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

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  • rah2464
    rah2464 Member Posts: 1,192
    edited January 2021
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    What a wonderful discussion. I can vaguely remember when I was in the decision making process over single or double mastectomy for what we then thought was DCIS. At that point, I didn't have this information, I was reacting to having dense breast tissue that was hard to image and hiding the little monster. This data is so valuable for us to understand. Beesie we need a risk primer boiled down in easy speak for those newly diagnosed (hint hint)

  • summerangel
    summerangel Member Posts: 182
    edited January 2021
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    I just want to point out that there are more than two choices here. You can bury your head in the sand and assume you're cured. You can wait, often with anxiety or depression, thinking that the cancer will eventually come back to get you. You can also be well-informed and aware of your personal risk and still skip off into the sunset and enjoy your life as it is, knowing that life is wonderful and there's no reason to ruin it by worrying about what might happen. I'm sure there are other options as well. I think that some of this probably isn't a choice, as personalities are different, but it's very possible to be happy and positive and not ignorant of the risks of recurrence.

  • melissadallas
    melissadallas Member Posts: 929
    edited January 2021
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    And, as Beesie has repeatedly tried to point out, there is a big difference in this (outdated) statistic if you were Stage 1a vs. Stage 3

  • ctmbsikia
    ctmbsikia Member Posts: 757
    edited January 2021
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    I have also been following this discussion for awhile, and want thank you for the information. You guys are truly amazing!

    It is hard to believe just over 3 years ago I knew nothing, zero, even with a sister diagnosed at 50 in 2014. I was busy living life and also care taking of our dear mother. I followed along with sister's surgery, radiation, and later her MO ordered a bone scan which revealed a few bone mets.

    Now, I am one who chooses to be informed. I know my odds aren't zero as much as I want them to be. It does take a little time to get used to this reality all while going forward- which to me is the only way one should go.

  • cowgirl13
    cowgirl13 Member Posts: 778
    edited January 2021
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    Beesie, I always appreciate your posts and I have for years. Thank you.

  • nola70115
    nola70115 Member Posts: 61
    edited February 2021
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    I’m just feeling f’ing ripped off. My tumor was 2.1 cm so barely into stage 2, with clean margins and no lymph node involvement. I took the nuclear option of BMX followed by chemo, because I was only 40 and wanted to minimize risk. I have taken tamoxifen every day. After 5 years my onc said the risk of recurrence was very low. I had all those stats with the happy 5 year survival rates. My onc never even sent me for imaging or routine blood tests because I’d had a BMX what was there to image? I adopted a baby at 45. I felt safe.

    Now I’ve got a toddler and a lump under my arm and I’m reading that my risk didn’t really go down after five years, it actually went up because I was hr/pr+ and her-. What the hell why weren’t they at least giving me ultrasounds all this time? The lump could be something else, I’ve been having issues with my implants, but I’d really like to have been watched more carefully. I just applied for life insurance last month because I’m finally eligible again and I’m scared I’ll be denied.

  • moth
    moth Member Posts: 3,293
    edited February 2021
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    Nola, I hope you'll start a new thread & let us know what is happening with your armpit lump & where you're at with getting it diagnosed.

  • recoveringbelle
    recoveringbelle Member Posts: 23
    edited July 2023
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    2021 https://www.nature.com/articles/s41416-020-01161-4

    Based on this excellent thread, I started following up on the earlier and then subsequent studies and found this 2021 study, cited above . They refer to the 2005 study about 30% mets in their analysis and provide a helpful citation to another study (2018), cited below, that softens the 2005 claim.

    2018 https://pubmed.ncbi.nlm.nih.gov/30627694/


    Thanks so much for such an intelligent, heartfelt discussion. This place is a goldmine of information and inspiration.

  • recoveringbelle
    recoveringbelle Member Posts: 23
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    PS: Here's a key excerpt from the 2021 article I mentioned above, proposing an additional model of metastasis—what they refer to as a "parallel" vs a linear model of tumor cell dissemination. It fits w/ a lot of discussion on this thread and to me, rather than promoting a sense of helplessness, will enable much more personalized treatment from the earliest phase as more precise genetic and biologic featuers of tumors are understood.

    Excerpt from 2021  https://www.nature.com/articles/s41416-020-01161-4  :

    "When do tumour cells disseminate? Early versus late dissemination….

