July 1, 2022

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Why does breast cancer still recur after ten years?

Why does breast cancer still recur after ten years?

 

Why does breast cancer still recur after ten years?  Breast cancer is not only the number one cancer in women, but also the number one cancer in the world.

Recurrence and metastasis is the most concern of every breast cancer patient. It is generally believed that after the most critical 5 years, you can rest easy, but why do some patients still have metastasis after 10 years?

What bad things are causing the long-term recurrence of breast cancer patients?

Why does breast cancer still recur after ten years? 

 

 


▌How did long-term recurrence and metastasis occur?

The recurrence and metastasis of breast cancer patients are mainly concentrated in 2 to 3 years after surgery, and 5 to 6 years after surgery is another peak of recurrence. However, some patients still have recurrence and metastasis more than 5 years or even more than 10 years after surgery.

The results of a study on short-term and long-term recurrence factors indicate that the recurrence and metastasis rate of breast cancer patients within 5 years is 67.46%; the recurrence and metastasis rate for ≥5 years is 32.53%, of which the recurrence and metastasis rate for ≥7 years is 20.63%, and the recurrence and metastasis rate for ≥10 years is 20.63%. The rate is 7.1%. Long-term recurrence and metastasis of breast cancer patients are related to the age of the disease, whether menopause, PR, HER2 receptor expression, whether neoadjuvant chemotherapy, whether postoperative adjuvant treatment, surgical methods, pathological types, clinical stages, and the number of lymph node metastases.

 

(1) Physiological factors:

1. Age

The median age of patients with long-term recurrence and metastasis is 44.6 years, and that of patients with short-term recurrence and metastasis is 48.2 years old, indicating that the younger the age, the higher the risk of long-term recurrence and metastasis.

2. Whether menopause

Among the patients with long-term recurrence and metastasis, the proportion of non-menopausal patients is 74.4%, which is higher than 58.8% of menopausal patients. That is to say, the risk of long-term recurrence and metastasis of non-menopausal breast cancer patients is higher than that of menopausal patients.

 

(2) Treatment situation:

1. Neoadjuvant chemotherapy

Neoadjuvant chemotherapy refers to systemic chemotherapy before the implementation of local treatment methods (such as surgery or radiotherapy). The purpose is to shrink the tumor and kill invisible metastatic cells as soon as possible to facilitate subsequent surgery, radiotherapy and other treatments.

The study showed that patients who did not receive neoadjuvant chemotherapy accounted for a higher proportion in the long-term recurrence and metastasis group (79.3% vs 66.5%), which may be because neoadjuvant chemotherapy is often used in patients with larger primary tumors. Patients have a later stage, more aggressive tumors, and obvious high-risk factors for recurrence.

2. Postoperative adjuvant treatment

The length of postoperative recurrence of breast cancer is still controversial with respect to surgical methods, but postoperative adjuvant treatment can reduce the local recurrence rate and achieve a good prognosis. Postoperative adjuvant treatment is mainly for hormone receptor positive, large tumor, positive lymph node, modified radical surgery, breast-conserving surgery, radiochemotherapy or endocrine therapy.

It is necessary to consult a physician according to the actual situation, and timely perform postoperative adjuvant treatment. Reduce the risk of long-term recurrence.

 

(3) Type of disease:

1. PR and HER2 receptor expression

The long-term recurrence rate of PR receptor positive and HER-2 negative was higher than the short-term recurrence rate, which were 69.3% vs 61.2% and 86.8% vs 66.0%, respectively. It shows that patients with PR receptor positive and HER-2 negative have a higher long-term recurrence rate.

2. Pathological type

The short-term recurrence rates of invasive lobular carcinoma and other pathological types are low, 3% and 18%, respectively, but the long-term recurrence rate is higher than the short-term recurrence rate, increasing by 14% and 13.8%, respectively.

Although the short-term and late-term recurrence rates of invasive ductal carcinoma are relatively high, the long-term recurrence rate accounts for 59.8%, which is lower than the short-term recurrence rate of 87.6%.

