemed to affect the risk of death.

Women with a grade 3 tumor (a grade 1 tumor is the least dangerous) had a threefold increased risk of death; patients more than 60 years old at the time their first cancer was diagnosed had twice the risk of death; and patients who went more than eight years without a recurrent tumor had a threefold decreased risk of death.

How the local recurrence was treated did affect the risk of death in women who were pre-menopausal. In this group, women who had ovarian suppression either by surgical removal or radiation and chemotherapy had better survival rates. Ovarian suppression is used to stop the functioning of the ovaries and, thereby, stop the production of estrogen, which can fuel some breast-cancer growth.

"The study tells us that a careful pathological review would be the next step," Hudis says, referring to the finding that tumor grade affected risk of death.

It may also mean more treatment options for women faced with a local recurrence. Women who have already had breast-conserving surgery may not need a mastectomy for the recurrence. Also, women who have already had a mastectomy could receive local radiation therapy. In pre-menopausal patients, chemotherapy could be effective.

What To Do: For more information on breast cancer recurrences, visit the Y-Me National Breast Cancer Organization or the Susan G. Komen Breast Cancer Foundation.

Related Stories

No stories found.
logo
www.healthday.com