Will 30% of Early Stage (1-IIIA) go on to metastasize??
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I think this nuance has been mentioned many times, but in case some people have not read through the entire thread, I thought it important to reiterate that the recurrence risk tails off dramatically beyond the 5-year benchmark for ER-negative bc. However, ER positive has a persistent risk of late recurrence, even after five years of hormone therapy, and from my readings, those long term statistics are less reliable. There are many studies that affirm this (and many newer ones), but here one: http://ascopubs.org/doi/full/10.1200/jco.2011.40.1...
And there are many other disease variables: "Predictors of early recurrence of ER-positive breast cancer among women receiving endocrine therapy include larger tumor stage and positive nodal status, lower levels of hormone-receptor expression, higher grade and proliferative markers, human epidermal growth factor receptor 2 overexpression, and high recurrence scores on multigene arrays.5–8 Not coincidentally, these are clinical factors that are likely to confer benefit from adjuvant chemotherapy. By contrast, predictors of late recurrence are not well characterized, although nodal involvement and lobular histology are associated with greater risk of relapse after 5 years of endocrine therapy9–11."
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Such a shame that such misinformation is out there. ER+ vs ER- and this magical 5 year thing that is old nowadays. I feel bad for people who don't find this board to keep up.
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Bosum, my own onc tried to tell me some such, and after he got a piece of my mind, in rather spicy American (yeah, I swear at my onc when warranted), he sheepishly admitted that I had a point. It turned out that the patient just before me had been there with mets that showed up 10 years after an early stage DX.
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One lady I met at a talk was NED for 31 years, thinking cured at stage 1 only to now have a recurrence at the age of 77.
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New York Times Oct 1, 2017
http://www.nytimes.com/health/guides/disease/breas...
Recurrent Breast Cancer
Check under treatment on the left hand side.
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Thanks marijen for posting that link.
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You are welcome! I don't read the NYTimes but I was searching for Stage II recurrence. Did you see that most recur in the first two or three years according to that article?
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New MRI contrast agent differentiates between aggressive and slow-growing breast cancers
September 25, 2017A new magnetic resonance imaging (MRI) contrast agent being tested by researchers at Case Western Reserve University not only pinpoints breast cancers at early stages but differentiates between aggressive and slow-growing types.
"Doing both will help doctors find the right treatment," said Zheng-Rong Lu, the M. Frank Rudy and Margaret Dormiter Rudy Professor of Biomedical Engineering at Case Western Reserve and leader of the research. "There's no such technology available now that we know of."
The gadolinium-based agent is also more efficient and safer than traditional agents, requiring a gadolinium dose 20-times smaller, easily flushing from the body and leaving no accumulation in tissues, the researchers found in tests with mouse models.
At the low dosage, the agent lights up cancer biomarkers during scans, overcoming the low sensitivity of MRI's for imaging the markers. The research was published today (Sept. 25) in Nature Communications.
To make the agent, Lu and colleagues at Case Western Reserve combined commercially available tri-gadolinium nitride metallofullerene (Gd3N@C80), a highly efficient contrast agent, with a peptide labeled ZD2, which was developed in Lu's lab.
Compared to the gadolinium used in traditional agents, Gd3N@C80's "structure is different-;the gadolinium ions are encaged in a hollow molecule of fullerene that looks like a soccer ball," Lu said. "The cage prevents direct contact between the gadolinium and tissue, and the gadolinium will not be released, which prevents any kind of interaction with tissue."
"But the key technology for our targeted contrast agent is the peptide attached," Lu said.
The lab applies ZD2 to the surface of the soccer ball. The peptide specifically targets the cancer protein extradomain-B fibronectin (EDB-FN). EDB-FN, which is associated with tumor invasion, metastasis and drug resistance, is highly expressed in the matrix around cancerous cells in many aggressive forms of human cancers.
In testing on six mouse models, MRI's detected breast cancers in all cases. But the signal created by the accumulation of contrast molecules on three aggressive triple-negative breast cancers (MDA-MB-231, Hs578T and BT549) were significantly brighter. Because slow-moving ER-positive breast cancers (MCF-7, ZR-75-1 and T47D) produce less EDB-FN, fewer molecules attached. While detectible, the signal was muted.
Coauthors of the study are biomedical engineering PhD students Zheng Han and Xiaohui Wu, research assistant Sarah Roelle and undergraduate student Chuheng Chen; and William Schiemann, the Goodman-Blum Professor of Cancer Research at the Case Comprehensive Cancer Center.
