Will 30% of Early Stage (1-IIIA) go on to metastasize??
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Traveltext, same here,same stage too. However, there is no doubt that the chemo I had killed a lot of cancer cells. My doc also thinks it may have killed micromets
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As far as BC there is no KNOWN cure. Yes some of us are cured. We just don't know who.
Hell according to my oncologist there was a 40% chance only needed surgery ( but 54% chance I needed chemo/heceptin/AIs). She said if she knew I was one of those 40% she wouldn't be prescribing all that treatment.
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True that. And, we must live our lives as though we are 100% certain that we are cured.
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^^^^ No, that implies not being vigilant. Before cancer yup we live life like nothing is wrong but you can't forget precautions you were given (like lymphedema) and to be aware of you body for any changes that normally we wouldn't think twice about but now we do. Life before and after is not the same. That' what cured implies.
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After my first bout with BC and a double mastectomy, even though intellectually I knew there was no cure and I was only NED, I went back to living at full speed. After a recurrence in less than 2 years, there's no way to go back & and "forget" about cancer in the background. No way to live like I'm 100% sure it's gone. So I'll settle for NED most days and remain very vigilant.
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Speaking only for myself, I can say with certainty that living my life as though I've been cured - which I'm pretty sure I have been - in no way means that I don't remain vigilant. Nor does it mean that I live my life as I did before I was diagnosed.
If nothing else, I am always aware that as a woman, and particularly as a woman with a history of breast cancer, I remain at risk to develop breast cancer again. This is true even for those who've had a BMX. And I'm aware that as much as I hope and believe that I was cured, I could be wrong.
The simple fact however is that for anyone diagnosed with breast cancer, if no breast cancer cells remain alive in the body after surgery and treatment, then she is cured. She might develop a new breast cancer in the future, but the original cancer cannot redevelop (locally or as mets) if there are no cancers cells from that cancer left alive in the body after treatment. Of course we can never truly know if we are cured or not - there is simply no way to know if all the cancer cells were successfully removed and/or killed off - but since we know that most women who have early stage breast cancer never develop a recurrence, we can conclude that most of these women were in fact cured by their treatment.
There is no cure for breast cancer - we don't have that silver bullet treatment that guarantees to the patient that the cancer is completely gone - but most women treated for breast cancer are in fact cured by one or a number of imperfect but often effective treatments, and often by surgery alone.
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All good, Beesie, but how can we ever know that no bc cells remain in our bodies following surgery and other treatments?
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Well I've seen around here that folks where the MO says you are cured become less vigilant. They let that guard down and then for some, it became too late. Heard stories in my bc support group. People listen to their docs, which is why they should be very careful about throwing the word cured out there since many take it that no worries. It doesn't mean it's on your mind a lot but like for lymphedema, one gal took her being cured as no need to worry about it either and now she has a bad case because she forgets precautions as she's out in the world now completely cured..
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I think this boils down to trains of thought.
1) the tumor being in the breast and if it isn't LVI, or spread to the nodes or spread during the surgery/biopsy, then if you get all of it and have huge clean margins, you effectively removed the cancer...
or...
2) Cancer is in all of our cells floating around and some people are just more susceptible to it becoming a tumor... and no amount of surgery ever removes the stray cells floating in our body. thus you need a whole body approach and change your diet / environment / immune system, even if you have stage 1A - tiny tumor
To be honest, (and I asked the BS this and he actually agreed with me)... I think biopsies can actually spread contained tumors. If I now have cancer cells floating in my body it very well could have been from puncturing the seal of the tumor. The BS told me that yes, there is a risk of that but the benefits in outweigh those risks since most biopsies are benign. However, I KNEW mine wasn't and if I could have had a clean BMX without the core biopsy I would have done that. They drained a cyst after the biopsy and it was filled with blood. The radiologist said it was from the tumor. GREAT... they just unleashed Fing cancer into other areas of my breast.
The pathology came back as contained with very good margins and no LVI, but still...
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Traveltext, as I said, "Of course we can never truly know if we are cured or not - there is simply no way to know if all the cancer cells were successfully removed and/or killed off - but since we know that most women who have early stage breast cancer never develop a recurrence, we can conclude that most of these women were in fact cured by their treatment."
Let's remember that this is a thread in the Stage I forum and it is talking about how 30% of early stage women go on to metastasize.
Importantly, what this also means that 70% of early stage women do not go on to metastasize. The percent is considerably higher for those who are early early stage (Stage I). Some of these women will develop local recurrences, but most will not. Most were cured by their treatment.
To some of the earlier discussion, to suggest that we are all just in remission, or to imply that those who think or say that they are 'cured' are foolish or fooling themselves or not taking proper care is doing a huge disservice to early stage women. Of course some will recur. Of course some will develop mets. Of course we can never really know if we are cured or not. Of course we all must remain vigilant. But most of us are cured, and to think this and believe this - while remaining aware of the risks - is reasonable and healthy.
