Risk of Early-Stage Breast Cancer Recurring 10 or More Years After Diagnosis Linked to Estrogen Receptor Status, Other Factors

In In The News by Barbara Jacoby

By: Jamie DePolo

From: breastcancer.org

The risk of early-stage breast cancer coming back (recurring) 10 or more years after diagnosis is linked to a number of factors, including the size of the cancer, the number of lymph nodes that contain cancer, and whether the cancer is estrogen receptor-positive, according to a Danish study.

Overall, the study found that recurrence happened up to 32 years after diagnosis. This is the first time research has shown that breast cancer recurrence risk lasts longer than 30 years.

The research was published online on Nov. 8, 2021, by the Journal of the National Cancer Institute. Read the abstract of “The Incidence of Breast Cancer Recurrence 10-32 Years after Primary Diagnosis.”

About breast cancer recurrence

During surgery to remove early-stage breast cancer, surgeons remove all the cancer they can see. In some cases, there may be individual cells circulating in the bloodstream or hiding in the bones or other places in the body. These cells may be inactive and not growing, or what doctors call dormant. But at some point in the future, the cells may start growing and cause a recurrence.

Doctors prescribe treatments after surgery — such as hormonal therapy, chemotherapy, and targeted therapies — to destroy any cancer cells left behind and reduce the risk of recurrence.

The risk of recurrence is unique to each person diagnosed with early-stage breast cancer and depends on a number of factors, including:

  • cancer stage
  • cancer size
  • number of positive lymph nodes (lymph nodes that contain cancer are called positive)
  • hormone receptor status
  • HER2 status
  • age at diagnosis

Doctors work very hard to estimate the risk of recurrence for each person. They use that estimate to tailor a treatment plan you can start after surgery to keep the risk of recurrence as low as it can be.

About the study

Because of more and more effective treatment options, the number of people alive with a history of early-stage breast cancer has been increasing each year. According to the American Cancer Society’s Breast Cancer Facts & Figures 2019-2020, more than 3.8 million U.S. women with a history of breast cancer were alive on Jan. 1, 2019. Some of the women were cancer-free and others still had evidence of cancer and were likely receiving treatment.

Many doctors talk about cancer survival in terms of five-year survival rates. This means the cancer hasn’t come back in the five years after diagnosis. But it doesn’t mean the cancer can’t come back more than five years after diagnosis. Research suggests that estrogen receptor-positive breast cancer is more likely to come back more than five years after diagnosis.

In this study, the researchers looked at the risk of late breast cancer recurrence, meaning the breast cancer came back 10 or more years after diagnosis. They also looked for any factors linked to the risk of late recurrence.

The researchers looked at information from 20,315 Danish women diagnosed with early-stage breast cancer between January 1987 and December 2004. None of the women had experienced a recurrence in the 10 years after diagnosis, so they were considered 10-year disease-free survivors.

The researchers followed the women starting 10 years after diagnosis and for up to 22 more years. This means they followed some of the women for 32 years after diagnosis.

At diagnosis:

  • half the women were younger than 55 and half were older
  • nearly 60% of the women were diagnosed between 1992 and 2001
  • 62.5% of the women were post-menopausal
  • 46.1% of the women had stage I breast cancer
  • 44.5% of the women had stage II breast cancer
  • 8.8% of the women had stage III breast cancer
  • 64.1% of the women had negative lymph nodes, meaning there was no cancer in the lymph nodes
  • 65.6% of the cancers were 2 centimeters or smaller in size
  • 54% of the cancers were estrogen receptor-positive
  • 52.4% of the women had a mastectomy
  • 33.8% of the women had a lumpectomy and radiation therapy
  • 27% of the women received chemotherapy
  • 65.5% of the women received hormonal therapy

During follow-up, 2,595 women had a breast cancer recurrence:

  • 1,234 recurrences happened 10 to 12 years after diagnosis
  • 646 recurrences happened 13 to 15 years after diagnosis
  • 353 recurrences happened 16 to 18 years after diagnosis
  • 210 recurrences happened 19 to 21 years after diagnosis
  • 105 recurrences happened 22 to 25 years after diagnosis
  • 47 recurrences happened more than 25 years after diagnosis

Factors linked to a higher risk of late recurrence were:

  • having more positive lymph nodes
  • having a larger tumor
  • being a younger woman
  • being diagnosed with estrogen receptor-positive cancer
  • having lumpectomy versus mastectomy

“Our observed high cumulative incidence of late breast cancer recurrence is a concern given the increasing prevalence of long-term survivors,” the researchers wrote. “Our findings suggest that a subset of patients — with larger tumors, positive lymph nodes, or [estrogen receptor]-positive disease — are at risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapies.”

What this means for you

If you’ve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.

If you were diagnosed with hormone receptor-positive, early-stage breast cancer, it’s likely that your doctor will recommend you take some type of hormonal therapy medicine — either tamoxifen or an aromatase inhibitor depending on your menopausal status — for five to 10 years after surgery.

Chemotherapy after surgery is usually completed in three to six months. If you’re also receiving a targeted therapy, such as Herceptin (chemical name: trastuzumab), with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.

Radiation therapy after surgery can be completed in one to seven weeks.

So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.

Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early, in many cases because of side effects.

Still, as this study shows, breast cancer — especially hormone receptor-positive breast cancer — can come back 10 to 30 years after diagnosis. So it’s very important that you take the medicine for as long as it’s prescribed and at the prescribed dose.

If you’re having troubling side effects, talk to your doctor right away. Don’t wait until the symptoms are intolerable and you have to stop taking the medicine. There are steps you can take to ease these side effects, including switching to a different type of hormonal therapy.

Learn more about Staying on Track With Treatment. You can read about why it’s so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.

To talk with others about staying on track with hormonal therapy treatment, join the Breastcancer.org Discussion Board forum Hormonal Therapy – Before, During, and After.