Will 30% of Early Stage (1-IIIA) go on to metastasize??
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Another one here with BMX. It was my choice. Going into surgery, the surgeon believed that he was removing a cancerous right breast and prophylactically removing lefty. At that point, my breasts had been mammoed, U/Sed, MRIed and CTed. All 4 methods showed nothing of any concern in lefty, except a few, tiny calcifications that all the docs swore were benign. The path report showed LCIS and various other pre-cancerous stuff in the supposedly healthy breast. Good riddance, I say. ILC is sneaky.
As for pre-surgery imaging, my surgeon insisted on doing full staging scans, meaning a bone scan and CTs of brain, lungs and abdomen. I don't know if he does this with all patients, or just with the stage 3 ones. In any event, it was reassuring at the time to know that it hadn't metastasized.
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This study, which is new, shows there are reasons younger women need to consider BMX over lumpectomies. More studies need to be done, but it's an important read.
http://www.breastcancer.org/research-news/best-surgery-for-early-stage-may-depend-on-age0 -
I had umx after a lx due to my BS being unable to get clean margins. The day of my umx we got the results of my genetic testing and I have up to 30% risk of a NEW cancer. So, I am scheduled next week for a prophylactic right mx. In hindsight, as much as I was trying to cut down on recovery time, I should have just decided to have a bmx.
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I chose BMX. My doc ordered a full set of scans: Mammo, ULS, MRI, CT, CT w/contrast, nuclear PET/CT - all showed righty was OK. Like several others, they found cancer in both breasts in surgery that was not seen on scans. Unfortunately, even with clean margins & two SNB clean on each side - I had a recurrence under my collar bone. I found the new lump myself just under 2 years from the first surgery. The cancer had changed to IDC & migrated into my lymph system. So chemo before surgery & more chemo after ALND surgery & rads & herceptin for a year. Be vigillent.
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I chose to do a UMX. My genetic testing all came back negative, I didn't feel the need to remove a healthy breast and was hoping to keep feeling in at least one breast. Unfortunately I had a reduction/lift on the left side and lost some feeling in the nipple. I've been seriously considering having the left one removed. The 10 yr AI study showed the greatest benefit was in preventing a new primary. Having a BMX would greatly reduce this risk. I'm just not sure I want to go through all that again after 2+ years.
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LCIS and ILC can be hard to find and doesn't show up on mammo/US most of the time. Sometimes can't even be seen in MRI. A friend of mine ended up with ILC in her good breast side under her reconstruction (under her butt boob). She had mets when they finally found it. She had broken her neck and was rushed to the hospital. Yes be diligent! If you have unexplained bone pain demand a scan.
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BosumBlues it's about 2-3%. You have a higher risk of dying from a car accident (I think it's about 5%)
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- The odds of a car occupant dying in a transportation accident were 1 in 47,718 in 2013; the lifetime odds were 1 in 606 for a person born in 2013.
Maybe she meant odds of being in a car crash. I've been in 2 so far.. in my 40 years. (all my young stupid fault)... but not for the last 20 years.0 -
bosom...when you are doing statistics, the statistical chance per individual does NOT get added to the following individuals. So, if you have a 5% chance of getting something, then the next individual in the sample population also has that 5% chance of getting the same thing. Think about tossing a coin. Each time it is tossed, whether it is tossed by you or someone else, the chance of getting a head or tail is constant...there will always be a 50% chance of getting a head or tail. If you toss it 99 times and all 99 times it comes out heads, when you toss it that 100 time, it will still remain a 50% chance that it will be a head or a tail.
Hooe that makes things a little bit clearer....
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If I flipped a coin 99 times and got 99 heads, I'd think maybe it was a bad coin!
Actually, while you can't add percentages that way, you can calculate the chance that at least one person in a group of eight would be affected if each has a 5% chance by multiplying the chance that it doesn't happen (95%) eight times and subtracting that from 1:
1-(0.95)^8=0.3366, or about 34% that one or more would be affected.