Edited to add: Artista, I think there is a huge difference between what a patient chooses to believe for herself and how she chooses to move forward in life, and what a doctor tells a patient. Since we can never know for sure who among us is cured and who will have a recurrence or develop mets, of course any doctor who pronounces to a patient that she is "cured" is an irresponsible idiot. For early stage patients, I am fine however if a doctor says something like "I hope and believe that your treatments were effective and that you have been cured, but since there is no way to know this for sure, it's important that you always remain diligent, come in for all your tests and call should you ever experience any unusual pains or develop any lumps."
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The fact is that all our lives are “on loan" whether or not we have any kind of acute or chronic disease. A bc dx just makes us acutely aware of that. The other shoe can drop at any time--but it can for anyone. We just are likelier to know that. I live my life to the best of my ability as I did before cancer, but also to keep an eye out for potential symptoms of recurrence.....or of other disease. (It's just stupid, e.g., to ignore chest tightness, sweating, shortness of breath simply because we have breast cancer and therefore “a heart attack is much less likely to kill me than is my cancer").
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Susan I am stage IIB, node negative, no LVI. My oncologist considers me high risk for recurrence due to tumor size (over 5cm). I don't worry about recurrence just know what the symptoms are for metastatic disease. It's been 6 years and I'm still good.
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So then what does that mean for those of us with positive nodes?
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Speaking as a former stage 1, (24 years ago) I was told by countless medical professionals that I was 'cured". It wasn't until years later that I realized there really is no cure, but whatever cells, my younger immune system etc, we really don't know, eradicated the cancer then.
I have a entirely new cancer different tumor make up, and hopefully I will be as fortunate as I was before. Before I was extremely active, ideal weight, did not eat refined products, red meat etc. Non smoker. Yet had BC at 32.
same this time and have it again at 56 different breast.
They say knowledge is power, but in my case, I personally long for the days of my ignorant bliss I was in years ago about breast cancer. Funny I've seen the word vigilant a lot in this thread. That's what my MO put on my final report after surgery this time. That though I had a good response to neoadjuvant chemo , clear margins etc, they will watch me closely and be vigilant with follow up.
My docs years ago were vigilant until the 5 year mark. Then it was as if I never had cancer at all. I'm the one that remained vigilant over the years.
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I have an MO that docs all call "brilliant." She's never letting me go. She considers me high risk and we won't be doing 1 x a year for what sounds like 8 years. Then it's 1 x a year for life. My bs is another one that is a lifer since I had BMX. First 5 years is 2 x a year then it's 1 x a year for life. Them and my pcp are lifers.
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Right now my MO is seeing me every 4 months. I think he'll move me to every 6 months eventually. He never mentioned once a year but who knows. My BS since I had the prophylactic mx on my remaining breast may end up either seeing me annually or not at all. I have to see once I am healed from this surgery. I know she considers me one of her high risk patients because of the nodes, lvi and my genetic mutation. She said mx cuts my risks by a lot.
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Is it so easy for other cancers to recur? Or it's BC's special characteristics? I feel I don't hear about people "battling" and be vigilant about other types of cancer for such a long time.
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I wonder the same thing. I always thought breast cancer was very treatable--not as good as say, thyroid cancer, but definitely the kind of cancer, if caught early, did not kill you. Reading this site has taught me different, and to be honest, scared the hell out of me. I do, however, understand that this site is not representative of the breast cancer population as a whole.
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My MO still sees me every 3 months since I finished chemo which was Feb 2015. Normal blood work done then he sees me for as long as I need to talk ask questions vent. Periodically he exams my remaining boob. Had an mx on the cancer side. This is all at my request. He wanted to go to 4 then 6 months but I am not ready for that. Psychological I guess.
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Many other cancers don't have a particularly high survival rate, even at five years, so the issue of recurrence may not arise for many, sadly. You don't see people talking about survivorship plans for those with pancreatic cancer or liver cancer, for example. However, my understanding is that for those who do survive beyond the five year mark, the chance of recurrence still exists but is not as common as it is, say, with many breast cancers.
The whole notion that 'after 5-years NED you're good for life' is not accurate and arose from methods of quantifying survival rates rather than indicating lifelong cure. At least, that's how I understand it.
As to Kathy's impression (a very common one) that breast cancer was very treatable and did not kill if caught early - I attribute much of that to the whole pink business of portraying survivors of breast cancer in the most glowing terms and rarely addressing the fact that it DOES kill. Even before I was dx I had lost friends and relatives to breast cancer but many people don't see that happening around them or simply assume it was found "too late" for them to be treated successfully.
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Some cancers are effectively cured if they don't recur in the first 5 years. According to the article I linked below Stage I BC could be one of them. However in other BC types, particularly ER+, there is a potentially long dormancy phase. Somehow cancer cells can remain dormant and then wake up decades after the initial treatment.
Prognosis for patients with cancer generally improved with each year survived. The good news is that it improves for patients with most tumour types. Patients with colorectal cancer, cutaneous melanoma or stage I breast cancer exhibited hardly any excess mortality after 3–15 years, whereas for patients with other tumours survival remained poorer than for the general population. Insight into conditional survival is especially useful for (ex)patients, who may use this information to plan their remaining life.
