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Recurrences can Happen Very Late in ER Positive Breast Cancers

Posted 1/26/2016

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  I am trying hard to put a positive spin on this information, and this is the best that I can do: It is better to have a breast cancer (or any kind of cancer) recurrence after twenty years than after three years. Over twenty years, a lot of life can happen, and the cancer experience usually fades into more subtle worries. It is, however, very disturbing to understand that ER positive breast cancers sometimes do recur decades after the initial diagnosis and treatment.

  Personally I already knew this. Just within the last couple of weeks, I have met three women who were more than sixteen years post breast cancer when the cancer returned. That is so long that the immediate reaction to back pain or a cough is not "OMG! I am scared it is cancer." Not only is the woman less scared, but most PCPs don't first think of cancer after this long an interlude. It is shocking when that turns out to be the diagnosis.

  When I speak with women in this situation, I always talk about the absolute certainty that theirs is not a wildfire kind of cancer. If it were, it never would have been dormant for so long. There are so many unanswerable questions: Why now? What stimulated a remaining cancer cell to start to grow? Could it have been prevented? It is especially difficult if the woman took anti-estrogen therapy (Tamoxifen and/or an AI) for the suggested number of years (usually 5-10), and then, at her doctor's suggestion, stopped it. Increasingly, because of news like this, oncologists are sometimes reconsidering the "time to stop" suggestion. Many women, including me, are on these drugs indefinitely, maybe for life. That is not really a happy thought, but it is surely better than a metastatic cancer recurrence.

  Here is an article from MedPage:

Recurrence Rate High in ER+ Breast Ca Up to 24 Years Later

Patients with ER-positive (ER+) breast cancer had a significant risk of relapse even after
more than 10 years of follow-up, analysis of data from the International Breast Cancer
Study Group clinical trials (IBCSG) indicated.
Annualized hazards of recurrence remained elevated beyond 10 years, even for those with
no axillary involvement (2.0%, 2.1%, and 1.1% for years 10 to 15, 15 to 20, and 20 to 25,
respectively) and for those with one to three positive nodes (3.0%, 3.5%, and 1.5%,
respectively), according to Marco Colleoni, MD, of the European Institute of Oncology,
Milan, Italy, and colleagues.
"The risk of breast cancer recurrence continues through 24 years after primary treatment,
supporting the importance of continuing care for patients with breast cancer," the
investigators reported online in the Journal of Clinical Oncology. "New targeted treatments
and different modes of breast cancer surveillance for preventing late recurrences within
this population should be studied. Developing cost-effective mechanisms to maintain the
follow-up of patients enrolled in current randomized clinical trials is essential."

The analysis looked at data from 4,105 eligible patients with breast cancer who entered
the five prospective, randomized IBCSG clinical trials I to V from 1978 to 1985. Annualized
hazards were estimated for breast cancer-free interval, which was the primary end point,
as well as for disease-free survival and overall survival.

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