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carpe...perhaps that coin was headed on both sides!😱 On a more serious statistics note... When some one is betting and having a winning streak, one's judgment should never be clouded by the winner's streak "luck." The house NEVER loses sight of the statistical chances. So if our gambling friend bet the house that that 100th throw of the coin was going to be heads, s/he might be in for a very rude awaking when the tail appears and they lose EVERYTHING! 😫😫😫😰😰😰
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carpe, just above your post, someone said that there is a 1 in 606 chance of dying in a transportation accident. If you are a group of 8 it's possible that NO ONE in your group will die that way.
Just like breast cancer is a 1 in 8 odds. I know a lot of women and if I group them into 8's the stats wouldn't support what they say. You have to look at really big numbers for the stats to make sense, not just a small group.
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barbe...if the sample population is chosen carefully, then you can extrapolate and interpolate. That is, from the statistics you can make all kinds of judgments from the data. Likewise, if those samples are chosen carefully, the "chances" become more accurate. Also, don't confuse raw numbers. One of eight, percentage wise, is the same as 10 of 80 as well as 100 out of 800. That is, you will be as lucky to find 1 of 8 women who have breast cancer as you would find 100 of 800. Those 1 of 8 might NOT be in the same room because in that room you are looking at the raw numbers of people in a room,but if you put 8000 people in a stadium, you might find that 1 of every 8 women in that stadium will have had a breast cancer diagnosis.
On a coincidental note, I was at a lecture yesterday that was filled with older women and I began counting heads, wondering how many of the women seated there were like me, a bc survivor. Counting every 8 women, I came to the conclusion that there were likely 5 other women in the room who were also survivors based on approximately 50+ women in the room. With that few of women, it could be POSSIBLE that I was the only one, however, it was more LIKELY that there were 5 more people like me.
When you train your mind to think like a mathematician, you see things differently and your language effectively changes as well. Words like "possible" and "likely" are used accordingly and have very specific meanings when you are discussing statistics. Bottom line is that statistics affords us the opportunity to understand chance and risk and with that knowledge, it prepares us better to be able to make informed choices.
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voraciousreader It's not 50/50 for coin toss. I believe the tails side of the coin is heavier and therefore tends to fall with heads up… unless you flip the coin
Yes my statistic was wrong. But
591,699 people died of cancer (not just breast cancer) in 2014
136,103 people died of an accidentBut statistically if you add up all the other numbers you are way more likely to die of something else.
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vr, that's why I said you had to consider a very large number of people for it to make sense. Also, if you were in a room discussing breast cancer odds (or stats!) then the probability of the 1 in 8 working would be higher.
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barbe...the chance of 1 of 8 vs 100 of 800 is still the same! The probability stays constant regardless of the number of people! Probability tells us you are LIKELY to find a bc survivor in every interval of 8 people. Will some intervals of 8 have none? Yes! Likewise, some intervals might have one or more. Will every group of 800 women have 100 survivors? Probably not! Some may have more, while others might have less. But, you are LIKELY to find 100 survivors in 800 women. The probability is constant. Of course the more people you sample the more likely there will be accuracy. However, if your sample population closely resembles the population that you are interested in, then your results from that small sample should accurately reflect the group you are studying.
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back to the initial OP (which is actually cited in this article).. in 2015, it looks like they actually confirmed, well close enough, with the 30% number *They found the true number to be 28%... but it does include Stage 3A... If this has been published on this thread sorry I must have missed it.
http://www.medscape.com/viewarticle/8496440 -
Emphasis should not be placed on the inflammatory supposed 30% statistic but, rather on the word "contemporary"...There is no basis for comparing early stagers from 5 or even 10 years ago because treatments have changed dramatically in the last five years. Five years ago ER+ patients were recommended 5 years of endocrine therapy. Now the recommendation for many is 10 years. Herceptin for HER2 positive disease combined with neoadjuvant Pejerta is now being recommended in the last year or two.These dramatic changes in treatment for early stagers should lead to dramatic improvements in survival. Hopefully, in a few more years, with the help of better documentation we should be seeing more accurate data and dare I say, better survival statistics.
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When we say that 1 in 8 women in the United States, or 12%, will develop breast cancer over the course of a lifetime, we are talking about absolute risk. On average, an individual woman has a 1-in-8 chance of developing breast cancer over an 80-year lifespan.