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I do understand the pink-washing, but isn't that also a result of the fact that there are so many long term survivors out there? I think the general public does not understand our long term risk (as I did not) but the reality is that there are many many survivors of this, particularly those caught early-stage.
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I have to jump in here! Being caught "early" makes no difference in mortality. You could find a very, very aggressive breast cancer "early" and not have a chance in hell of making it to 5 years. My first cancer was certainly caught "early" and yet here I am!
I am now stage IV and won't see my MO until I get a symptom. There is no point in my case. I was seeing an onc every year until 5 years out and then every 6 MONTHS. The chance for recurrence increased the longer I was out. My cancer is ER+ which can be slow growing so I had to be more vigilant after the 5 year mark. Glad I was.
Now, as my onc said, it's just waiting to see where it will land next. We will only do scans with symptoms. Having said that, though, this year I've had 2 CT scans, a bone scan and multiple ultrasounds. They do move me to the front of the line when something seems wrong. I can't get an MRI due to a pacemaker which is frustrating for my team. One onc wanted me to get the pacemaker out, have the MRI and then put the pacemaker back in!! Nowadays you can get a pacemaker that can go through an MRI. I called my brand and spoke to someone who confirmed I could NOT go through an MRI...sigh.
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MyBIL has a slow growing lymphoma. He's recurred twice but beats it back and goes on. They call it remission because it's incurable.
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Barbe158... Everyone makes it sound like being ER+ is a blessing that you get the hormonal drug to take which they say is your biggest bang for your buck. Mine was grade 3 so naturally I am concerned. Did you have chemo and what led to you stage IV diagnosis ?
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"They call it remission because it's incurable." They used to have the same term for bc, but changed it to NED. Sounds better, for sure.
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"Being caught "early" makes no difference in mortality"
That is flat out wrong.
The fallacy is that catching breast cancer early guarantees survival. It doesn't. But it does give you better odds.
Of course anyone of any stage can develop mets. But the risk of developing mets is lower for those who are early stage than it is for those who have a more advanced diagnosis. Yes, there is some overlap - a Stage I woman with a particularly aggressive pathology might have a higher risk than a Stage II woman with an indolent pathology - but as a general rule and for most women, the earlier her breast cancer was caught, the lower her risk of mets.
Barbe, with your original diagnosis, your risk of mets was relatively low - but it was far from zero, particularly because you had micromets in your nodes, which is unusual for a papillary breast cancer and therefore may be indicative of an aggressive cancer. You unfortunately landed on the wrong side of those odds. As you have pointed out in earlier posts, and as I remember well from when you first arrived here and talked about your treatment plan (a BMX only), you fell through the cracks when your doctor became ill and as a result, you were under-treated. There is no way to know if chemo and/or hormone therapy would have made a difference, but by not having the appropriate treatments for your diagnosis, your odds unfortunately were worsened - probably more equivalent to Stage II (which, as I recall from your posts at the time, was actually your diagnosis, since back in 2008, any nodal involvement, even micromets, automatically moved someone to Stage II; Stage IB for those with nodal micromets only came into being around 2011. Additionally, as I recall, in 2008, Stage II almost always meant chemo.). All that to say that your situation perhaps was not as much against the odds as it might seem, since your risk might have been considerably higher than you thought.
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Beesie, you've supported my statement by saying "The fallacy is that catching breast cancer early guarantees survival. It doesn't. But it does give you better odds." Thank you for that. I know you wanted to sound like my statement was "flat out wrong" but your statement actually corroborates mine! And thank you for agreeing that I was "under-treated". Yet another "early detected" breast cancer not being taken seriously enough.
ThinkingPositive, I was one of the "lucky ones" who's cancer was caught "early". So no Tamoxifen, no chemo and no rads! Early detection saves lives, right??? I had a double mast only and didn't even see an oncologist until I was 9 months out due to people on this board saying that my surgeon wasn't the one to decide my "treatment" plan. He had said to me to "save the big guns for next time". I thought he knew what he was doing and he didn't send me on to an oncologist. I learned so much from this Forum.
We can talk about this until the cows come home (what does that mean anyway????) but it will just keep going in the same circle it's been going in since I joined this Forum in 2008. Some people swear by statistics and others don't. No one has that crystal ball to be able to tell us what to do and when to stop doing it.
Only He knows and He ain't telling. Life happens while you're making other plans.
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Bessie
Thank you for that post...breast cancer caught earlier is better, the stats prove it. It does not guarantee a cure like you said but unfortunately, this is what the public believes. I do think because BC is the most common cancer in women and there are a lot of survivors (or NEDvivors !) Due the sheer number of diagnosis, the general population probably only has first hand experience with early stage BC that has not recurred. I have personally have known 3 people who died of BC but I don't think that's the norm, I always hear "my grandmother., aunt, colleague etc etc..had it and she's fine! so if in your life this is your experience then you are oblivious to the reality of BC/Recurrence etc (wish I was one of them!)
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