Why Is This Study Important
The results of this study offer an immediate new treatment option for some people with HER2-negative metastatic breast cancers. Doctors look for the presence of the HER2 protein in breast cancer cells to guide treatment. In the past, people with breast cancer were considered HER2-positive
breast cancer. They are relevant to both hormone receptor-positive and hormone receptor-negative metastatic
What Are The Two Types Of Breast Cancer
Two types of hormone receptor-positive breast cancer are estrogen receptor-positive breast cancer and progesterone receptor-positive breast cancer. In these cancers, the cancer cells receive their growth signals from estrogen and progesterone, respectively. When the growth of cancer cells results from problems
Late Recurrence In Er
Joseph A. Sparano, MD Kathy D. Miller, MD
Kathy D. Miller, MD: Hi . I’m Dr Kathy Miller, professor of medicine at the Indiana University School of Medicine in Indianapolis. Welcome to Medscape Oncology Insights, coming to you from the 2017 San Antonio Breast Cancer Symposium .
For patients with hormone-sensitive disease, 5 years is not a very good benchmark. More patients have a recurrence after 5 years than in that first 5 years. Those late recurrences have been a vexing problem for decades. I’ve asked my next guest, Dr Joe Sparano, to give us some recent insights about who might be at greatest risk.
Joe is professor of oncology at the Albert Einstein College of Medicine and associate chair of the department of oncology at the Montefiore Medical Center in the Bronx, New York. Welcome, Joe.
Joseph A. Sparano, MD: Thank you, Dr Miller.
Late Recurrence in Hormone-Sensitive Breast Cancer
Dr Miller: Tell us how you first got interested in this problem of late relapse.
Dr Sparano: As a clinician, it’s a problem I face every day in my clinic, and a frustrating one especially for the patients who have been through the entire process of surgery, radiation, chemotherapy, and 5 years of hormone therapy. Generally, people celebrate after 5 years because they feel that they have completed their therapy.
What Drives Late Recurrence?
Dr Miller: Tell us about the biobank that you helped develop to try to tackle this question of what drives late recurrence and who might be at risk.
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Am I Still At Risk Of Breast Cancer Recurrence If I Have Had A Mastectomy
Yes. You are still at risk of breast cancer recurrence if you have had a bilateral mastectomy . Undergoing a bilateral mastectomy drastically reduces your chances of local or contralateral breast cancer recurrence as almost all of the breast tissue has been removed. However, there is still a chance that residual breast tissue or cancer cells could recur on the chest wall.
If you have had a single mastectomy , you are still at risk of developing cancer in the breast that remains.
It must be noted that having a mastectomy or bi-lateral mastectomy does not reduce your risk of developing cancer in other parts of your body .
Circulating Tumor Cells At 5 Years Post
In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.
In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.
Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.
That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.
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Breast Cancer Genomic Recurrence Signature Influenced By Bmi In Young Patients
NEW YORK Body mass index appears to influence an established gene expression-based breast cancer recurrence score in young women with a history of estrogen receptor -positive, HER2/ERBB2-negative breast cancer, according to new research by a Korean team.
“The findings of this study suggest that increasing BMI might be associated with a higher genomic risk in younger patients with ER-positive, ERBB2-negative breast cancer,” co-corresponding authors Sung Gwe Ahn, with Gangnam Severance Hospital, and Sae Byul Lee, at the University of Ulsan College of Medicine’s Asan Medical Center, and their colleagues wrote.
As they reported in JAMA Network Open on Monday, the researchers brought together data for nearly 2,300 Korean women diagnosed with stage I to stage III ER-positive, HER2/ERBB2-negative breast. The participants included women diagnosed between the ages of 22 and 81 years old who had undergone multigene panel testing with the Oncotype Dx 21-gene expression panel between the spring of 2010 and late 2020.
The team did not consider breast cancer cases diagnosed at stage IV, those classified as HER2-positive, or cases that involved neoadjuvant chemotherapy treatment prior to surgery.
In the subset of 776 women who were 45 years old or younger, the team saw differences in genetic recurrence score and related treatment patterns in the 101 women with a BMI of 25 or higher relative to the 675 women with a BMI below 25.
Study Confirms Letrozole Prevents More Breast Cancer Recurrences Than Tamoxifen
Adapted from the NCI Cancer Bulletin.
