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Will 30% of Early Stage (1-IIIA) go on to metastasize??

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  • wised
    wised Member Posts: 184
    edited December 2018

    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.

  • herb
    herb Member Posts: 31
    edited May 2019

    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

  • april1964
    april1964 Member Posts: 153
    edited May 2019

    is that what the BCI test tests for?


  • herb
    herb Member Posts: 31
    edited May 2019

    It tell your risk of reacurance (metastasize) and also your need to take AI drugs for 10 years.


  • Spoonie77
    Spoonie77 Member Posts: 532
    edited May 2019

    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.

  • jo6359
    jo6359 Member Posts: 2,009
    edited May 2019

    Spoonie-please share the information after talking to your MO. Thanks

  • summerspring
    summerspring Member Posts: 14
    edited May 2019

    I had stage 1a. No node involvement. 9 months after I finished treatment diagnosed with stage iv. :( tnbc.

  • trishyla
    trishyla Member Posts: 698
    edited May 2019

    So sorry to hear that, Summerspring. What a kick in the gut. Sending hugs.

    Trish

  • herb
    herb Member Posts: 31
    edited May 2019

    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.

  • herb
    herb Member Posts: 31
    edited May 2019

    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.

  • herb
    herb Member Posts: 31
    edited May 2019

    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?

  • herb
    herb Member Posts: 31
    edited May 2019

    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.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918681/

  • anna-33
    anna-33 Member Posts: 108
    edited May 2019

    How is BCI tested? They told me I have poor prognosis due to high grade, high Ki67 and lots of nodes involved.

  • lala1
    lala1 Member Posts: 974
    edited May 2019

    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.

  • Spoonie77
    Spoonie77 Member Posts: 532
    edited May 2019

    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.

  • muska
    muska Member Posts: 224
    edited May 2019

    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.

  • hopeful82014
    hopeful82014 Member Posts: 887
    edited May 2019

    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.

    https://www.breastcancerindex.com/prognostic-studies

  • meow13
    meow13 Member Posts: 1,363
    edited May 2019

    Hopeful, I agree it is information to take into consideration. Don't put too much into the result.

  • lala1
    lala1 Member Posts: 974
    edited May 2019

    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.

  • peregrinelady
    peregrinelady Member Posts: 416
    edited May 2019

    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.

  • simonerc
    simonerc Member Posts: 151
    edited May 2019

    Hi Peregrinelady,

    My oncologist at Johns Hopkins says no more than 4 glasses of wine a week. 2 glasses max, twice a week were actually his exact words.

  • minustwo
    minustwo Member Posts: 13,001
    edited May 2019

    My oncologist is still saying moderation - in everything

  • lala1
    lala1 Member Posts: 974
    edited May 2019

    Peregrinelady---Both my MO and my BS offered the same advice. They said lose 10 pounds (which still wouldn't put me in normal BMI but pretty close), exercise 5 days a weeks for at least half and hour to 45 minutes ( I do 6 days a week for 45-60 minutes sometimes broken up throughout the day), eat "some" fruits and/or veggies every day, try for 8 hours of sleep in a dark-as-you-can-get-it room which helps with melatonin production and get Vitamin D levels up to good range.

    As to Vit D, my levels were in the 20s as diagnosis despite an outdoor job which my BS attributes to heavy sunscreen use. He'd like it to be closer to the 70s. So he put me on 5000IU daily and I am now at 73. He's completely convinced that low Vit D levels contribute to BC and our increased use of sunscreen is the problem. He doesn't advocate sitting around in the sun of course but taking Vit D supplements.

    As to getting "good" sleep, he advocates keeping a regular bedtime, sleeping in a very dark room (I use a sleep mask) and keeping the temperature low which promotes healthy sleep. I have a fitness watch which tracks and scores my sleep and I can attest to all these tips working very well!

    As to the fruits and veggies, I am a terrible eater of the good stuff! I hate to cook and prefer that all my food come at me through a window! :) But I've gotten better and try to eat at least one big serving of a fruit and veggies every day even if it's nothing more that adding a bunch of lettuce to a sandwich.

    Both of these doctors gave me percentage improvements for these tips. They said if my recurrence put me at about 7-8% then losing 10 pounds would cut that by 20% and exercising daily (ish) would cut that by another 30%. And the fruits and veggies, for me, would give another 20% and the Vit D another 20%. They put it all to paper for me and calculated that I would go from the 7-8% chance to about a 2-3% chance. And that would reduce my odds by more than if I continued on Tamoxifen for another 5 years!! I'll take those odds any day! Now none of this means they would EVER say not to do my 5 years on Tamoxifen. It's just an example of how much lifestyle changes can help with recurrence rates.

