Recurrence Risk Lasts and Lasts

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

NOVEMBER 14, 2017

This is not good news, but it is not surprising news. We have known that the recurrence risk for women with breast cancer, especially ER positive breast cancer, lasts for a long time. Unfortunately, rarely does a week pass that I don't meet a woman who is ten or twelve or even more than twenty years post diagnosis and now has a first recurrence. Most of us grow past the acute anxiety about our health, but it is reasonable that some uncertainty and caution linger.

Women with ER negative, especially those with triple negative, breast cancers can more reliably draw a semi-relieved breath after five years, certainly after ten years, pass. They, too, never get a promise, but those cancers are more likely to return sooner if they are ever going to do so. This makes sense since those women don't benefit from ongoing hormonal/estrogen therapy. Once their chemotherapy is done, they are finished with treatment.

Those of us who have ER positive breast cancers are almost always treated with hormonal/estrogen therapies. Traditionally, those medicines were prescribed for five years. More recently, the duration has increased to up to ten. Since I have had two ER positive breast cancers, I have been on one or another of these treatments since 1993 (with a six month break for chemo for the second cancer). I suspect that I will be on these medications for the rest of my life, and that is totally fine with me.

A new study suggests that the risk of recurrence remains constant for 15 or more years, and that at least some women should continue with hormonal treatments for an indefinite period of time. This is definitely a conversation that you should have with your doctor. Rather than quoting a lot of this to you, here is a article from Eureka Alert: 

Breast cancer recurrence risk lingers years after treatment ends

Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy

ANN ARBOR, Michigan -- Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.

Standard treatment for estrogen receptor-positive, or ERpositive, breast cancer includes five years of the endocrine based treatments tamoxifen or aromatase inhibitors, both of which are a taken daily as a pill. Researchers from the Early Breast Cancer Trialists' Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy. Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.

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