Lu's lab is now investigating ways to reduce the cost of producing the agent to make it more attractive for clinical use.
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My DCIS with BMX recurred in exactly 2 years as IDC. Unfortunately I'm not ER/PR positive so no continuing treatment options. But I AM HER2+ so I did Herceptin for a year. Moving ahead and trying to believe "we got it" the second time. Glad to be NED most days.
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Researchers identify new genetic test to help predict cancer recurrence
September 21, 2017
Researchers have discovered a new genetic test which could help predict cancer recurrence paving the way for more precise, personalized treatments.
Mitochondrial genes can be routinely checked in biopsies of patients diagnosed with many different cancer types, including breast, lung, ovarian or gastric cancers.
And they prove more accurate than current methods of predicting a patient's response to treatment.
Scientists identified the new measures by looking at the expression levels of mitochondrial genes in samples from posttreatment cancer patients.
"Early detection of cancer recurrence is everything; if we have information about a patient's prognosis we can act much more effectively," said Dr Michael P Lisanti, Professor of Translational Medicine at the University of Salford, and a coauthor of the study.
"You never know if cancer will return or how to prepare for that, so knowing who will and who won't respond well to treatment offers reassurance to doctors, patients and families, and allows a degree of closer monitoring."
Professor Lisanti, who describes mitochondria as "the engine room of cancer stem cells" the cells that cause secondary regrowths (metastasis) looked at more than 400 mitochondrial genes and found many to be more accurate in the prediction of recurrence or metastasis, than standard cell proliferation markers, such as Ki67 or PCNA.
The team used multiple KaplanMeier curves to extrapolate how mitochondrial gene levels correlated with recurrence in hundreds of cancer patients. Certain genes predicted up to 5 times higher rates of recurrence or metastasis. One particularly useful biomarker, namely HSPD1, is associated with mitochondrial biogenesis, the process of making of new mitochondria.
The researchers say using mitochondria biomarkers would enable clinicians to predict with far greater accuracy which patients will respond poorly to drug treatments, such as Tamoxifen, which is commonly administered to prevent disease progression in a subset of breast cancer patients.
They also hugely increase the number of readily available clues to patient prognosis.
"In practical terms, a person in remission could be predicted to be 80% likely to fail treatment," added coauthor Dr Federica Sotgia, at the University's biomedical research center.
"If doctors can predict that a treatment will likely fail, it gives them more positive options; either they can monitor the patient more closely or offer an alternative course of treatment."
The Salford research team recently described how cancer cells exploit the energy of mitochondria to resist drugs like Tamoxifen.
Their latest observations are further evidence that mitochondria are both biomarkers and potential drug targets. Ultimately, they say, the generation of new mitochondria could be controlled with novel therapeutics to more effectively prevent treatment failure.
An estimated twothirds of cancer deaths occur due to recurrence after initial treatment.
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Minus Two I hope you stay NED too.
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SCIENTISTS in Salford, UK, have identified a gene which is 'revving the engine of cancer' against the world's most common breast cancer drug.
For reasons unknown, 50% of patients with breast cancer treated with the estrogen receptor-blocking drug tamoxifen eventually become resistant to the treatment and cancer recurs.
In a paper published this week in the journal Oncotarget, biochemists tested a hypothesis that the mechanism of tamoxifen resistance is related to energy-generating mitochondria in cancer cells.
In doing so, they identified the protein NQ01 as the 'trigger' which determines whether cells would survive tamoxifen or not.
Mitochondrial power surge
Michael P Lisanti, Professor of Translational Medicine in the Biomedical Research Centre at the University of Salford said: "In simple terms, the process of poisoning the cell (with tamoxifen) actually has the opposite effect, stimulating the cancer cells to respond by revving their engines in order to survive."
Lisanti and collaborators Dr Federica Sotgia and Dr Marco Fiorillo tested their idea that cancer cells were fighting against tamoxifen by using their mitochondria – the 'powerhouse of the cell' – that produces all their energy.
In the laboratory they directly compared sensitive cells with tamoxifen-resistant cancer cells, and demonstrated that higher mitochondrial power is what distinguishes a drug-sensitive cell from a resistant cell.