After a median of 8 years of follow-up from a large randomized trial, women with estrogen receptor positive breast cancer who received 5 years of treatment with the aromatase inhibitorletrozole were less likely to have their cancer recur or to die during follow-up than women who had 5 years of treatment with tamoxifen. In addition, 5 years of sequential treatmenteither 2 years of letrozole followed by 3 years of tamoxifen or 2 years of tamoxifen followed by 3 years of letrozolewas not better than 5 years of letrozole alone at preventing recurrence or death. These results, from the BIG 1-98 trial, were published online October 20, 2011 in Lancet Oncology.
Researchers from 27 countries enrolled 8,010 postmenopausal women with invasive breast cancer that could be removed surgically in the trial. After surgery, the women were randomly assigned to one of four groups: 5 years of letrozole , 5 years of tamoxifen , or one of the two sequential treatment groups. Novartis, the maker of letrozole, provided funding for the trial, along with NCI and the International Breast Cancer Study Group.
- Posted:December 2, 2011
Histopathological Evaluation Of Til Density
TIL density was evaluated pathologically using biopsy specimens. The pathological diagnosis and examination were jointly performed by two breast pathologists. The definition and evaluation method for TILs followed the International TILs Working Group 2014 . Specifically, the density of infiltrating lymphocytes was averaged on full sections, at least five fields, of the tumor stroma. The results were divided into four groups according to previous reports .
Histopathologic evaluation of the tumor-infiltrating lymphocytes density was performed on hematoxylin and eosin-stained tumor section. The density of them was averaged on full sections, at least five fields, of the tumor stroma. The results were divided into four groups ,> 1050% ,10% , and absent , respectively)
Treatment Type And Breast Cancer Survival
Overall survival is the same for lumpectomy plus radiation therapy and mastectomy. This means both treatments lower the risk of dying by the same amount.
For a summary of research studies on lumpectomy plus radiation therapy and mastectomy in the treatment of early breast cancer, visit the Breast Cancer Research Studies section.
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Who Is At Risk Of Breast Cancer Recurrence
Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.
Ep: 10future Directions In Hr+ Breast Cancer Management
Lets talk about late recurrence. This is the bane of our existence with hormone receptor positive disease. Triple-negative and HER2 positive tend to recur early if they do relapse, usually in the first 2 to 3 years. But ER positive disease can recur 10, 15, or 20 years after the fact. Theres a stubborn 1% or 2% risk of relapse per year for about 20 years. How do we identify those patients?
Lee Schwartzberg, MD, FACP: Thats a great question. Were still struggling in some cases to identify them. Its well established that over half of the recurrences occur after year 5. Our traditional thinking, and whats out there in popular culture, that youre home free if youre disease-free at 5 years, unfortunately isnt true for HR+ disease. Thats a difficult discussion that I have with our patients all the time, that we have to continue to monitor these patients, particularly if theyre at higher risk. It was very sobering a few years ago when the Early Breast Cancer Trialists Collaborative Group looked at the recurrence rate for up to 20 years, even in patients who had T1N0 tumors. It continues up through 20 years. Of course, the larger the tumor in terms of T size or the more nodes that are involved, the curves shifted upward as well. This is a substantial problem going out to 20 years.
Lee Schwartzberg, MD, FACP: Right, for stage IIB or certainly for stage III cancers. The guidelines are consistent with that recommendation as well.
Transcript edited for clarity.
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Risk Of Late Recurrence Is Underestimated
A survey led by the Canadian Breast Cancer Network found that women often underestimate their risk of late recurrence. In the survey, only 10% were aware of the risk of recurrence after five years of tamoxifen therapy, and 40% felt that they were cured after hitting the five-year mark.
Many breast cancer survivors underestimate their risk of late recurrence.
Interrupting Endocrine Therapy To Pursue Pregnancy Doesn’t Lead To Worse Short
Breast cancer patients who paused their endocrine therapy to try to get pregnant experienced short-term rates of breast cancer recurrence similar to women who did not pause therapy for pregnancy, and many went on to conceive and deliver healthy babies, according to results from the POSITIVE clinical trial presented at the San Antonio Breast Cancer Symposium, held December 6-10, 2022.
While breast cancer is most commonly diagnosed in middle-aged and older women, in the United States, about 5 percent of new diagnoses each year occur in women aged 40 or younger. These younger patients face some unique considerations, including fertility, said the North American study’s lead author, Ann Partridge, MD, MPH, vice chair of medical oncology at Dana-Farber Cancer Institute and professor of medicine at Harvard Medical School.
