Will 30% of Early Stage (1-IIIA) go on to metastasize??
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http://link.springer.com/article/10.1007/s12032-01...
Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies
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As far as the discussion on eating as a reward, etc... a couple strategies: 1. Use a smaller plate. Fill half the plate first with veggies. Then add some of the foods that are your rewards. You still get your reward but have built-in portion control. You can still get seconds, but it takes conscious thought and effort to do so. It may seem silly, but people have done studies where they offer subjects the same buffet of food (all you can eat) and those who are given smaller plates eat significantly less calories. It may also help to have a salad about a half hour before a meal. 2. Keep healthy snacks out. This seems so simple, but working in a fire station, where people bring yummy cookies and treats all the time, it can be a challenge to make healthy snack choices. When that's all that's there, that's what we all grab. Now when there's a counter full of treats, one of us will go and get a bag of baby carrots or some strawberries, blueberries, etc. We put them out on the counter. When we do, that's what we much on throughout the day. It seems so simple, but mindless eating (eating because it's there) can be responsible for a lot of calories. Make the snacks count nutritionally and save the treats for dessert, etc. When you do have dessert, just have a small portion. I still have my brownie for desert, but I choose a small one, and I don't add scoops of ice cream and chocolate syrup to it. 3. Don't drink your calories. Water is free and zero calories. Herbal teas, lemons, in your water, etc can help if you're not much of a water drinker. If you like your soda, etc, then start by substituting a glass of water for the soda (or juice, or whatever) once per day, then twice, etc. Anyway, a bunch of us on my shift have really made an effort to make healthier choices and these are things that have been successful...mostly because they're simple changes to make.
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My PCP says to exercise for health and well-being--but not for weight management. Food intake and (surprisingly) sleep (the hunger hormone ghrelin and the belly-fat-depositing hormone cortisol are both increased by insufficient sleep) account for the lion’s share of weight loss or gain. What exercise does accomplish is to increase aerobic capacity and thus stamina; increase physical strength and improve balance and flexibility; and enhance the immune system. The stronger you are, the better your endurance--and that means the better able you are to deal with side effects of treatments as well as symptoms of disease; and the easier it is to deal with emotional stress as well as resist inflammation. As to strengthening bone, only weight-bearing exercise against gravity will do that: walking (on ground, floor, or treadmill) and upright (not recumbent) cycling and elliptical training. (It had been believed that ballistic--i.e., high-impact such as running, jogging, or jumping--exercise was necessary, but that is not so, to the relief of those with artificial joints who must avoid ballistic exercises lest our prostheses loosen). Water aerobics and swimming, while they are resistance activities, do not operate against the pull of gravity--so while they improve strength and endurance they have no effect on bone.
I am one of those who hate, hate, HATE exercise. The only kind of exercise I ever did that made me look at my watch and exclaim “Damn--I got carried away and now I’m running late” instead of “Can’t I stop yet???” was cross-country skiing (and the weather and snow condition had to be exactly right for that; now that I need to avoid falling or twisting, am older and heavier, and we can’t count on the confluence of good-enough snow and cold-but-not-too-cold weather here in Chicago, that exercise is less available to me. (And Nordic Track, even with a simulation video, is no substitute--the machine in my attic can attest to that). I have very poor balance, thanks to chronic inner-ear problems, so have never been able to ride a bicycle (only a stationary one). I can’t dance--I’m no good at it, even when nobody’s watching, and I get bored with it. So I’m pretty much limited to walking--and pretty much need a destination to motivate me to do it.
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thanks everyone. I've been on vacation so I didn't see the posts earlier till I came home
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BWH & DFCI got money from DoD for the trial/study http://mobile.nytimes.com/2014/05/20/opinion/a-can...
Will ask my MO about this, dosage specifically
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I've been a regular swimmer for decades. Did it stop me from getting breast cancer? No, but I think it may have stopped me from killing a few people who richly deserved it! I've also had high blood pressure since my 20s, despite being really fit and having a great diet. Sometimes you can't outrun your genes.
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Wicked: That's funny!
I think science has discovered quite a lot about why people get sick, but why some people live to be 100 remains baffling. In this morning's NYTimes there is a study reported that loneliness is a better predictor of death than obesity and that Great Britain has made strides to address loneliness as a public health problem. Still so much to parse out in this conversation about BC statistics which have been generated for decades.
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70 Gene Signature as an Aid to Treatment Decisions in Early Stage Breast Cancer
BACKGROUND
The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy.
METHODS
In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher.
RESULTS
A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease.
CONCLUSIONS
Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy.
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SelenaWolff this is what I want to know.... what is considered "early stage" bc? I am 2b with 2/2 lymph nodes positive, Am I considered early stage?
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jdfly - you are considered early stage
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The NCI defines early stage as stage 0 to stage IIIA.
Edited to add: For the discussion in this thread, based on the link in the header, the early stage patients had invasive cancer, so would be stage I-IIIA.
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So me not receiving chemo the first time was logical. Easy to get to 5 years with slow growing ER+ cancer!
