Examining Late Risk of Breast Cancer Recurrence

by Jane Sprague Zones

In August 2008, TV star Christina Applegate, 38, told an interviewer that she was 100 percent cancer free one month after her breast cancer diagnosis and a double mastectomy. “It did not spread—they got everything out, so I’m definitely not going to die from breast cancer.” We certainly hope that is true and that she never has to deal with this disease again. However, as we note on the “Breast Cancer Myths Debunked” portion of our web site (www.bcaction.org/faq), women cannot count on their breast cancer being “cured,” even after being disease free for five or more years after diagnosis and treatment.

Information about risk of recurrence over the long haul has been scanty. The Journal of the National Cancer Institute recently published a study of 2,838 women who had been treated for Stage I, II, or III breast cancer between 1985 and 2001.1 Five years after diagnosis, all were alive and disease free following surgery and systemic treatment that included chemotherapy and/or hormone therapy. Researchers followed these women and found that 89 percent had no breast cancer recurrence five years after the conclusion of adjuvant therapy (this would be approximately ten years after diagnosis), and 80 percent remained breast cancer free 15 years after diagnosis.

Abenaa Brewster, the lead author on the study, pointed out that these statistics might be reassuring to women, whom she believes consider their personal risks of recurrence to be quite high. However, the article describes the risk of late recurrence as substantial (11 percent and 20 percent at 10 and 15 years after diagnosis). These two perspectives on the data were reflected in media reports of the study, which generated headlines that varied from “Risk of relapse low” to “Risk of…relapse can linger.”

The study sample was refreshingly diverse: 48 percent of the study participants were premenopausal when diagnosed; and 9 percent were African American, 12 percent were Latina, and 3 percent were other women of color. However, the median follow-up time for the sample was only two years and four months after five years from the start of adjuvant systemic therapy. This means that half the sample was followed only about seven and a half years after diagnosis, and the number of those who were studied 15 years after diagnosis was very small. Only three women in the study who had been diagnosed with Stage I breast cancer were disease free at 15 years from diagnosis, making those figures statistically unreliable. Hopefully, this database will be maintained so that these women will continue to be followed in the years to come.

Because of the timing of entry into the study (before 2002), researchers were unable to assess the prognostic features of characteristics such as HER2/neu expression or the survival impact of newer treatments, such as Herceptin or aromatase inhibitors. They did find, however, that those with hormone receptor-positive tumors had significantly higher risk of late recurrence, as did women with low-grade (slower growing) tumors and those with higher-stage tumors at the time of diagnosis. The researchers concluded that risk reduction strategies need to be developed for hormone receptor-positive patients beyond the standard five years of systemic hormone therapies.

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1 Abenaa M. Brewster, et al, Journal of the National Cancer Institute, 2008 (August 20); 100(16):1-5.

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