How to Cope When Breast Cancer Returns
The lessons to be learned from Elizabeth Edwards -- very public battle with cancer recurrence.
How Cancer Recurs
When oncologists talk about breast cancer recurrence, they refer to two
different types: local, which recurs in the breast; and distant, or metastatic,
which recurs elsewhere in the body, such as in the bones, brain, liver, or
lungs. Recurrence is caused by cancer cells left behind during primary surgery,
even though they may not show up on tests. Edwards' cancer is distant, since it
has spread to her bones.
Breast cancer may seem to have the highest rate of recurrence because breast
cancer itself is the most frequently diagnosed cancer in women in the United
States, except for skin cancer. Although every cancer is different (and largely
dependent on the cancer's stage), lung, pancreatic, and ovarian cancer all
recur more often than breast cancer. Freedman says breast cancer recurs in
about 20% of survivors, compared to roughly 70% of women with ovarian cancer
(which is usually detected at later stages). And he says death rates from
breast cancer are actually decreasing, thanks to better and earlier detection
and improved treatment.
According to Virginia Kaklamani, MD, assistant professor and a medical
oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern
University in Chicago, when breast cancer recurs, two-thirds of the time it
shows up in places other than the breast. The risk of recurrence depends on the
length of time from the first diagnosis (the more quickly it recurs, the more
aggressive the tumor and the worse the prognosis) and the characteristics of
the tumor, such as its size.
Kaklamani says in Stage 1, when the breast cancer has not spread to lymph
nodes and the tumor is under 2 centimeters, it returns in about 10% of
patients. At Stage 2 (when the tumor is 2 to 5 centimeters) and Stage 3 (when
the tumor is larger than 4 centimeters), 20% to 30% and 40% to 70% of
survivors, respectively, will have a recurrence.
Freedman says the most important factor is whether the recurrence is local
or distant. "Local recurrence can still have an excellent prognosis," he says.
"Distant recurrence can't be cured, except in rare cases with a single isolated
occurrence in the lung or liver." Other factors include where the distant
recurrence is (cancer in the bone has a better prognosis than cancer in an
organ) and whether it is estrogen receptor-positive, or ER-positive, which
means it may respond to hormone therapy.
Freedman says when the vast majority of tumor cells are confined to the
breast area, they can be cured with surgery and radiation; and chemotherapy and
hormone therapy can even eradicate small amounts of undetectable, microscopic
disease that has spread through the bloodstream to, for example, the liver.
"But there are very few cancers that can be cured once they have spread to
other organs and are systemic like leukemias, lymphomas, or testicular cancers
that are the most sensitive to chemotherapy," Freedman says, adding that doses
of chemotherapy simply can't tackle the large number of cells present when the
cancer spreads to distant organs. So once breast cancer spreads, it can be
controlled but not cured.