Then they used a combination of protein profiling, genetics and metabolism to identify which genes were necessary to confer tamoxifen-resistance. They observed that by adding just a single gene, NQ01, the cells would survive.
http://www.salford.ac.uk/ April 05, 2017.
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Research News
Statins could be new treatment option in women with oestrogen receptor positive breast cancer
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3108 (Published 02 June 2016)Cite this as: BMJ 2016;353:i3108- Zosia Kmietowicz
- Author affiliations
Researchers have called for clinical trials into the effects of statins in women with recurrent breast cancer, after finding that these cancers can make a molecule from cholesterol that mimics oestrogen.
As many as 40 000 women in the United Kingdom have oestrogen receptor (ER) positive breast cancer diagnosed each year, and many are treated after surgery with tamoxifen or aromatase inhibitors to block the effects of oestrogen and to reduce the risk of recurrent disease. But, even after endocrine treatment, around 12 000 women with ER positive breast cancer have a recurrence.
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I am following this discussion, with a growing sense of doom. Which is kind of funny since I didn't think my doom could get any worse. Been pretty bad lately. But nope, I was wrong, I can feel worse. Am right now.
I realize that I may be confused on a point. Recurrence. What exactly are we saying when we say recurrence? Are we talking about more breast cancer in the same breast? Are we talking about a new and different cancer is the same or other breast? Or are we talking about the breast cancer showing up elsewhere in the body, which is metastasis?
I have read over and over that breast cancer IN THE BREAST does not kill anyone. It's when breast cancer goes traveling through the body that things get serious. Which is metastasis, as I understand the term. Recurrence, to me, means that more or new cancer in the breast.
If I am taking tamoxifen to prevent a recurrence just in my breast, I will be very, very angry at myself for being too stupid to figure that out. I was hoping that the tamoxifen would block ANY AND ALL cancer cells from getting their food supply, no matter where they might be floating around in my body.
These studies ... sometimes I have to throw the switch and quit looking. I want to know the truth. But it seems there is no hard and fast truth in any of this. Just a whole lot of maybes.
I am following this discussion with interest and despair.
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runor, don't give up on the Tamox, it really is appropriate for your ER+/PR+ HER2- diagnosis. It will work to prevent both a local recurrence, which can be treated as the original bc was, and a distant recurrence, known as metastasis. This is not to say that the Tamox will work for everyone, for ever, since with some people the cancer gets around a hormone blocker.
It's easy to despair, but so many people here go a long time and forever on the drug. Look at the stats of people here and you'll see this. So, take heart in the 70% + five year survival rate and understand that your long-term survival odds are very good.
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Sorry Runor, it upsets me too. But we have to look at the information available. I went back to check the study date: April 5, 2017. Traveltext said it better than I could. I am hoping for new treatments to replace the anti-hormonals
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BosomBlues, I get it completely--were they lying or misinformed? Very good question. It was only through googling and reading this board that I discovered that the cells that escape through the blood stream and/or lymph system lie dormant... you know the rest of the story... What were ONJ and Laura Beckland told by their MOs in the early years of their original diagnosis?
My MO in S.F. said my cancer was "curable." My current MO watches me like a hawk with liquid biopsies and other blood tests. Unfortunately, I pay for a lot out of pocket with a high deductible, and the liquid biopsy is not covered. I don't know if I can continue such vigilance beyond 5 years :-(.I try not to dwell on it, but the niggling fear is not far from my conscious mind.
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BosumBlues - They are to determine the number of circulating tumor cells (CTCs), although I don't think the one I get checks for the mitochondrial mutations mentioned on the prior page of this discussion. There are different types (see discussion here: http://www.guardanthealth.com/liquid-biopsy-myths-dispelled/), and to be honest, I am not sure which one I am getting, but it is done through a blood draw. My MO would start treating me with a more powerful drug if he deemed me at risk. For instance, I know my tumor had the PIK3CA mutation, so he might treat me with Everolimus. I am not sure if my liquid biopsy also checks for gene expression mutations.
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runor - I agree with what Traveltext 7 Marijen have posted.
Unfortunately there are so many different breast cancers. I had both breasts removed with clear margins & clean nodes. I was ER/PR negative - no further treatment & no breasts. Then two years later I found a lump under my collar bone. My docs called it "recurrence". The term is used in any number of ways. For me, the supposition is that a micro met escaped before it was excised, but no one really knows.
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My expert BS told me you can't feel a clavicle lymph node, was it a lymph node Minus Two?
