Written By: Shraddha Rupavate | Updated : February 24, 2015 10:43 AM IST
October is Breast Cancer Awareness Month
Cancer is a disease that progresses in an unpredictable pattern. Even after months of chemotherapy and radiotherapy, the possibility of recurrence of cancer cannot be overlooked. Breast cancer can either recur at the original site (local recurrence) or at a site away from the original site (distant metastatic recurrence).
What are the chances of breast cancer recurrence after primary treatment?
According to Dr Vedant Kabra, Director, Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, relapse and survival rate mainly depends on the stage of cancer, the pathological features and biological characteristics of the cancer. The survival rate also depends on the age of the patient, ethnicity and the socio-economic background.
Broadly, following are the approximate five year survival rates and relapse rates according to the stage. Some of these patients would be alive with the relapse of disease so typically, relapse rate would be slightly higher than the survival rates:
Stage 0 - 100% -Relapse rate around 5%
Stage I - More than 95%. Relapse rate around 10%
Stage II - Around 90%. Relapse rate around 15%
Stage III - Around 70-75%. Relapse rate around 30%
Stage IV is not curable but long term survival with good quality of life can be achieved in a significant percentage of patients with stage IV cancer as well. Around 20-25% five year survival is seen even at this stage,' he explains.
Dr Dhairyasheel Savant MS FICS, Consultant Cancer & Reconstructive Surgeon, Asian Institute of Oncology highlights the differences in recurrence of breast cancer after different treatments. 'For women with early breast cancer, the recurrence rate ranges from 4-7% after removal of the breasts (mastectomy) or conserving surgery. The chances of recurrences increase in breast conserving surgery not receiving adjuvant radio therapy. About 50-75% of spreading of cancer remains confined to a single organ,' he says. Majority of the breast cancer recurrences occur within first five years of diagnosis. If relapse occurs within first two years, distant cancer is already present in 25-30% of the cases.
Can relapses be prevented? How?
'Women who have undergone breast cancer treatment in the form of surgery, chemotherapy and radiation therapy either in combination or individually depending on the stage of tumour are at a risk of developing local recurrence as well as distant relapses. They are more prone to relapse in presence of incomplete treatment.
Relapses in a completely treated breast cancer survivor cannot be prevented but can be picked up earlier by regular screening as advised by the treating consultant.
These patients should receive ongoing age-appropriate screening and preventive care, consistent with recommendations for the general population. Their regular follow up should include medical history, physical examination, surveillance mammography, evaluation and treatment of treatment related side effects,' says Dr Savant.
According to Dr Kabra, relapses can be prevented by timely and appropriate treatment, having healthy and happy lifestyle and a positive attitude.
What treatment approach is followed for relapse cases?
'Treatment of relapse would depend upon the type and extent of relapse. Local relapses are, on most occasions, amenable to surgery and radiation therapy whereas distant organ relapse or widespread relapses are usually treated by hormone or chemotherapy. Most of the time a combination of these therapies is needed and the sequence in which they would be used is decided by a panel of oncologists,' says Dr Kabra.
According to Dr Savant, women who are treated with breast conservation surgery can have a mastectomy. However women who have not received Radiation Therapy earlier can be treated with local excision and radiation therapy in combination.
Systemic therapy should be in combination with any form of treatment usually. In case of local relapse, absence of distant metastases should be ruled out before initiating the starting treatment. 15 -40% of metastatic relapses are to chest wall. Rest are usually confined to single organ,' says Dr Savant.
Image source: Getty Images
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