Breast Cancer Recurrence
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
MARCH 07, 2018
For all of us who have been treated with the hope of "cure", recurrence is the big worry in our health lives. We know all too well that we are rarely to never going to be told that we are indeed cured, that any anxiety about cancer can be in our past. There are exceptions to this: leukemia and some other cancers that don't recur in the first five years are probably gone for good. The common belief about five years being the safety point for most cancers, however, is wishful thinking. Generally the best we will hear from our doctors is something like "Everything looks great" or "You are doing fine" or "NED" (no evidence of disease).
As a gross generalization, more aggressive cancers tend to recur more quickly. If enough safe time passes, you can start to feel a little less worried. For plenty of other cancers, including most ER positive breast cancers, recurrence can happen much later. Since women with ER positive breast cancers are routinely treated for years with anti-estrogen/hormonal therapies (tamoxifen and the AIs), there are too often late recurrences. This is the reason why many of us are staying on those drugs for far longer than the original five year plan. I see women weekly who are 10 or 15 years past breast cancer and now dealing with a new recurrence. I realize I need to pause here and be reassuring: Most women who are well for this long will stay well. But there are exceptions, and it is not crazy to maintain some level of concern.
In the early months, cancer is omni-present. It is our last thought at night and our first thought in the morning. That slowly changes, and eventually whole days, whole weeks, pass without the anxiety. For most of us, however, it does not take much to again fall down the rabbit hole of fear. I wrote yesterday about reporting in, and that same advice holds if you are ten years post cancer and have a worrisome symptom that persists for longer than two weeks. A danger can be the assumption that enough time has passed that it can't possibly be cancer. I have known a few women who had back pain years after breast cancer and it never occurred to them that cancer could be the culprit. In this case, ignorance is not bliss, and they went for months to a chiropractor or other clinician who also never considered cancer – and the pain got worse, and the cancer was not identified and treated until things had progressed a bit. Not a good scenario
Truly I am not trying here to scare anyone and recognize that is likely what is happening. I am trying to be reassuring that, as time safely passes, you are likely to stay well. But be sadly aware of the realities and take care of yourself and any worries that you have in the future.
This is an article from Living Beyond Breast Cancer about some new thoughts and strategies to combat the risk of recurrence. Good news.
February 2018 Ask the Expert: Recurrence
Angela DeMichele, MD, MSCE
At our November 2017 Breast Cancer 360, Keeping Cancer at Bay: What Researchers Are Learning About Recurrence; and our December 2017 webinar, Living With the Unknown: Coping With Fear of Recurrence, people who attended the programs had more questions than our experts had time to answer.
For February's Ask the Expert, Living Beyond Breast Cancer expert Angela DeMichele, MD, MSCE, who spoke at the Breast Cancer 360, answered questions we missed during those two programs, such as what role tumor cells play in recurrence lifestyle changes can lower risk of recurrence.
Read more: Ask the Expert: Recurrence