The absolute risk of developing breast cancer during a particular decade of life is lower than 1 in 8. The younger you are, the lower the risk. For example:
- If your current age is 20, the probability of developing invasive breast cancer in the next 10 years is .06%, or 1 in 1,732. This means that 1 in 1,732 women in this age group can expect to develop breast cancer. Put another way, your odds of developing breast cancer if you are in this age range are 1 in 1,732.
- If your current age is 30, the probability of developing invasive breast cancer in the next 10 years is .44%, or 1 in 228.
- If your current age is 40, the probability of developing invasive breast cancer in the next 10 years is 1.45%, or 1 in 69.
- If your current age is 50, the probability of developing invasive breast cancer in the next 10 years is 2.31%, or 1 in 43.
- If your current age is 60, the probability of developing invasive breast cancer in the next 10 years is 3.49%, or 1 in 29.
- If your current age is 70, the probability of developing invasive breast cancer in the next 10 years is 3.84%, or 1 in 26.
As you can see, the older you are, the higher your absolute risk of breast cancer. Keep in mind that these numbers and percentages are averages for the whole population. Your individual breast cancer risk may be higher or lower, depending on a number of factors, including family history, reproductive history (such as menstrual and childbearing history), race/ethnicity, and other factors.
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I know the odds stay the same. But the PROBABILITY of seeing it out would be with a bigger sampling. Just like I said above, for example, that I don't have anyone else in say, my immediate circle of 16 women who has breast cancer like me. But if I widen the sampling, I have some.
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Lisey, I had a look at that medscape article. On the last page, it describes Dr. Brawley's work to track this down, and it says,
"Dr. Brawley worked with 2 ACS epidemiologists to examine the issue. They looked at breast cancer specific mortality (as identified on death certificates) in 12 healthy districts in the United States from 2008 to 2012. They were surprised by the finding: "28% of the women who died of breast cancer during that time period had localized disease at diagnosis," said Dr. Brawley."
This is very different from saying that 28% of all women diagnosed with local disease will go on to develop metastasic disease. The study population only includes women who died of BC. Many, many women initially diagnosed with early stage disease will eventually die of completely unrelated causes. These women are not included in the count at all, so it strikes me that you cannot apply the 28% figure to everyone diagnosed with early stage disease. It might reasonably suggest that 28% of women diagnosed with metastatic disease were initially diagnosed with early stage BC, but not that 28% of all women with early stage disease will progress to mets
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I'm new to this thread, and of course its many pages long, so this could have been posted. I was stunned to see that statistics are not kept on how may go on to mets, only who is Stage IV at diagnosis. This is from MBCN.org
Metastatic Breast Cancer Incidence
MBC incidence is the number of newly diagnosed cases of metastatic breast cancer in a given year.
• Statistics not collected. Statistics are not collected for metastatic recurrences which comprise the larger portion of mbc cases. Statistics are only gathered for initial diagnosis of Stage IV metastatic disease.
• Approximately 6-10% of new breast cancer cases are initially Stage IV or metastatic. This is sometimes called "de novo" metastatic disease, meaning from the beginning. For 2012 this means new cases of Stage IV were in the range of 13,776 - 22,096.
• The number of metastatic recurrences are unknown, but are estimated to range between 20-30% of all existing breast cancer cases
• Dr. Joyce O'Shaughnessy estimated the rate to be 30% in developed countries [O'Shaughnessy, J. "Extending Survival with Chemotherapy in MBC" The Oncologist 2005:10]• Dr. William Gradishar of Northwestern University : "Breast cancer can become metastatic in roughly 30% of patients..." at 1:30 mark in interview (
http://www.youtube.com/watch?v=UoUftDNl4fo) 11/2009• Quote from The Oncologist Journal "Prognostic and Predictive Factors in Early-Stage Breast Cancer" (May 2004) "The poor outcome with the Halstedian approach, as well as the observation that 20%-30% of node-negative patients ultimately develop metastatic disease, led to the currently held micrometastatic paradigm. This paradigm asserts that many patients with early-stage disease have distant micrometastatic disease present at the time of diagnosis, putting them at risk for the later development of overt metastatic disease."
•Quote from Musa Mayer's Report: Silent Voices, 2006: "Stage at initial diagnosis is a strong predictor of distant metastatic recurrence, with women diagnosed with cancer that is locally advanced, spread regionally beyond the breast, much more likely to recur than breast cancer diagnosed as localized, although as many as 30% of localized cancers ultimately do recur, and many of these will go on to develop distant metastases."
