Breast cancer recurrence: What you should know
When women stop breast cancer treatment early, they take a big risk.
Elyse Caplan remembers it well; that first conversation with her oncologist. She had just been diagnosed with stage IIB breast cancer, and they were discussing the plan for treatment. If her oncologist mentioned “recurrence”, the possibility that her cancer could return, it was lost on her, she says.
“You sit through an hour-long appointment and take notes, but when the doctor says one thing that's very upsetting, you just freeze”, she says. “You're thinking, ‘I'm going to lose my hair. How am I going to tell my boss, my kids?’ You don't hear much after that.”
Yet the risk of breast cancer returning is a critical issue that must be emphasised early on, she says. “The whole goal of treatment is to eradicate the disease and hopefully reduce risk of recurrence”, Caplan tells says. “But I'm not so sure doctors are speaking as directly to that point as they could be.”
It's true that many oncologists don't directly address the subject of recurrence, says Dr Victor Vogel, of the University of Pittsburgh Cancer Institute in the US.
“I don't think we've come up with a good way to talk about it”, Vogel says. “Recurrence is fearsome stuff, disturbing.” No one likes the uncertainty of it, he explains, which patient will have a recurrence, when it will happen, how long we can control it, when they will die from it. “So we hide behind the business at hand, stay busy with the treatments.”
“We've got that one shot to get it right, in that initial treatment, so we focus on that”, Vogel says.
The problem is that some women stop taking breast cancer medication, without realising it raises the risk of the cancer returning. Some are having serious side effects from the medications. Others are feeling fine and don't see the harm of stopping, he explains.
By giving up the treatment, they may put their lives at risk. If a patient completes the treatment, there is significantly less chance of recurrence. “Oncologists need to do a better job of explaining that,” says Vogel. If side effects are the problem, there may be options to provide relief.
There are also lifestyle changes that women can make to either prevent cancer from returning or catch it early if it does, so treatment can begin quickly.
Importance of sticking with the plan
When a woman is first diagnosed with breast cancer, her oncologists analyse the tumour closely, already calculating her recurrence risk, to determine the best plan of attack, explains Dr Mark Pegram, a breast cancer specialist.
More than ever before, today's breast cancer treatment is individualised, tailored to the make-up of each patient's cancer cells, Pegram says. He adds that if a woman has a large tumour that has spread to her lymph nodes, recurrence is more likely than if the tumour is smaller, contained and less aggressive.