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Barbe, I don't think anyone was disputing the chemo or not.. it was more that you didn't take any hormonals. Mammaprint expects low risk people to still take Tamoxifen / AIs... That is what protects us from a potential recurrance.
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Aha! Got it.
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SpecialK, the NCI definition of early stage does include everyone from Stage 0 to Stage IIIA, but for those reading this thread, it's important to point out that the "30% of early stage go on to metastasize" stat includes only those with invasive cancer, Stages I to IIIA, and does not include Stage 0.
Lisey, it's actually quite interesting that based on today's treatment standards, for someone with Barbe's original diagnosis, I believe the recommendation would be that an Oncotype test should be done to determine the benefit of chemo. However in 2008, before the Oncotype test was incorporated into the treatment guidelines, treatment standards would have recommended chemo for anyone with nodal involvement, followed by hormone therapy for those who are ER+.
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you know what is scary? How hard and arbitrary diagnosis is for BC! I know there are other cancers much harder to detect early, but boy, my MO told me that since BC is a slow growing cancer (compared to other kinds) it takes years(!!!!) for the cells to become a detectable mass. I found my lump 11months after my mammogram, and 5years after an MRI which at first detected a suspicious area that needed to be biopsies but on a follow up MRIwasnt found in the same breast. My MO said that more than likely I've had cancer all along. And I can't still wrap my mind around the fact that in less than a year the cells grown into a > 1cm mass. My cancer was multi focal, and the first three spots were identified by US and mammo, whereas the last 2 areas were detected on MRI a week before MX. This is probably the key reason for chemo - to kill the cells before they get reactived and start growing. It requires so much vigilance on our part - to get screened and listen to our bodie
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Yes, BC can be slow growing but when it takes off it can move very fast as many Stage IIIB,C people here know only too well. Ten years before diagnosis, I was sent for mammogram which showed a couple of benign lumps on the left side. Fast forward to age 64, with no annual scans to gauge tumor progression, those lumps went crazy enough to warrant neo-adjuvant chemo, mx, rads, and ht.
I'm now an advocate for BRCA1/2 males to be included in annual breast screening programs from age 50 because we have a one in eight chance of developing the disease. Otherwise our continued later diagnoses means our prognoses are worse as shown in this study.
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I did know there was a chance but didn't know how high the risk is.
I am new to this group. I was diagnosed with Stage 1 breast cancer in 2011. I chose to have a lumpectomy and no further treatment. I refused radiation, though it was highly recommended. They even wanted me to do chemo. Made no sense to me to put myself through either treatments since the cancer had not spread to my lymph nodes.
I have a concern now. I have for several years did monthly breast exams. I never had a mammogram until I found a painful lump in my right breast, near my armpit. Last year, I found a lump in my left breast, which was painful. I had a mammogram and an ultrasound. I was told nothing was there. Yesterday I went for my yearly mammogram. I told them I still had a painful lump in my left breast. The women tells me," You had that looked at last year and there was nothing there and besides, breast cancer lumps are not painful." I told her how wrong she was. The cancer in my right breast was painful. Anyway, after the mammogram and another ultrasound, this time I'm told there is something there but it's nothing to worry about, it's just a cyst.
I'm not sure if I can trust their diagnosis of," just a cyst", since they missed it last year, when it had to have been there then because I could feel it. How do I know it is just a cyst and no cancer? I don't know what I should do. Should I be concerned or just let it go and trust that it's nothing to worry about because this person say's it's a cyst?
I would greatly appreciate feedback as to what others would do.
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PaperDolls, the best lump is a lump in a jar. I'd think with your history they'd pursue it a bit harder. I had to argue from October last year to mid-January of this year on the lump I found that ended up being malignant. I don't mean to frighten you, but you're posting here for a reason. Get a second opinion if need be.
Breast cancer NORMALLY doubles in size every 180 days. So think - one cell, then two, then four, then eight. You can see why it's slow to first appear and then seem to grow so quickly. Obviously there are variants to this "speed"....
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A cyst will be symmetrical, have regular borders, and compress (squish) visibly when pressed on by the ultrasound probe. It will also absorb or reflect sound waves differently from the way a solid tumor would, because it is fluid-filled. That is what my radiologist told and showed me when she did my diagnostic ultrasound last year, and explained that because my mass was painless, irregular in shape and borders, and did not change shape at all when pressed on, it needed to be biopsied. A cyst is likelier to hurt than is a tumor, especially if it’s a sebaceous cyst which is a type of localized infection.
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PaperDolls,
I don't know how old you are, but cysts are very common in women in their 40s, the pre-menopausal years. I am well past that age, but still have a number of cysts. Cysts are the easiest mass to identify with imaging - they have a very distinct appearance on ultrasounds because they are fluid filled. Depending on location, cysts can be painful. So the odds are good that what you have is a cyst - and therefore completely harmless.
