Will 30% of Early Stage (1-IIIA) go on to metastasize??
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jo - looks like you're doing the same regime I did - TCHP. But maybe you had your surgery first since you listed the nodes? Hopefully you're about finished with the chemo.
Mstein - if you don't mind sharing, what was the reason for the initial ANA testing? Where are you in the BC process? Are your HER2 positive?
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Hey - just thought I would join in on the subject of inflammation. I have been reading a lot of journal articles as well linking inflammation to not only auto-immune disorders but also diseases like cancer, Alzheimer's, depression, schizophrenia, diabetes, heart disease etc. Researches are really just starting to get the bigger picture of the detrimental, degrading quality of inflammation on the immune system. I have been trying to talk with not only my MO but my GP and my psychiatrist about this. However, they wont test me for inflammation so I will probably end up going private for on going testing as also think it is a good indicator of what is going on. Tumours also increase inflammation in the body. The reason why my docs wont test me is because the science is just at the discovery stage. They are starting to do trials with anti-inflammatories with cancer treatment with some success. For my own health I also eat a low inflammatory diet and I also include Bromelain (pineapple enzymes) to decrease inflammation in my body. Low dose naltrezone also helps your body with auto-immune disorders as well.
Mstein1970 - i would also be concerned as well if your ANA levels keep increasing. You may want to consider full body scanning if you can afford it or get insurance to cover it. Or you may want to include other cancer markers in your blood work to see if you have other elevated levels.
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minustwo- you are correct. I had surgery first before Chemo. So since I had one positive lymph node radiation was recommended after chemo. That's Okay. We do what we have to do to get through this thing. Have a great weekend.
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Solfeo, good to know! I am strangely addicted to chewing fish oil capsules (I love the taste and they are like dissolving gum) I have maybe 4 a day.... maybe my body knows what it needs.
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jo6359, the ANA is a non-specific indicator of inflammation in the body. As Roaming Star says, the medical profession knows still understands very little about its role in cancer, and most doctors still think of it mostly in relation in autoimmune diseases like lupus. Despite my long history of abnormal ANA levels, my medical oncologist refused to order my most recent ANA test for me, saying it was irrelevant. (One of my other doctors ordered it.) But studies clearly show that it is an indicator of inflammation that may be caused by cancer (often before the cancer is diagnosed). And that the inflammation may then create conditions that enable the cancer to spread. Here are links to some studies (I may have copied some links twice)::
http://news.cornell.edu/stories/2013/01/study-find...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44534...!po=47.8022
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867234/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44534...
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Mstein- thanks for all the information about ANA. The next time I see my medical oncologist on May 18th I'm going to discuss it with him. I'm going to read your links also. Thanks.
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I am supposed to get yearly MRIs done as well as part of my overall treatment plan as set up by my surgeon and MO. I was 36 at diagnosis and have extremely dense breasts so they wanted me doing MRIs every year so they can spot any changes right away. What's funny though is that the first MRI I had showed the tumor and that nothing had spread beyond it, so they were going to go ahead with the lumpectomy but the MAMMOGRAM I had at the surgeons office showed calcifications and other things within the breast which is why they opted for the mastectomy instead. I don't think mammograms show lymph nodes and the chest wall obviously, but the calcifications weren't picked up by the MRI.0
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When I was being evaluated I had mammogram which saw something then ultrasound then biopsy and finally mri before the mastectomy. I got my first real piece of good news from mri and mastectomy pathology. My surgeon said my pathology report was really good considering the 2 tumors. Bad news came with oncodx test results of 34.
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I'm a new early stager and was linked to this thread. I found it really interesting and want to thank everyone who provided on-topic, substantive, and thoughtful information.
Others have probably seen this study but I don't think it was linked here yet and it seemed on topic for at least a subset of us (node negative, ER+, Her-). Although it only goes out to ten years, I still found it encouraging.
It's a 2017 Italian retrospective study (with the limitations that entails). They looked at outcomes for women with early stage who got tamoxifen alone versus tamoxifen plus chemo. Overall, the women who got chemo had higher risk factors (makes sense why their doctors would have prescribed chemo).
10 year disease-free survival rate/Overall Survival Rate
- tamoxifen alone (tended to be lower risk): 94.1%/99.4%
- tamoxifen+chemo (tended to be higher risk women): 87.8%/96.9%
- Everybody together: 91.5%/98.3%
They found that the 'best' predictor of higher recurrence was the grade of the tumor.
They said that the chemo used was mostly older technologies, due to the timing, and this shouldn't on its own be taken as an indicator against using the newer more customized chemo regimes for HR+ women. Still, it might make other women like me feel better about avoiding chemo - just because adding chemo feels like doing more, it's not necessarily actually 'throwing the whole book at it' or anything.
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I also want to mention the new staging guidelines. They were revised to make prognostication more consistent, and they might be helpful to women looking to better understand our own risk profiles. I found that my doctors were not at all good about communicating with me the nitty gritty of this.
One thing that was a nice surprise, though it doesn't apply to me personally, is that under the new guidelines, HER+ actually reduces staging. I presume that's because of the efficacy of herceptin.
These are some helpful resources I found, but none of them is a really good 'snapshot' approach so if anyone has that, that would be helpful:
- Small 2018 study: A retrospective prognostic evaluation analysis using the 8th edition of the American Joint Committee on Cancer staging system for breast cancer: Research paper with many charts with survival rates, compares the clinical/anatomic staging to the new pathological staging
- It notes that the anatomic and pathologic staging only matched about 50% of the time. To me that means that if you haven't figured out your pathologic stage according to the new guidelines, it would be helpful to do that and verify if it's the same or different.
