When Cancer Returns: How to Cope with a Recurrence

More women than ever are surviving breast cancer, long enough to face a new threat: a recurrence of breast cancer.

By Louisa Kasdon

Q. How do you know what to hope for?A. You know, I’ve worried since 1993 about the possibility that I might die of breast cancer, so I’m still worried. But I’m not more worried. I know a whole lot more about the science and the biology of breast cancer than I knew in 1993. I became a very motivated student in the intervening years and took a fabulous course that the National Breast Cancer Coalition puts on for breast cancer advocates. It’s called Project LEAD and teaches you about the science of breast cancer. So I know enough to believe that my second breast cancer, as breast cancers go, was a pretty good breast cancer. There are always surprises — you never know for sure — but this ought to be okay. So I’m optimistic. But like every other women who has had breast cancer, I often think about it coming back.

Predicting Recurrence

Today’s technology can give you an idea of your risk. Here’s what to do, rather than lying awake at three a.m., worrying.

Know that the odds are in your favor. "Most women [85 to 90 percent] with small cancers won’t have a recurrence," says Lowell E. Schnipper, MD, chief of hematology/oncology at Beth Israel Deaconess Medical Center, and Hester’s husband of 11 years. "And the majority of those with larger cancers and lymph node involvement will stay healthy." But some will face cancer again.

Get the details. Doctors look at the size of the tumor, the number of lymph nodes involved, and how similar to normal cells the cancerous cells appear (this is known as the tumor’s grade — a high so-called nuclear grade usually means a faster-growing group of tumor cells).

Find out your receptor status. Pathologists run a series of tests to see if your tumor cells produce receptors that bind estrogen and progesterone, as well as a protein called the HER-2 receptor. "Twenty percent of all breast cancers produce too much of the HER-2 receptor, and those cancers grow faster and are often more likely to recur," Schnipper explains. (Those women are candidates for Herceptin.) "Oncologists use the test results to estimate the risk of future recurrence. You’ll use this information to decide with your doctor whether/which type of systemic treatment, in addition to local treatment, is appropriate," Schnipper says.

Put in some computer time. You and your oncologist will look at the data and come up with a prediction based on your age, your health, and the lab results. "Most oncologists use an online program, such as Adjuvant Online, to calculate the chances that a recurrence will occur," Schnipper says. It can also compare the projected recurrence risk of several treatments, helping you decide whether to go with hormonal treatments, chemotherapy alone, or a combination of hormones and chemo. The goal is to weigh benefits of a certain treatment against possible negatives, such as the odds you’ll have side effects.

Skip the body scans. "Survivors should have annual mammograms and breast exams performed by a physician. These detect cancer as often as 80 percent of the time," Schnipper says. "There’s just no point in obsessive scanning." Because finding a cancer three months earlier doesn’t usually increase life expectancy, frequent scans are not recommended unless a new problem is suspected.

Originally published in MORE magazine, October 2006.

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