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Thank you for sharing the articles, Marijen. Especially having triple negative cancer, I wish I had a better idea on my prognosis. I've spent the last 17 months and thousands of dollars I can ill afford on treatment with five surgeries, chemo and radiation. I now have lymphedema and neuropathy and have no idea if the treatment was effective. It would be very helpful to know in advance whether treatment is likely to be successful. Some patients will still want to pursue every possible treatment, but, as an older, single woman with no children, I would not have done so
Runor, fortunately, the Tamoxifen improves your odds of survival, NOT just the chances that cancer will recur in the breast. I've seen on other threads how understandably distressed you are by your diagnosis. There are no guarantees, but you have so much going in your favor...hormone receptor positive, a moderate grade indicating your cancer isn't super aggressive, negative nodes and your tumor size is a tiny millimeter away from Stage I size. I don't have all your details, but based on some assumptions, your odds of survival are excellent ( http://predict.nhs.uk/predict_v2.0.html ). I think you acknowledged this in another thread, yet I can feel the ongoing anxiety in your notes. Could your oncologist perhaps recommend a therapist to provide you with some coping techniques to help calm your fears? I didn't know this when I was diagnosed, but it's not uncommon for cancer survivors to develop post traumatic stress syndrome. This stupid cancer can affect our quality of life after treatment in many ways and professionals can help, whether it's a lymphedema pump, physical therapy or emotional / mental health support. I know you're currently suffering and hope you'll reach out to your medical team for help.
Lyn
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Marijen - I had a lump just under my collar bone exactly 2 years from my original surgery. You could both see & feel it. Yes, it was determined to be in a lymph node.
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Wish I knew Bosum. Either way, I'm not totally giving up the things I enjoy - like a glass of wine with dinner. My life plan is to do everything in moderation and keep moving forward. (so no more full bottle of wine - LOL)
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I plan on switching to an AI in a few years in hopes of keeping those cells at bay, but if they can produce a test to see if my cancer will be kept at bay with Tamox, I'd welcome that test. The more research the better, IMO
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Thank you VLH for your kind words. Yes I am having a bad time. I feel so stupid. I feel so sucker punched, probably like every other woman who has their life derailed by this diagnosis. I expect with some more time passed I will begin to pull my head out of my ass. But I have to be honest and say that this has really knocked me for a loop.
I am thinking ... (not always a good thing)... that maybe there is some benefit to continuing tamoxifen after 5 years. Maybe dial it back to a 5 mg tablet every other day, or every third day. There are still studies that say lower doses are effective and who knows, maybe it' the OVERdosing (if 20mg is indeed an overdose) that renders tamoxifen ineffective for some people? Maybe a longer time on a lower dose would provide less drug resistance and effective recurrence prevention? But this is just my own thinking and not proven in any way.
I continue to read this thread with interest, continue to massage my arm and walk around with it over my head like a lightning rod, to drain the damn lymph fluid. I take my tamox and try to act normal, as normal as you can waving your arm in the air. Today I ran into a very distinguished and attratcie gentleman friend who wrapped his arms around me and said he had only recently heard, was so very sorry, just KNEW that I was going to be okay but if we were going to have an affair we'd better hurry up since time is of the essence. Hell yeah! So the day wasn't a total loss. (he is very cheeky and works with my darling husband, but a girl can dream....)
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Runor there is a certain way to massage your arm upwards, maybe you know this. If not there are plenty of youtube videos on MLD
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Minus:
I'm there with you. I have decided that I cannot give up my glass of wine or great craft beer. Keeping to one -- 2-3 times a week -- except for vacations when all bets, I'm sorry Cancer God, are off.
And, LOL, this is less than before!!!
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Minus, how big was the lump you felt under your. Collar bone? I hope you don't mind me asking since I have two of them that docs keep telling me not to worry about They are tiny but moveable. Could they just be from the truncal edema I have
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Loving - I don't mind but I can't wrap my mind around the truth anymore. I started to say 'golf ball size' in my previous post, but I think my memory is tricking me and it couldn't have been that big. On the other hand, it was 4.5 cm, which is about 1-3/4". But of course a lot of it was below the surface of the skin. It was a significant lump.
I have truncal & breast LE but I don't know about that causing lumps. My LE didn't really become serious until after chemo & ALND surgery & rads. Below is a great LE reference guide that was written in part by some of our BCO members.
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