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Topic: BCO Podcast: Characteristics of Early-Stage BC

Forum: Stage II Breast Cancer — Meet, share and support others with Stage II Breast Cancer

Posted on: Oct 30, 2019 11:24AM - edited Nov 5, 2019 12:14PM by Moderators

Moderators wrote:

Characteristics of Early-Stage Breast Cancer That Make It More Likely to Come Back

October 25, 2019

Shah chirag

Dr. Chirag Shah is a radiation oncologist and director of clinical research for the department of radiation oncology at the Cleveland Clinic. Dr. Shah received his bachelor's degree from Youngstown State University and his medical degree from Northeast Ohio Medical University. He completed his internship and residency at William Beaumont Hospital from 2007 to 2012 and joined the Cleveland Clinic Staff in 2015. Dr. Shah serves as a reviewer for various medical journals and is a member of various medical societies. His primary research interests are breast cancer, sarcoma, prostate cancer, lymphoma, and innovative radiation treatment schedules as well as lymphedema. He has participated in numerous clinical trials.

In this podcast, Dr. Shah talks about specific characteristics of early-stage breast cancer that make the cancer more likely to come back, which doctors call recurrence, as well as what can be done to lower that risk.

Listen to the podcast to hear Dr. Shah discuss:

  • the difference between local/regional recurrence and metastatic/distant recurrence
  • the characteristics of early-stage breast cancer that make the risk of recurrence higher
  • steps people can take to reduce their risk of breast cancer recurrence

Running time: 15:28

Edited to make changes consistent with main site edits and add:

Editor's note: Please know that Dr. Shah does point out that more research is needed on how diet, alcohol use, and smoking affect recurrence risk because current data are inconsistent. His ultimate point is that a survivorship care plan, which includes monitoring, is the most important tool we have beyond following your treatment plan to reduce the risk of recurrence. A survivorship care plan includes:
• monitoring for and managing long-term physical and emotional side effects
• guidance about diet, exercise, and health-promoting activities
• resources to help with financial and insurance issues
• surveillance

Listen now or read the transcript.
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Nov 1, 2019 06:38AM sbelizabeth wrote:

There doesn't seem to be anything new here, as far as "steps people can take to reduce their risk of recurrence." Be compliant with your anti-estrogen therapy and stay vigilant for signs/symptoms of recurrence or mets. Be followed by an oncologist or surgeon.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Nov 1, 2019 07:55AM berries wrote:

Since you're so far out from your diagnosis, anything special you have done?? :)

Dx 8/6/2019, DCIS/IDC, Left, 5cm, Stage IB, Grade 1, 4/4 nodes, ER+/PR+, HER2- Surgery 9/18/2019 Mastectomy: Left; Reconstruction (right) Chemotherapy 10/24/2019 AC + T (Taxol) Surgery 2/17/2020 Reconstruction (left): Silicone implant Radiation Therapy 3/31/2020 Whole-breast: Breast, Lymph nodes Chemotherapy 4/30/2020 Xeloda (capecitabine) Hormonal Therapy 5/8/2020 Arimidex (anastrozole)
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Nov 1, 2019 05:08PM Hopeful82014 wrote:

I agree, sbelizabeth. This:

"Jamie DePolo: Ok, and it sounds like, from what you said, having a survivorship plan that includes monitoring of breast cancer recurrence is really the most important thing to reduce the risk of recurrence? Is that fair to say?

Dr. Chirag Shah: I would say absolutely, yeah. Being vigilant and making sure you're following up and being surveilled for any recurrence is very important in my opinion."

Plus the advice to remain compliant with endocrine therapy was pretty much the gist of the advice re: lowering risk of recurrence - and I don't see that watching for recurrence equates to reducing the RISK of recurrence.

Being that most oncologists downplay the need for surveillance (other than mammograms, maybe US and MRI if dense) and that the majority of breast cancer survivors do NOT have a survivorship plan, that leaves darn little other than staying on therapy - which we already know we need to do.

In some ways, I wish these experts would come right out and acknowledge how little they have to offer us in terms of reducing recurrence risks. I'm at 5+ years on femara, 100% compliant. BMI of 20, work out 5 days a week, don't drink or smoke. Quit nattering at all of us about "lifestyle changes" and give us something concrete, (in addition to endocrine therapy) please. Or just admit you can't help us.

(I appreciate what BCO is trying to do here, but there's not much there, there.)

