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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 later.

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 Committee.

But, he adds, previous phase III trials attempting to evaluate whether women with breast cancer benefit from chemotherapy have not been successfully completed.

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: http://www.nsabp.pitt.edu/B37_Information.htm.

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