Although the late recurrence rate of invasive lobular carcinoma and other pathological types of tumors has increased, overall, the long-term recurrence rate of invasive ductal carcinoma is relatively high, and this type of patients should also be the most important thing to pay attention to.

3. Clinical staging

The later the clinical stage, the short-term recurrence rate gradually increases, from 10.6% to 52.3%, but the late recurrence rate is similar to a parabola, 56% in stage II, 13.3% in stage I and 30.7% in stage III.

4. Number of lymph node metastases

The chart shows that when the number of lymph node metastases is between 1 and 3, the long-term recurrence and metastasis rate is 40.5%.

 

(4) Psychological factors:

Depression is associated with cancer recurrence, all-cause mortality, and cancer-specific mortality. Depression is associated with a 24% increase in the risk of cancer recurrence. In addition, compared with studies with a follow-up time of more than 5 years, studies with a short-term follow-up (≤5 years) tend to report a higher risk of recurrence [risk ratio 1.37]. In other words, depression not only increases the risk of short-term recurrence, but also increases the risk of long-term recurrence, but the risk of short-term recurrence is higher.

 


▌How to reduce the risk of long-term recurrence?

There are so many reasons for the long-term recurrence of breast cancer patients, how to prevent the disease before it happens is the most important thing!

01 Strengthen follow-up

There are high risk factors for long-term recurrence and metastasis: such as young age, premenopausal, PR receptor positive, HER-2 negative, no neoadjuvant chemotherapy, no postoperative adjuvant treatment, modified radical mastectomy and breast-sparing surgery, invasiveness When the type of ductal carcinoma, the clinical stage is late, and the number of lymph node metastases is large, follow-up needs to be strengthened.

According to the recommendations for patient follow-up in the 2018 Chinese Breast Cancer Diagnosis and Treatment Guidelines, the follow-up interval of more than 5 years is changed to once a year, and this is also another peak of recurrence and metastasis of breast cancer patients. If patients with high-risk factors consult a physician, the follow-up period can also be shortened appropriately, such as once every six months.


02 Actively participate in treatment

For patients with hormone receptor-positive, lymph node metastasis-positive, tumor diameter ≥5 cm, and breast-conserving surgery, consult the attending physician and encourage active participation in postoperative adjuvant treatment, including radiotherapy, chemotherapy, and endocrine therapy.


03 Self-inspection

Perform regular self-examinations on the breasts and bilateral armpits. If there are isolated, painless, very hard lumps in the breasts and bilateral armpits during the self-examination, you should go to the hospital as soon as possible to check for recurrence and metastasis.


04 Regular physical examination visits

①Recurrence monitoring at the primary site: During follow-up, breast color Doppler ultrasound/X-ray should be checked regularly, especially for patients after breast-conserving surgery, to be alert to the primary site recurrence;

②Remote metastasis monitoring: If there are corresponding target organ symptoms, improve related examinations to understand the status of breast cancer easily metastatic organs.

·If hemoptysis or persistent dry cough occurs, if necessary, complete chest CT to see if there is lung metastasis;

·If you have body aches, low back pain, fractures, etc., you need to be alert for bone metastasis, and if necessary, complete the bone scan;

·There are liver discomfort, swelling, swelling and pain, etc., if necessary, improve the liver color Doppler to understand whether there is liver metastasis;

· Headache, dizziness, epilepsy and other symptoms can be perfected for brain CT to understand whether there is brain metastasis.

05 Keep your mood happy

Through self-regulation, psychological suggestion, family support, social assistance, seeking medical advice, etc., you can adjust your own psychology. You can use the depression scale to evaluate yourself regularly to adjust your mentality in time.

From the above introduction, we know the factors that affect the long-term recurrence and metastasis of breast cancer patients. Physiological factors and disease types cannot be changed, but the treatment and psychological factors are controllable.

For patients at high risk of recurrence, contact the attending doctor The teacher communicates the choice of preoperative and postoperative treatment, surgical methods, regulates depression, strengthens follow-up, regular physical examinations, and self-examinations, and I believe that a better prognosis will be achieved.

 

 

 

(source:internet, reference only)


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