    And as a last note, I no longer drink. Even before my diagnosis, I would only drink about half a dozen times a year. I had a total hysterectomy 2 years after BC and drinking makes my hot flashes so bad it's totally not worth it. But my best friend was diagnosed after going through a rough patch and drinking waaaay too much at night. I asked my docs about how that could have affected her diagnosis and they both said they think drinking more than a drink or 2 a couple of nights a week increases your risk by about 30-40%! They don't say quit totally but definitely would rather I didn't drink. So yeah, just another reason for me to not drink. Doesn't mean I'm giving up my chocolate though!! I just make sure it's 72% or greater cocoa just to make me feel a wee bit better for eating it!!

    Sorry this is so long. Hope some of it helps!

  • peregrinelady
    peregrinelady Member Posts: 416
    edited May 2019
    Thanks, guys. Lala, thank you for the detailed answer. I agree about the vitamin D and the advent of sunscreen. I was drinking more than usual when diagnosed and have cut way back, but have considered stopping altogether. Good to hear what other oncologists are saying. Mine gives absolutely no recommendations at all.
  • dtad
    dtad Member Posts: 771
    edited May 2019

    lala1...wow! I refused anti hormone therapy from the start and have always thought that weight loss and exercise reduces recurrence rates by about 40 percent. Now you are telling me that an expert in BC is saying 50 percent! I also have always thought that taking a drug that makes both weight loss and exercise difficult, if not impossible for some, is very contradictory. We all have to make our own informed decisions and I expect that, but this is very enlightening information! Thank you and good luck.

  • vlh
    vlh Member Posts: 766
    edited May 2019

    My oncologist recommends the Mediterranean diet. I think my survivorship plan spoke to alcohol, but at age 65, I don't plan to give up my handful of Sangria Margarita swirls annually so it's a moot point for me.

    Lala1, this statement cracked me up!

    As to the fruits and veggies, I am a terrible eater of the good stuff! I hate to cook and prefer that all my food come at me through a window!

    Hey, I usually get a fruit cup at the Chick-fil-A or Jason's Deli drive-through lane. Doesn't that cancel out any bad mojo? 🤔

    Seriously though, I wonder how those who were already living a super healthy lifestyle feel about information seeming to suggest that diet and exercise is a panacea? Not that anyone "deserves" cancer, but it must be especially frustrating to get it under those circumstances.

    Lyn

  • Artista964
    Artista964 Member Posts: 376
    edited May 2019

    yeah. There is no magic bullet. I know some big time exercisers who eat healthy mets. Blows my mind. It's a crapshoot bottom line.

  • jo6359
    jo6359 Member Posts: 2,009
    edited May 2019

    rosabella- I turned 60 this past March. My whole life I've eaten healthy/no meat, avid runner, minimal alcohol and never had any issues with weight. I don't even like sweets. Therefore when I was diagnosed there really wasn't much I could change with my lifestyle. I was already doing everything that was recommended. I live the same lifestyle as I did prior to being diagnosed with cancer. My oncologist encourage me to have one glass of wine per evening. I don't even do that. I have a glass of wine when I feel like it. which is infrequent. I do believe being in excellent health helped me deal with my double mastectomy, chemo and h&p for a year. I worked through chemo and I power walk or ran almost every single evening. Within 8 days post BMX, I tied my drainage tubes to my oversized shirt and started walking. My oncologist encouraged me to power walk and start running as soon as I felt like it. Iran a 5K 6 weeks post op and the day after my second chemo I'm not Superwoman. Exercise keeps me sane. There were days I had to give myself a very stern talk to get off my ass and get moving. I had no issues with radiation. I do not lecture others about making drastic changes to their lifestyle because people are going to do what they're going to do. Dealing with cancer is Tough Enough. My Lifestyle works for me and hopefully each of you will find a balance that works for you. What I find very annoying is when acquaintances feel that they have to search for a reason as to why I would have cancer. There have been a few individuals who have told me, see. You've done everything right and you still have cancer. I've LED my life exactly the way I wanted to with plenty of mistakes along the way. It's easy for individuals to sort of blame others for their cancers. They must have drank too much, smoke, overweight, never exercised, etc. It really scares the hell out of healthy people when they find out I have cancer. I have always been the poster child for healthy living . My friends look at it if I can get cancer so can they. Reality check we all can get cancer . Sometimes it is just a bad hand. Most of the time I deal with stupid comments with patience and education. There are moments when I just look at them and say get real.

  • KBeee
    KBeee Member Posts: 695
    edited May 2019

    jo..... I am in the same boat. I eat healthy, am thin, exercise daily (did a half marathon during chemo...albeit a slow one), and still got BC...twice. We do all we can to reduce our risk, but many things come into play, and sometimes things just are the way they are. I also recovered from surgery quickly, and had an "easy" time with chemo. I don't know if it was lifestyle or luck, but I know the lifestyle surely didn't hurt!

  • ShetlandPony
    ShetlandPony Member Posts: 3,063
    edited May 2019

    My point of view is that living healthy can possibly give us an edge in avoiding cancer or in dealing with it if we get it. But it can’t overcome genetics. I think that many bc patients, especially the premenopausal ones, do have something genetic going on, even it it is unknown at this time.