    The first step of the metastatic cascade refers to the ability of cancer cells to escape from the primary tumour. In regard to the ‘when’, two different models of metastatic dissemination—linear and parallel—have been proposed33 (Fig. 2.1). The linear model, based on the natural stepwise progression of cancer40 and on the aforementioned correlation between primary tumour size and the risk of relapse,30 surmises that only advanced neoplasms contain enough molecular aberrations to facilitate all of the obligate steps of the metastatic cascade. Accordingly, only fully malignant cancer cells (termed ‘late’ DTCs) can break away from the primary source and give rise to deadly metastases.41 

    The parallel model, by contrast, posits that metastatic dissemination can be a precocious event in tumorigenesis in which incipient tumour cells (termed ‘early’ DTCs) can develop into deadly metastases in parallel with each other and the primary tumour. Accordingly, early DTCs would simultaneously, yet independently, acquire genetic and epigenetic alterations as compared with their tumour of origin, perhaps based on the specific niche-related microenvironments they lodge in ref. 33. This model is supported by a plethora of tumour-growth rate studies asserting that some metastases were too big to have been initiated by late-stage tumours,42,43 as well as by the detection of secondary lesions in patients with cancers of unknown origin.33 Furthermore, DTCs have been detected in the bone marrow of patients with early-stage cancer,44,45,46,47,48,49 wherein their presence did not correlate with tumour stage, subtype, histological grade nor axillary lymph node status.50

    Altogether, these results suggest that the parallel model of cancer cell dissemination is a much more common phenomenon than previously thought (Fig. 2.1). Although more compelling data are needed to elucidate the temporal pattern of DTC spread, the majority of metastatic human neoplasms appear to have already disseminated—albeit without being detected—at the time of diagnosis,51 despite the fact that metastases tend to be associated with larger tumours (as mentioned above30). Thus, both parallel and linear dissemination might occur, even within the same patient. Importantly, despite the fact that both models assume a clonal relationship between primary tumours and metastases, they differ not only in regard to the timing of the emergence of metastasis-prone DTCs (as discussed above), but also in the expected genetic divergence between paired sites—bigger in the case of parallel dissemination, smaller in the case of linear progression.35 Consequently, phenotypic differences that distinguish early and late DTC functions have been reported,45,46,52 the implications of which are discussed later in the text."

  • homemom
    homemom Member Posts: 830
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    You just have to shake your head at why we haven't done more to cure this disease. I only give to Metavivor or institutions like that where all of their money goes to MBC research.

    I was told I had "good guy cancer" in that it responds well to chemo and then I just take a pill. There is also a letter in my chart that states that the longer women with my type of cancer go from initial diagnosis without a recurrence, they are considered "cured".

    I've stayed on the AI for 9 years now because the "longer the better" from my MO

  • herb
    herb Member Posts: 65
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    May 28, 202

    Relationship between tumor size and metastatic site in patients with stage IV breast cancer: A large SEER-based study..... studies are now coming out to show how and where mets occurs. I read a study on size of tumor that metastasized. It was 5mm. Most stage 1a are around 1 cm so 2 times that size. So ablility to tumor metastasis has already occured in nearly all breast cancers by the time they are seen on a scan. https://ascopubs.org/doi/10.1200/JCO.2021.39.15_suppl.e13065#:~:text=At%20the%20same%20time%2C%20the%20results%20indicated%20that%20Luminal%20A,likely%20to%20develop%20liver%20metastasis.

  • kaynotrealname
    kaynotrealname Member Posts: 412
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    Yeah I've read that. Pretty much we all can expect that breast cancer cells have been released in our body. Luckily though metastasis is very inefficient which is why a small portion of us have distant relapse.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,955
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    Yes, it’s important to remember that there are no guarantees and though the overall recurrence rate is too high*, the majority of early stage patients are treated and don’t recur. That 30% is not broken down by stage either. The most difficult part? None of those stats have any predictive value for how an individual will do.
    * Many who’ve been lulled into pretty pink land are shocked to find out recurrences can and do happen even decades after treatment and that while most early stagers don’t recur, a not insignificant subset do. And there seems to be little known rhyme or reason to recurrences. The unpredictability is hugely frustrating, coupled with no cure for stage IV.

  • herb
    herb Member Posts: 65
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    I agree in my local breast cancer group a stage 1a with BMX 9years out has mets now. BTW you're doing great over 10 years mets. This give hope to others. I know 2 ladies in my local group mets with her2 both are 10 years.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,955
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    Thanks herb. Unfortunately, why I have done so well is completely unknown. That may give hope to others but provides no actual help.