One of the most common fears people have after cancer treatment is, “What if it comes back?” This is a valid concern since women who have been treated for cancer in one breast have triple the normal risk of developing a second primary cancer in the opposite breast. This risk is even higher for those who have a strong family history or a mutation in one of the BRCA genes, and reaches beyond breast cancer to include an increased risk of certain other cancers as well, especially ovarian cancer. Fortunately, there are steps that can reduce the risk of recurrence. The most important is to get regular medical care after treatment. The tests and examinations done at these follow-up visits are extremely important in helping detect cancer that has returned to the same breast, as well as cancer in the opposite breast. In fact, early detection of second breast cancers can reduce the risk of death by nearly half, according to a new international study.
For the study, published online in the Annals of Oncology, researchers analyzed information on 1,044 women who were seen at a medical center in Florence, Italy from 1980 to 2005 and who developed a second breast cancer. In 699 of the women, the second cancer was diagnosed in the asymptomatic state, while the remaining 345 women had already started to experience symptoms. A mortality registry was used to calculate the impact of cancer diagnosis timing on rates of survival.
Based on the data, the study authors concluded that the chances of survival improved between 27 and 47 percent when the second breast cancer was detected in the asymptomatic stage rather than at a later stage when symptoms were already apparent. Asymptomatic tumors were smaller than symptomatic ones, and early-stage tumors were more common in asymptomatic women (58 percent) than in symptomatic women (23 percent). Fewer women with asymptomatic cancer in the opposite breast (contralateral) than symptomatic cancer had node metastases, an indication the cancer may have spread.
In addition, mammography was found to be more sensitive than clinical examination for detecting second breast cancers—86 percent compared to 57 percent. Nonetheless, a significant number (13.8 percent) of the cancers were detected only by clinical examination. “Our study provides new evidence on several aspects of early detection of second breast cancers,” lead author Dr. Nehmat Houssami, a breast physician in the School of Public Health at the University of Sydney, Australia, said in a news release.
Previous studies have explored this topic, but each had certain methodological limitations, the study indicates. “We set out to estimate the effect of early, asymptomatic detection while adjusting for the two main biases known to be associated with non-randomized studies of the impact of early detection—lead time and length bias—so we believe that the estimates we report are more valid than previously reported estimates, while acknowledging the limitation that the evidence is not from a randomized, controlled trial,” Houssami said. “In addition, we have estimated this for early detection of either ipsilateral (same breast) or contralateral (opposite breast) cancer, while other studies have focused on one or the other, so our estimates may be more useful for clinicians discussing this aspect of breast cancer follow-up with their patient.”
“Intuitively, it makes sense to consider that early detection of second breast cancers will improve prognosis, since breast cancer survivors have a long-term risk of developing further disease or relapse in either breast,” Houssami concluded. “I think this work provides a timely reminder of the potential benefit of early detection of second breast cancers and supports ongoing surveillance in this group of women.”
Approximately 2.5 million women in the U.S. have been treated for breast cancer. And though annual mammograms are strongly recommended for these women, a report issued in April of 2006 showed that as many as two-third of survivors were not getting them. Screening rates in the study were high early on, with four out of five getting a mammogram in the first year after treatment. However, that rate declined over time and by year five, only a third of the women had gotten an annual mammogram every year since their cancer treatment ended. Women who saw their primary care physician or gynecologist regularly were more likely to get screened than women who did not.
The report noted that too many survivors are “lost in transition” once treatment ends and said more attention needs to be paid to follow-up care in the transition from cancer patient to cancer survivor. It also called for every cancer survivor to receive a comprehensive care summary and follow-up plan in writing that would include a specific schedule for future cancer screenings.
Breast cancer is the most common cause of cancer-related death among women in most of the Western world and the leading cause of death for women under 50. The disease strikes more than 211,000 American women each year and kills 46,000.
By: Madeline Ellis
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