“Forty to 60 percent of patients who are diagnosed with breast cancer at age 40 or younger are concerned about their future fertility, especially if the disease occurs before they could decide whether to become a mother or not,” she said.
Coauthor Olivia Pagani, MD, who is the international study chair on behalf of the International Breast Cancer Study Group, said only about 5 to 10 percent of younger breast cancer patients go on to become pregnant.
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Vaccine Derived From Her2 Protein May Help Prevent Breast Cancer Recurrence
A new breast cancer vaccine that is derived from the HER2 protein may help prevent recurrence in patients with HER2-positive disease and appears safe. Phase II study results of the vaccine were released at the 2014 Breast Cancer Symposium, September 46, in San Francisco.
The HER2 protein, also known as human epidermal growth factor receptor 2, is found on the surface of certain cancer cells, including breast cancer. In normal cells HER2 helps control cell growth. Cancer cells, however, can make too much of the protein, which can cause cells to grow more quickly and be more likely to spread to other parts of the body.
The HER2-derived vaccine, known as GP2, is designed to provoke the bodys immune system to fight cancer by recognizing tumor cells that express HER2. It is administered in addition to standard breast cancer treatment, such as Hercpetin® , with the goal of preventing recurrence.
Based on these findings, the GP2 vaccine appears promising in addition to standard therapy in women with HER2-positive breast cancer, as it might have the potential to safely and effectively prevent recurrences. The researchers also speculate that GP2 works with Herceptin in a specific way to stimulate immune response and that further research into this interaction is warranted.
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When To Contact A Doctor
A person may wish to contact a doctor if they notice signs that their cancer has returned.
Since the cancer may have spread, a person should contact a doctor about any unusual symptoms throughout their body, not just their breasts.
When making an appointment, a person should be prepared to talk about any new symptoms they are experiencing. They may also want to be ready to discuss their history with cancer.
A doctor may want to ask questions, order tests, and perform a physical examination.
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Survival Of Breast Cancer Based On Stage
Statistics are given below for the overall survival rates for breast cancer based on certain stages of disease development.
I made this page many years ago, when there was nothing like this data available on the internet. Recently this page has been up-dated with the most recent statistics that we can find. Prognosis will be even better than the numbers here suggest because modern targeted treatments have improved a lot.
Breast cancer staging is determined by many factors and these include:-
- The presence and size of a tumor
- Whether the tumor is node negative or positive, this means whether lymph nodes are involved or not
- If the cancer has metastasized beyond the breast
If breast cancer is diagnosed and it is determined that there is no metastasis to the lymph nodes then the chances of survival are extremely good.
Once breast cancer has spread to the lymph nodes the mode of treatment tends to shift to the chemotherapy medicines, and the odds of survival are somewhat lower.
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What Causes Breast Cancer Recurrence
The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.
Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.
What Types Of Breast Cancer Have The Highest Recurrence Rates
A study published in the Journal of Clinical Oncology found the risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.
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Rna Extraction And Qpcr Analysis
We applied the Trizol method to extract total RNA according to the operating procedures provided by the reagent manufacturer. Based on the real-time PCR method, the reverse transcription was performed with Takara reverse transcriptase . A total of 2µg purified RNA was utilized to synthesize cDNA and then amplified by PCR using specific primers. Then, RT-PCR was performed using an ABI7500 real-time fluorescence quantitative PCR system and SYBR Green . The internal reference we applied was 36B4. The primer sequence is illustrated in Table . We used the 2CT method to detect relative gene expression levels. We repeated this at least three times for every experiment.
Table 1 The primer sequence of qPCR analysis.
How Long Does It Take For Breast Cancer To Recur
Recurrence can happen anytime, but it usually takes place within 5 years of treatment. The good news is that recurrence is less likely today than ever before. This is largely due to the latest targeted treatments. In fact, most people treated for early stage HER2-positive breast cancer dont experience recurrence.
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Treatment For Local Recurrence
Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.
If you had breast-conserving surgery then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.
If you previously had a mastectomy, surgery may be possible to remove the affected areas.
Nearby lymph nodes may also be removed.
Radiotherapy is usually only an option if you havent previously had radiotherapy in the same area.
The way radiotherapy is given for a recurrence is similar to how its given to someone newly diagnosed.
Radiotherapy may be offered if surgery isnt possible.
Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.
Its not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases.
If you have previously had chemotherapy then different chemotherapy drugs may be used.
The most widely used targeted therapies are for HER2 positive breast cancer.