Dx IDC
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Nov 1, 2019 05:14PM - edited Nov 1, 2019 05:16PM by Scrafgal

I agree...I was disappointed with this podcast...monitoring for recurrence in NOT lowering the risk!

Dx 12/2016, IDC, Right, 4cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2- Surgery 2/6/2017 Mastectomy: Right; Reconstruction (right): Silicone implant, Tissue expander placement Chemotherapy 3/22/2017 Taxol (paclitaxel) Chemotherapy 6/15/2017 FAC Hormonal Therapy 9/25/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 10/13/2017 Reconstruction (right): Fat grafting, Silicone implant Surgery 5/9/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting Surgery 10/16/2018 Reconstruction (right): Nipple tattoo Surgery 5/9/2019 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting Hormonal Therapy 7/23/2019 Arimidex (anastrozole) Surgery 9/6/2019 Reconstruction (right): Nipple tattoo
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Nov 1, 2019 05:32PM - edited Nov 1, 2019 05:33PM by Beesie

Monitoring for recurrence to lower risk? It's kind of like saying that mammograms prevent breast cancer, which unfortunately too many people believe.

Uh, no.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 1, 2019 09:09PM ShetlandPony wrote:

Yes, I caught that too and was kind of disgusted that the interviewer, who ought to know better, would say that. Knocking my head on the wall here.


2011 Stage I ILC 1.5cm grade1 ITCs sn Lumpectomy,radiation,tamoxifen. 2014 Stage IV ILC mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD
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Nov 2, 2019 03:30PM Cowgirl13 wrote:

Just what we need....not. Another thing to scare those who are newly diagnosed.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/18/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Nov 2, 2019 04:00PM MountainMia wrote:

It was a terrible interview. I'll pile on with comments like the others: nothing new here; monitoring does NOT reduce risk. And for those of us with triple negative, we got NOTHING.

The rain comes and the rain goes, but the mountain remains. I am the mountain.
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Nov 2, 2019 04:01PM MountainMia wrote:

Oh, one more thing, the only thing expressed for increased risk is being "younger." Younger than WHAT? Have you done studies that show age grouping for risk? Is there a way a younger person can get to be OLDER, so they can reduce their risk?? Again, not helpful.

The rain comes and the rain goes, but the mountain remains. I am the mountain.
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Nov 3, 2019 04:32PM Euphoriaa wrote:

MountainMia: Antihormonals work very well to make we older ... :( Hopefully they will work just as well to prevent recurrences

Dx 9/24/2018, IDC, Left, 3cm, Stage IIA, Grade 1, 1/8 nodes, ER+/PR+, HER2- (IHC) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Chemotherapy AC + T (Taxol) Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Nov 5, 2019 12:18PM Moderators wrote:

Thank you all for your helpful feedback. We have made edits to the Podcast page to reflect your concerns and have added the following:

Editor's note: Please know that Dr. Shah does point out that more research is needed on how diet, alcohol use, and smoking affect recurrence risk because current data are inconsistent. His ultimate point is that a survivorship care plan, which includes monitoring, is the most important tool we have beyond following your treatment plan to reduce the risk of recurrence. A survivorship care plan includes:
• monitoring for and managing long-term physical and emotional side effects
• guidance about diet, exercise, and health-promoting activities
• resources to help with financial and insurance issues
• surveillance

To send a Private Message to the Mods: community.breastcancer.org/mem...
Log in to post a reply

Nov 6, 2019 10:34AM sbelizabeth wrote:

Let's get specific. Is there new information to tell us how to decrease the risk of breast cancer ever coming back, either locally or in distant mets?

Those of us here who are Stage 1 - 3 are hoping to never deal with breast cancer again. An article with "REDUCE THE RISK OF RECURRENCE" is simply click-bait unless there's solid data that indicates "diet, exercise, and health-promoting activities" can help keep any stray cancer cells locked in the dungeon.

Yes, all the factors described are important factors to a survivorship care plan. Live healthy, live longer (maybe). No new news.

Not to draw too fine a line, but a survivorship plan does not reduce the risk of recurrence.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Nov 6, 2019 12:40PM - edited Nov 6, 2019 12:41PM by ShetlandPony

I believe there is a lifestyle factor with pretty good evidence to show it is helpful, and that is exercise. It seems everyone wants to talk about diet instead.

(Sorry, I can’t hunt down the citations right now.)

2011 Stage I ILC 1.5cm grade1 ITCs sn Lumpectomy,radiation,tamoxifen. 2014 Stage IV ILC mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD

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