When Breast Cancer Comes Back
Recurrence is always possible. But when the cancer comes back, where it is and how it behaves all affect the outcome.
Recurrence Can Mean Different Things continued...
If, on the other hand, you finished treatment for your original breast
cancer only six months or a year ago, and the cancer has already recurred, that
may be a sign that the tumor may be very aggressive.
"This indicates to us that a woman may be at a higher risk to have a
systemic recurrence," says Winer. If you didn't have chemotherapy before,
doctors may recommend an aggressive chemotherapy regimen now. But if you've
completed rigorous chemotherapy fairly recently, oncologists may not be in a
rush to put you through that again.
Of course, there are some complicating factors to treatment no matter when a
recurrence occurs. For example, a woman who has previously had Adriamycin
(doxorubicin) or another chemotherapy drug that is known to damage the heart
cannot be prescribed that drug again -- whether it's a year later or ten years
And a breast that has been treated with radiation cannot be radiated again.
For that reason, if you had a lumpectomy the first time around, which was
probably followed by radiation, your doctors will likely advise a mastectomy if
the cancer recurs.
Decisions to Consider if Breast Cancer Recurs
Deciding on a course of treatment for breast cancer recurrence is complex.
There's the question of what kind of treatment you had before and how well you
responded to it. Also, doctors don't have a lot of information about comparing
treatment approaches in women with recurrent breast cancer.
"There's something of an information vacuum here," says Winer.
"Although there are studies looking at the natural history of these
patients, telling us how well we can predict they will do, there are almost no
definitive studies looking at which treatment strategy is better."
That's because while breast cancer recurrence is certainly not uncommon,
it's uncommon enough to pose challenges in setting up a randomized clinical
trial -- the gold standard of research to evaluate treatment options.
For women with hormone-receptor positive cancers, doctors know that hormonal
therapy offers a benefit when the cancer recurs. "We do have the results of
clinical trials showing that," says Eleftherios Mamounas, MD, medical
director of the Aultman Cancer Center in Canton, Ohio, and Chairman of the
National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast
But, he adds, previous phase III trials attempting to evaluate whether women
with breast cancer benefit from chemotherapy have not been successfully
A New Clinical Trial
Doctors hope that will change soon. Beginning in January, the NSABP began
signing up patients for a new trial that will assess the benefit of
chemotherapy in women with local breast cancer recurrence.
Women in both parts of the trial will receive surgery and then hormonal
therapies if they're eligible. One group of women will also receive
chemotherapy, while the other will not. Women interested in signing up for the
trial, which involves centers in more than 20 U.S. states and Canada, can find
out more about the trial and who to contact here: