Adjvnt Therapy: Destroys or delays growth of stray BC cells?
Comments
-
Back in 2005 there was a landmark study that said moderate exercise reduced breast cancer mortality.
0 -
To me it seems logical to test all our tumors to see which chemo cocktail will do the most good. I know it is being done in some larger tumors, but not in the smaller ones as far as I am aware of. I think the Oncotype test is a great first step, but it doesn't tell us which cocktail will do the most good.
0 -
They should make chemo assays routine for Stage IV. Right now I think it is still experimental.
The oncotype test is great in theory. It is relatively new, though, so long term outcome data are not yet available.
0 -
I have wondered some of the same things too. I took the chemo despite being stage 1 because I had angiolymphatic invasion but clear nodes. I felt like the cells had pathway to travel by blood established and I was scared they were just running through my body. One med onc said the tammi would take care of them. The other med onc suggested chemo because of angiolymphatic invasion and age and my overall health. I hope the chemo did it's job.....I hope the tammi does it's job too. Through all of my diagnosis and treatments, not one doctor has used the word "curable". They always say "treatable"......even with stage 1. I really don't think they know...it's all "hocus pocus" in a way.....I had also wished there were studies about women with stage 1 that had done BMLX and chemo - you know, more specific to my situation. Sometimes the studies include many types of patients so it's hard to understand what the stats really could be for you personally. I guess in the end the stats don't matter and niether do the odds....someone always gets cancer or recurs. 1 in 8 gets BC and I was the 1 in 8........ I have less than a 10% chance of recurrence they tell me, but someone is always in that 10%...you never know who will be in the minority.......UGH! BC stinks!
0 -
I agree it should be routine for stage IV, but why not all stages. I may be nuts, but to me if the best cocktail were used in the first place maybe fewer people would have the BC return.
0 -
I think the bug/exterminator analogy is a good one.
Remember that the definition of Stage IV is not that you merely have cancer cells elsewhere in your body. It's that you have tumors in other organs that are big enough to be visible using the current screening tools we have (CT, MRI, PET, Bone scan.) I believe they need to be at least 1 cm to be detectable by PET, for example.
So early-stagers may have cancer cells floating around, and they may even have started new 'colonies' in other organs...but if they are still small enough to not be visible with the technology we currently have, we are not Stage IV.
Many early-stagers probably have this situation going on, which is why, if they only get surgery some percentage (depending on stage and cancer cell type) will eventually develop tumors in other organs. We get chemo and hormonal therapy to attack and try to either kill or make dormant any remaining cancer cells.
To the question of why chemo can obliterate (apparently) smaller colonies of cancer cells, but not bigger ones, the reason seems to be that as tumors grow, the cells continue to mutate and develop resistance to would-be killers like chemo or our immune system. A 2 cm tumor has more than a billion cells. So among those billion, there will be some that can survive chemo and can keep growing. But if you have, say a 2 mm micrometastatic deposit on an organ, there would only be a few million cells, and you might be able to kill them all with treatment.
This must be why the studies show better outcomes for early stagers who get chemo and/or hormonal therapy, vs. those who do not.
And while it might seem reasonable to think that treatments only "delay" recurrence, the evidence doesn't support that. If it were, all the younger cancer patients (who can go on to live decades, if they beat their cancer) would eventually recur. But they do not.
0 -
I have always wondered....How do they KNOW if the Tamoxifen or any of the other Hormone suppressants actually prevent your cancer from coming back? Are there any tests that will show this?
I had to quit Tamoxifen after 14 months because I lost my hearing...... I was afraid to take it any longer....and I was too afraid to try the Arimidex or Femara! So I am just getting Mammograms every 6 months, & taking lots of supplements....
But I think that if they remove your tumor, with clear margins, 0/3 nodes, with radiation, that my tumor is gone.... I just can't figure out how they KNOW that Tamoxifen taken for 5 years will keep that cancer from coming back! Maybe, just MAYbe it would not come back with taking nothing!
If my Oncotype score was over 19, then I might have gone with chemo also...but sometimes the cure is almost worse than the original problem.... Like going deaf.... But who knows? No-one would have been able to tell me that this would have happened... Or that if I took the Tamoxifen for the 5 years, that THIS prevented any cancer from coming back.....It might have NEVER come back anyway....IMOHO....
0 -
Beeb75 said ~ "And while it might seem reasonable to think that treatments only "delay" recurrence, the evidence doesn't support that. If it were, all the younger cancer patients (who can go on to live decades, if they beat their cancer) would eventually recur. But they do not."
...... but this still doesn't stop my nagging question from rolling around in my brain .....it still doesn't prove that rogue cancer cells were "killed" in the above situation. It could merely mean that this particular person never would have had a recurrence in the first place. Such as there are many that have chemo/hormonal therapy ..and they STILL move on to a recurrence or Stage 4. So it still makes me wonder if recurrence fate is really determined at time of surgery/discovery. And that if you don't have a recurrence ~ you were cured from the beginning (i.e. it was fully removed at surgery/radiation) regardless of what adjuvant therapy route you did or didn't choose. I understand that if this were true (and we may never know), it doesn't really change anything since there is no test for rogue micromets. Say they were able to prove that adjuvant therapy could not wipe out micromets...that it only delayed recurrence for an unknown amount of time. I'm sure people would still elect to take that chance and have that delay of months...years...decades?
0 -
Exactly Susan! I mean if they could have proven to me, with the stats that they have, that taking the Tamoxifen even THOUGH I lost my hearing, I might have continued taking it.... Except at MY age, almost 74, I thought how many more years do I have left? I would rather take my chances on maybe getting breast cancer again, even without taking any more drugs.... If I DO get BC again, or for that matter heart disease, or any other serious disease, I just have to deal with it.
I just feel so bad for the younger women with children that get Breast Cancer! I thought I was too old to even have a Mammogram....much less breast cancer!
My older friend had a mastectomy, then Tamoxifen for 5 years....And she is still NED after 14 years. But who is to say that the Tamoxifen helped "cure" her, or the mastectomy itself?
This is really an interesting thread...I hope it keeps up....Thanks!
0 -
Susan... We do know that taking hormonal therapy does reduce the chance of recurrence. But like I said earlier, there is NO definitive way of knowing who is cancer free following surgery or who has the potential to recur. That's also the premise behind the Oncotypedx test. Oncologists knew they were over treating many women, but they didn't know EXACTLY who was being over treated with chemotherapy. The utility of the test permits doctors to hone in on the prognostics and then make an educated guess. Rgruff mentions the effects of diet and exercise with regard to recurrence. Again, we can use meta - analysis for clues to how effective therapies are, but at the end of the day, doctors still cannot predict whether or not any therapy will eradicate a tumor. Nor do they know who may have been cured following surgery.
0 -
VR ~ "We do know that taking hormonal therapy does reduce the chance of recurrence"
Okay...wait... here I go again
Has it been proven that hormonal therapy "reduces" the chance? I don't think it has. At best, they can say it "delayed" a chance of recurrence. Right?
0 -
And Chevyboy...I don't blame ya for stopping the Tamoxifen in your situation. For you, I agree.. the % of benefit it may or may not provide you was outweighed by your SE's.
0 -
Susan... Simply put, when they introduced hormonal therapy.. Mortality rates dropped. So for a number of women, it stopped a recurrence from occurring. We still don't know which of the many women who chose to take it, wouldn't have recurred in the first place because the surgery wiped out the cancer. Recall, i also said that I also think there were women who were going to recur from the get go no matter what treatment they do. But tests like the Oncotypedx test are getting better at determining who needs therapy.. What I would like to see in a number of years what becomes of the women who scored ZERO on their Oncotypedx tests. Ultimately they are the ones who should have been cured with surgery and wouldn't need tamoxifen to mop up anything. Time will tell. Stay tuned!
0 -
I believe hormonals are a crapshoot. Am highly ER/PR+. Arimidex worked for 18 months - had a recurrence in the bones. None of the other hormonals worked. I am 67 where are the hormones coming from. Should say I was IIIB at tx because you can't compare apples and oranges.
0 -
Sorry to hear you have a recurrence in your bones, imbell. So it makes you wonder if Arimdex delayed it showing up in your bones for 18 months? ...or did nothing at all? Have they been able to stabalize the bc in your bones?
Yup. When all is said and done...like a lot of things in life ~ it's all a crapshoot.
0 -
Voraciousreader ~ That would be interesting to see the follow up of women that scored ZERO on the oncotype test. Reading that book (Emperor of all Maladies).... it reiterates how hard it is to conduct proper trials...how statistics can be interpreted various ways..and that there are just so many variables you can never really be comparing apples to apples. As I discussed with my Onc...is there a trial out there that tested women my age, my fitness level, my same eating habits, that had mastectomies, that were not menopausal, that had the same size tumor/node/ER/HER2/grade, etc, etc out there? Obviously not. It will be interesting to see what advances are (hopefully) coming in cancer treatment. They seem to have done a lot better with earlier detection...but obviously have a LONG way to go with what to do once metastasis occurs.
0 -
SusansGarden. You say"...... but this still doesn't prove that rogue cancer cells were "killed" in the above situation. It could merely mean that this particular person never would have had a recurrence in the first place. Such as there are many that have chemo/hormonal therapy ..and they STILL move on to a recurrence or Stage 4. So it still makes me wonder if recurrence fate is really determined at time of surgery/discovery. And that if you don't have a recurrence ~ you were cured from the beginning (i.e. it was fully removed at surgery/radiation) regardless of what adjuvant therapy route you did or didn't choose."
You are right that for any individual's situation, we have no idea if they were cured at surgery, cured by adjuvant therapy, or not curable no matter what they did. But the studies show that a percentage of women are curable by adjuvant therapy, and that's why we all do it.
Just to give you an example. If 100 women had my exact cancer stats, 45 would die of cancer within 10 years, even if they had surgery. If everyone also did adjuvant therapy of chemo and anti-hormonals, then only 17 would die of cancer within 10 years. But, we just don't know who would have been the 55 who didn't need additional treatment, who were the 28 who benefited from treatment and who would not have been helped no matter what treatment they did.
But the overall drop in breast cancer death rates...even among younger women dx with the disease, shows that whether the adjuvant treatment delays or prevents recurrence, the effect is the same. Those women live to die of something else, hopefully at a ripe old age.
There are probably three factors that determine the fate of a breast cancer patient. The first is the type of cell that becomes cancerous. The second is when the cancer is discovered. The third is what type of treatment is chosen and used.
But it's NOT true that if you don't have a recurrence you were definitely cured by surgery. Some percentage of the women these days who do not have a recurrence were "cured" by adjuvant treatment. Studies show a clear difference in outcomes between people who do adjuvant treatment after surgery and those who do not. I can point you to such studies.
0 -
Very good questions ladies. I wonder why chemo and radiation can't get rid of stage iv too. If you get lung cancer ( not from BC) they can kill it, but if it is metastized BC, they can't??
0 -
The problem is that statistical research/observational studies can establish an association (eg: between Tamoxifen and lower rates of recurrence over x number of years) but it is hard to establish a cause and effect.relationship. Much of cancer research is based on established associations between drugs and outcomes rather than lab-observed phenomenon. That is why academics are so careful in how they couch study language. The word "believe" and the word "may" are king. This -and the fact that so many go on to progress and die despite all the treatment in the world-- is why one has to look at existing treatment protocols with healthy skepticism. You follow your treatment plan with your fingers and toes crossed, believing as much in the power of interlaced digits as in the medical care you agree to.
0 -
Beebe - surgery does cure some. We just don't know whom for sure.
0 -
Beeb75 ~ Interesting. And yes.. I would love to be pointed to the studies that say that women are definitly "cured" by adjuvant therapy.
Athena ~ I like that ... "believing as much in the power of interlaced digits as the medical care we agree to".
0 -
re: "I understand that if this were true (and we may never know), it doesn't really change anything since there is no test for rogue micromets."
I could not find the initial article I once saw, that they are now able to do this, but here is another with similar information.
0 -
Just wanted to say thank you to everyone for their input so far..I think the conversation is bringing up interesting points/ideas/opinions from everyone. I love trying to wrap my head around this kind of stuff. Reminds me of when I start trying to ponder where/what is exactly at the end of the universe. 0
-
Unfortunately, I am going to open a can of worms by saying that for a select group of women, early detection will not reduce mortality. Instead, they will only know this beast longer. Likewise there are a select group who are diagnosed with breast cancers that are so indolent, that they will die of other causes. Yes, with early detection we are finding more cancers, but the mortality rates are sadly only declining very slowly. Even more sad is that the mortality rates for the youngest sisters with BC are going down the slowest. Regardless, i remain hopeful that each day will bring new discoveries that will ultimately, one day soon, spare most women of this vicious disease. I wish I could believe that early detection is the key to saving lives, but unfortunately, I am not convinced.
0 -
I thought I had read something about that elimar. Wouldn't that be exciting news if they could figure out how to test for that in early stage cancers.
0 -
So the earth isn't flat?
0 -
I also agree with those of you saying, how do we know that it was the drug that prevented a recurrence and not that maybe it never would have recurred anyway, drugs or no drugs. I also don't completely trust clinical trials because results can be tailored and interpreted in different ways like Susan says. I think a lot of results obtained from studies can be coincidental. I also read that book, "The Emperor of all Maladies" by the way.
The other thing I have an issue with is, does estrogen cause or just feed breast cancer? I really don't believe that it causes it, but do believe that it can feed it once it's already started. And I've never liked the idea of therapies that cut off all our estrogen supply (AIs). I want to keep estrogen in my body as it serves many beneficial purposes. The tamoxifen I'm OK with, because it blocks it where it needs to be blocked while other parts of the body still have it available.
The other thing that makes me take the tamoxifen is reading about women who have taken it, saying how it shrank their tumors. In my mind this means that it is doing something observable and that maybe it could benefit me.
0 -
Cans of worms are welcome.
... I agree that early detection may just have some women "knowing this beast longer". Do you believe that some tumors though... when discovered and taken "early" saved them? So in that case... a mammogram (early detection) did help? I know the studies do not show a significant drop in mortality since the introduction of mammograms to the population. But just logical thinking leads me to believe that it has to be true?0 -
rgiuff....I'm not so sure that Tamoxifen shrinks tumors....Did you read that somewhere? I would think that any tumors should have been removed.
I wish the blood tests taken during our treatment would show that the Tamoxifen showed any difference in our tumor markers. Mine have stayed the same, even though I quit taking it in January! My Radiologist said she won't be taking the usual 3-6 month blood tests, because she thought they wouldn't show anything. I think if I were a higher stage, it would show a difference, or some change....
I quit going to the Oncologist because she wanted me to stay on Tamoxifen, even after the hearing loss, but I didn't want to lose anything else! So since I am not taking any more drugs, I asked my Radiologist if she would take over my care, like ordering Mammograms....
I WOULD have stayed on the Tamoxifen if this hadn't happened. With the T pill, you still produce a small amount of estrogen, but it is blocked from feeding any stray cancer cells....at least that's how I understand it. Since Tamoxifen is a chemo drug, it is as hard as chemo on your hair follicles, and that's what your "nerves" are in your inner ear...like little hairs.... So that's why I have permanent nerve damage.... But oh well! My hearing aids help a lot.....
0 -
Chevyboy... I believe that is still up for debate. 0