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loral...and av.... both of your points illustrate the important point in statistics that the SAMPLE population represent the ENTIRE population that you are investigating. That said, with documentation now being standardized across th globe, hopefully soon, we will be able to see more accurate data over shorter periods of time. Eric Topol, MD discusses this topic in his books. The story of how the SEER database was formed is eloquently discussed in his book! He explains how, back in the 1970's, two physicians who were both frustrated with the way documentation of medical info was taking place, decided that their computer geekiness could be put to better use and that led to the formation of SEER. Along with the Vioxx debacle which led the NIH to create a website to document clinical trials (an issue that Dr. Topol was directly involved in), we are now moving toward the more precise measurement of all kinds of medical data.
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I haven't followed all this thread so maybe this has all been said.....but for what it's worth: One of my oldest friends is an oncologist. Whilst struggling with the bc fear and researching like crazy I came to understand from her that reading papers and statistics was something she was extensively trained to do and I was not. So for example, the 'Halstead' quote above refers I think to a series of mastectomies that were literally last century (none of them had chemo); any research dated before 2005 may include Her2+ ladies with no herceptin which has made a substantial difference to the overall numbers; current chemo regimes are significantly more effective than those of 15 years ago; AIs have added another few per cent to statistical outcomes. You have to be very aware of when what you read was published and by whom, and exactly what the data (eg study size, population, disease profile and study duration) is based on.
Large contemporary databases such as those that power Adjuvant! or NHS Predict tell us that today well over 90% of women diagnosed with stage 1 disease will be alive in 10 years & cured. But it also remains true that currently over 30% of those diagnosed with bc overall (at all stages) die of the disease.
I was diagnosed as a presumed 2b, then restaged 3a then 3c. I know about fear. But there is more to all this. Women with highly aggressive stage 1 disease may be at as great a risk as low grade stage 2 or even 3. Above all I cannot wish myself into the 'safer' group if someone else has to be the 'statistic' that dies. Ultimately that 5% of stage 1 ladies who recurr are 100% in trouble. A friend of mine was one of those. Likewise the 35% of women who are cured at 3c could just possibly include me. I have to hope & imagine it possible in order to go forward for my little girl. And again my dear Stage 4 friend could be a 10yr survivor.
Statistics do not help or doom us as individuals, and ultimately, none of us are getting out of this world alive....BC is a terrifying sobering but not valueless reminder of that. So let us let the numbers slide away, hold hands, hope, live a good day today and work for the time when 100% of us do not have to suffer the particular pains of BCas we do. Peace to all. X
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Lisey,I saw that too, and it does,indeed, seem to confirm it.
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SSinUK, you make good points, but I have to say that with BC, living 5 or 10 years from DX does NOT equal "cured." The whole sticking point is that relative survival in BC is totally flat, i.e. if your risk of recurrence/mets is 3%, it stays 3% no matter how far out from DX you are
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Thank you Momine. With breast cancer there is no such thing as "cured". Ever. There is only NED - No Evidence of Disease - at any given time. So yes, we need to go on with our lives & try not to let fear control us. It's not easy and again, we must stay vigilant.
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I agree with Momine, too. I was a very "safe" stage 1. So safe I didn't get chemo, rads or tamoxifen. Now I'm stage IV. Shit.
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almost 6 years ago I met a gal here on BCO. She happened to be local. We both had the same stage and just a year apart in age. She was grade 2 but only hormone positive with a few nodes. I was grade 3 triple positive with a very large tumor but no nodes. Another one of our friends was diagnosed stage 3B, hormone positive only (and ton of nodes).
In 2012 she was diagnosed with mets. Lost her in 2014. Out of all those in our local group we both thought she would be the least likely to get mets. The stage IIIB gal and I are still NED coming up on 6 years.
While 30% seems high it might be best to look at the 60% that don't ever get mets. That number is higher. Because other than being healthy, controlling weight, exercising and doing what's prescribed there really isn't much more you can do. I refuse to "wait around" to see if it will happen to me. Try to let the fear go.
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Couldn't agree more with you SSInUK. You wrote clearly and what you said certainly struck a cord with me.
We are none of us statistics.
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