- Powerpoint about the need, application and impact of the guidelines
- Powerpoint overview of clinical/anatomic, genomic, and pathological prognostic staging, with charts near the end
- Notes that node negative ER+/HER- tumors 5cm or less with oncotype score under 11 or 'low risk' in other indexes, stage is 1a regardless of other factors.
- AJCC Cancer Staging Manual chapter about new breast cancer staging. Control-f '629' for the beginning of the prognostic staging charts.
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Thank you Salamandra for providing this!!
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Thanks Salamandra! The staging flow charts in one of the power points cleared some things up for me. My stage from my biopsy said 1a, but pathology said 1b. I was node negative, ER/PR+, so definitely 1a.
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I found a study done on Micrometastases cancer cells in the blood and bone. it showed that 33 percent of BC patients in the study had Cancer cells in their blood or Bones, thus the 33 percent chance of Mets. And now we have a BCI test that can determine if the tumor had the ability to send cells out into the blood stream..I was stage1A 0 nodes but I am at high risk for Mets per this new test.
Micrometastases are a small collection of cancercells that have been shed from the original tumor and spread to another part of the body through the blood or lymph nodes. They group together and form a second tumor that's too small to be seen with imaging tests such as a mammogram, MRI, ultrasound, PET, or CT scans.
https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21217
Braun et al found that in patients with early‐stage breast cancer, 31% had micrometastatic disease in the bone marrow, a compartment for cancer progression that will be discussed in more detail below.63
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is that what the BCI test tests for?
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It tell your risk of reacurance (metastasize) and also your need to take AI drugs for 10 years.
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HERB - is this a test that drs only do AFTER the 5 years or do they do at the beginning?
You would think after reading the article that these tests would be run in the BEGINNING so that patients know.
I see my MO this week and will be asking about this test and sharing the article with her.
Thanks.
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Spoonie-please share the information after talking to your MO. Thanks
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I had stage 1a. No node involvement. 9 months after I finished treatment diagnosed with stage iv.
tnbc.0 -
So sorry to hear that, Summerspring. What a kick in the gut. Sending hugs.
Trish
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Since it to determine if you need to take hormone blockers or tamoxifen drugs for 10 years they will do the test as early as year 4 of taking AI or tamoxifen. but it a 2 part test tell your risk of Metatic breaset cancer and your benefit of being on AI or tamoxifen for 10 years.
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yes its crazy knowing that they compared my original tumor's genes of those who ended up with Mets and found me to have the same genetic markers, making me high risk.. Still processing. This is exactly how a stage one Node negative survivor ends up in the 30 percent... and I am in shock that they now have a test for this.
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So sorry to hear ..I know it hard Keep living live large. I am resolved to not shut down knowing im at high risk myself. and I have lost friends already and saw their struggles, so I know whats in store if it comes back.... What did they put you on?
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here is the best information on Stage one node negative findings...
Greater than 50% of recurrences in estrogen receptor-positive (ER+) breast cancer occur after 5 years of adjuvant endocrine therapy. Biomarkers capable of improving the risk-benefit of extended adjuvant endocrine therapy for these late recurrences would be clinically valuable. We compared the prognostic ability of the Breast Cancer Index (BCI), Oncotype DX Recurrence Score (RS) and IHC4 for both early and late recurrence among patients with ER+, node negative (N0) disease within the ATAC clinical trial.
While all three biomarkers predicted for early DR, BCI-L was the only significant prognostic for risk of late DR. The three BCI-L groups identified two risk populations for both early and late DR with 84% (556/665) of patients having low risk for early DR, and a smaller population (39%, 230/596) having high risk for late DR who may benefit from extended endocrine or other therapy.
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How is BCI tested? They told me I have poor prognosis due to high grade, high Ki67 and lots of nodes involved.
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The BCI test is done on your original tumor at the 5 year mark after diagnosis, although I suppose it could be done sooner. Check with your doctor.
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Lala - I spoke with my MO this week about the BCI test. It's definitely only done after 5 years of therapy. Her thoughts were best summed up as it's a very good test but there are certain exceptions where it doesn't give very definitive answers. Sort of like grey areas and giving you info that you're not able to act on for x y z reasons (these went over my head). She will definitely run this after my 5 year mark.
Unfortunately I had so many other more important, pressing questions that I didn't get around to asking why they do not run it in the beginning. Maybe someone else will be able to get that answer. Although obviously we know it's one of the main determining factors about assessing whether 5 more years is effective for patients. There could be other reasons they wait. IDK.
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Anna, this website has a page with BCI description: BCI
The test has some prognostic value but only if there was no cancer in your lymph nodes, so not something we stage III gals can rely upon.
I personally would have questions about the reliability for making clinical decisions in lower stages too.
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The site does state that the test has been validated for up to three nodes positive, based on two studies involving 1700 cases.
I don't know that I'd feel comfortable relying on that but it is something I'll discuss with my MO later this year.
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Hopeful, I agree it is information to take into consideration. Don't put too much into the result.
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I had the opportunity a couple of years ago to informally consult with 2 of the top oncologists specializing in BC and one of the questions I asked was how reliable the BCI test was. Both said they felt it was one the more accurate tests out there in the toolbox....to the point of being accurate within .0001%! I don't know why or how they came up with that but I trust the experience of both. Doesn't work too well in my favor since I was High Risk for Recurrence/Low Benefit from continuing therapy but all their advice for future health was very helpful and eased my mind.
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Lala, could you please share that advice? Anything else besides BMI, exercise, and sleep? Iam curious if they said anything about diet and alcohol. Lillie Shockney (John Hopkins ask an expert) has recently come out and said no alcohol at all and I am wondering what oncologists are saying.
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