Surviving Breast Cancer Recurrence: A Comprehensive Guide

Every breast cancer patient and those supporting them face the daunting question: Can you survive breast cancer recurrence? This article provides a detailed guide to understanding, managing, and treating breast cancer recurrence, with the aim of improving patient outcomes and quality of life.

What Do We Mean by Recurrence?

Recurrence of cancer, particularly breast cancer, can manifest in different ways, depending on the individual:

Local Recurrence: This occurs when the cancer returns in the breast, specifically in the original breast or the chest wall area, which is left after a lumpectomy or mastectomy. Patients often feel lumps or nodules under the skin. Regional Recurrence: This refers to cancer cells spreading to the lymph nodes in the armpit or in the chest wall. Distant Recurrence: This is when cancer spreads to other organs such as the lungs, liver, bones, or brain. Distant metastases are less common but more severe.

How Common is Recurrence for Breast Cancer?

The risk of breast cancer recurrence varies with the stage and type of the cancer:

Stage of Cancer

Stage I: Low risk - 15-20% Stage II: Higher risk - 30-40% Stage III: Increased risk - 50-60%

Type of Cancer

There are various types of breast cancer based on the presence or absence of specific receptors and biomarkers (like HER2, oestrogen, and progesterone receptors). Some types are more aggressive and have a higher recurrence rate, whereas others may be slower-growing and have a more favorable prognosis.

Tests Done When You Get a Recurrence

Diagnosing a recurrence involves confirmatory tests like needle biopsy. Additional tests, including markers like oestrogen and progesterone receptors, HER2, and CDK 4/6 inhibitors, help in deciding the best treatment plan. Other investigations such as chest X-ray, ultrasound, CT scans, and bone scans are performed to stage the cancer, based on the treating doctor's assessment of your symptoms.

Treatment Options for Recurrence

The treatment approach is tailored based on the number and location of recurrent tumors, biological markers, and the patient's general condition, age, and health status. Here are the possible treatment options:

Surgery

Surgery may be performed for local recurrences in the breast or chest wall, especially if other areas are cancer-free. In some cases, surgery is offered even for distant recurrences if they are single or causing specific symptoms.

Chemotherapy

Chemotherapy drugs, often tailored to the individual's case, help to reduce the size of cancer and improve quality of life. Various combinations of drugs are used, and common side effects are managed effectively.

Hormonal Therapy

Medications like tamoxifen, letrozole, and fulvestrant are highly effective in cases where oestrogen and progesterone receptors are present. The choice of medication depends on the patient's age and previous treatment history.

CDK 4/6 Inhibitors

Drugs like palbociclib and abemaciclib are now available, highly effective in breast cancers with oestrogen and progesterone receptors. These drugs have fewer side effects.

HER2 Targeted Drugs

Drugs like trastuzumab (Herceptin) and lapatinib target HER2/neu receptors. These drugs are beneficial for cancers with this marker, which affects about 15-20% of breast cancer cases.

Radiation Therapy

Radiation therapy can be used for local/regional recurrences or painful bone metastases, and can also treat brain metastases. It is a powerful tool in managing breast cancer recurrences.

Outcomes of Treatment for Recurrent Breast Cancer

While a complete cure may not be possible for all cases, many patients achieve significant benefit from treatment:

Cure: Some local recurrences or limited distant metastases may be curable. Longevity: Treatment can significantly extend life for cancer survivors facing recurrence. Quality of Life: Many patients lead productive and enjoyable lives, even after recurrence. A positive mindset can enhance overall well-being.

Surviving breast cancer recurrence is about more than medical treatment; it is about maintaining a positive outlook and adhering to recommended treatments and check-ups. With the right support and treatment, many breast cancer survivors can have a fulfilling and healthy life post-recurrence.