It is strange that your cyst was not seen on your ultrasound last year. Therefore as a first step, if you don't already have it, I would suggest that you get a copy of the written report from this year's screening to see how the cyst is identified and defined. The write up should tell you if the appearance is clearly that of a simple cyst (which usually requires no follow-up) or if there is any uncertainty or the possibility of this being a complex cyst (usually benign but should be monitored). The write up should also include the BIRADs rating. With a simple cyst, the rating should be a BIRADS 2. Anything less certain would be a BIRADs 3. (BIRADs 4 indicates the possibility of cancer and the need for a biopsy). You also can get a second opinion by having another professional - another radiologist or perhaps your previous breast surgeon - review the imaging to confirm that all that is visible is a simple cyst.
Normally no action is required for simple cysts. I have several very small simple cysts that have just been left in place - since they are basically just little masses of fluid, over time they often dissolve on their own. If a cyst is very large or painful, as yours is, an aspiration can be done. This is a quick, simple, painless procedure that can be done in the doctor's office. I've had quite a few large cysts aspirated over the years. Since your cyst is painful, I think that asking for an aspiration is a reasonable approach. Assuming that the aspiration is successful - the fluid is removed and the cyst collapses - that will confirm that all you are dealing with is a cyst.
Edited to correct typo (good old auto-correct!).
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when dealing with cysts, I cannot stress enough the importance of having an extremely skilled ultrasound technician and radiologist. I was extremely fortunate to have a second radiologist appointment. The second radiologist was the one who identified my suspicious cyst and biopsied it and determined that I had the very rare, but favorable, mucinous breast cancer. Mucinous is usually missed by mammography, which for patients liked me,with cystic, dense breasts, makes diagnosing difficult, especially when the technician's skills are less than excellent.
For many women, most cysts are worrisome, especially after a breast cancer diagnosis. That said, having a great team should be able to discern when one needs to be concerned and when one need not worry.
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paperdolls, ask your gyn to send you for ultrasound. I have always had dense breast tissue and mammogram isn't always accurate. When I asked for ultrasound last year, my teaching. Hospital breast center said they wouldn't do it without a concern/pain. I truly didn't have anything at the time. So, they just did Mammo. I didn't do MRI because I didn't want to go thru contrast agent injection (not very smart of me). So, I suggest you ask for both. Your prior lumpectomy should be reason enough to get a thorough exam. Good luc
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Barbie....sorry to disagree but your statement that excercise has nothing to do with recurrence is false. There are studies that show its benefits on losing weight and well being. We all know that increased estrogen and weight gain go hand n' hand. Just because someone recurred while excercising does not mean there is no benefit. Unfortunately you can have a recurrence while on recommended treatment plans too. No guareentees :
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smilethrupain, PaperDolls has had an ultrasound. I would expect that's how the cyst was identified, since mammos may show a mass but usually can't distinguish between a solid mass and a fluid-filled cystic mass. Ultrasounds however are generally very good at identifying cysts vs. solids masses.
Given her history of breast cancer, certainly it's important that PaperDolls get confirmation that the mass has the very clear appearance of being a simple cyst, and to eliminate the pain, an aspiration most likely makes sense. But to say again, given that an ultrasound has already been done, odds are high that this is in fact just a cyst. A previous history of breast cancer does not mean the future lumps won't be simple harmless cysts - I certainly know this from experience.
PaperDolls, good luck and let us know how it goes.
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I agree with Beesie about an aspiration. I am pretty sure that is what my doc would do, just to be sure
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dtad losing weight and having a sense of well being doesn't mean you won't recur either. It's easy to blame the patient why they recurred! There are ladies reading this that might think they'll recur If they don't exercise. That's just not true. You could be a triathlete (we had one on the boards once) and still recur.
Not drinking alcohol is another hot topic. But let's not get onto that one!!
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Thank you so much for your feedback. I also have dense breasts. If I understand you correctly, you have been diagnosed in the past with a breast cyst, which turned out to be cancerous?
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I thank you for your response. When I had breast cancer in my right breast in 2011, it was very painful. The pain is what drew my attention to self checking for a lump. I know many people believe that if a lump hurts, it's not cancer. My Mother told me the same thing, while I was waiting for the results of my biopsy. Unfortunately, a cancerous lump can be painful. I don't know how knowledgeable the radiologist was that told me this lump is a cyst. As I said before, I had this same lump and pain in the same breast last year. My Primary Care doctor sent me for a mammogram and an ultrasound. I was told nothing was there. The size of the lump hasn't changed. That's why I'm confused as to why it was missed last year. I plan to request a copy of the films and a CD, to take to my Breast Surgeon for a more knowledgeable diagnosis. It's better to be safe then sorry. If it turns out to be just a cyst and he doesn't believe there's any possibility it could be a cancerous cyst, I'll leave it alone. It helps having others who understand, to talk to and get their opinions.
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I had a cyst near my left armpit that was super painful. The tech said it was a cyst.. and it was a dark hole on the mammogram... so indeed it looked fluid filled. But it hurt every month on my cycle. That's how I knew it was fine.. because it would come back monthly with the pain. I'm still super glad my boobs are gone and I don't have painful cysts to contend with.
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