Scientists starting to understand metastasis
Scientists starting to understand metastasis I came across this interesting article referred to on an American site. It’s worth reading.
Kathy
thanks Kathy I really think that the scientists should concentrate more on metastasis - when you get diagnosed with primary breast cancer they are very economical about the truth as far as this is concerned. In the NICE guidelines it says more than half of women with primary breast cancer go onto get secondary breast cancer. When I said this at my breast cancer support group I got told this was out of date information, but I don’t think it is. I think that people working with breast cancer patients have a tyranny of over - optimism.
The sooner research is aimed more at secondaries the better. Otherwise over-optimism is all we can rely on.
Mole
Yes thanks Kathy Interesting article. I agree with Mole…far more needs to be done about secondary breast cancer. There’s such a lot of hype about survivors of primary breast cancer and far too little information about secondaries. Its pretty impossible to get accurate figures about recurrence. I think that figures for disease free survival may have improved in recent years but I’m not convinced there has been much change in overall survival. Why is it so hard to get this information?
Jane
Excellent article It seems to me that the experience varies depending on subtype. For the ER positive types, they seem to be primarily succeeding in delaying recurrence.
I think, though, based on the retrospective studies that have been done that overall survival should be improving for her2-positive types, not just because of herceptin, but simply the move from CMF to FEC. The latter shift might halve the 10-year death rate, based on the results of a Canadian study
At last! The number of people who develop secondaries after having the full range of treatment for a primary tumour seems unacceptably high, so I’m very heartened to see that research is going on in this area.
I’m now a registered member of the New York Times site - couldn’t access the article any other way!
Sorry about that, Gandalf The link was working when I posted it, but I too found I couldn’t access it again later. As it happens I’ve saved the whole article to look at again, so could post it here if anyone wants me to.
Kathy
Yes please Kathy - Would be helpful if you could post the article
K
Thanks Kathy. Interesting article. Leaves me feeling in awe of the scale of the problem but humbled by the tenacity of the scientists who study it.
We have more hope than any previous generation but still such a long way to go.
Thanks again.
Ginny x
Many thanks Kathy! K x
Removing post HI all
After consultation with the Breast Cancer Care communications team, I am afraid I have had to take down the post which copied an article from the New York Times. This is because of legal reasons.
Sorry if this causes any inconvenience.
Best wishes
Moderator
Breast Cancer Care
NYT article OK folks - try this link instead
Thank you Phoebe Thanks for this Phoebe
Moderator
Breast Cancer Care
Hi Mole
Be careful making statements out of context. For instance, only 10% of Stage 1 patients ever proceed to stage 4 (ie. metastasis). In the NHS 2003 NEAT trial of E-CMF chemo (all early-stage bc, 70% node positive, 60% grade 3, 60% 2cm, 40% oestrogen negative), relapse-free survival over 5 years (ie. no distant mets or indeed recurrence) was over 80%.
Personally I’ve found oncologists not optimistic enough! They are often very careful not to give guarantees in case it comes back at them.
What is criminal, however, is how little nutritional advice and survivorship research there is here compared with the fee-paying US health system. I’d like more research on how to prevent secondaries too, but not only drugs but also lifestyle.
Tina x
(Stage II, Grade 3 Triple neg June 2005)
No problem Glad to be of help!
stage 1 what proportion of cancers are diagnosed at stage 1? not a lot I would say as by the time it is detectable it has often spread to the lymph nodes or reached a pretty large size.
Anyway the statistics seem very poor at the moment so no-one seems to know.
Where do you get your figs on stage 1 cancer by the way? I’ve seen figures of 95% survival for 10 years but that is different from saying you will never get secondaries. I was diagnosed at 48 and read an article recently that said anyone diagnosed under 50 cannot ever consider themselves cured. If I can find the reference to the article I will send it on.
Mole
Mole The article to which you refer sounds very interesting and I should very much like to read it. If you do find the reference could you post it on this forum so that I may locate and read it?
Many thanks
Roisin
Hi mole
Not sure whether you read my post all the way through? The NEAT trial was Stage 1 and Stage 2, including tumours over 2cm and node-positive.
The average self-detected tumour is 2cm or above. Those found by routine mammography are generally smaller, there are a lot of older ladies who indeed have Stage 1 (and often don’t need chemo).
5-year RELAPSE-FREE survival on the NEAT trial (done in the NHS) was over 80% on the E-CMF arm (the gold standard for early-breast cancer). The NEAT trial included a majority of node-positive patients.
Occurrence of breast cancer has increased, but at least treatments are more effective.
The figures on Stage 1 come from John Hopkins Hospital in the US. The US have much more stats available on Stage 1 since they screen for breast cancers at a younger age. Screened breast cancers are usually smaller and less likely to spread.
With a figure of 95% chance of no recurrence over 10 years, I would take that as a great day! I think considering yourself cured or not is a personal choice, everyone’s different. I decided I was cured as soon as surgery was done and it was out of my body, and I’ll maintain that until evidence shows otherwise, or I’d go crazy (this isn’t a general view I realise). I feel cancer leaves your body but never leaves your life.
Luckily my bc was so aggressive that I will know sooner rather than later if we got every little cell.
Let me know what other refs you need, the NEAT one is on the ASCO site. Luckily I’m a research scientist so I have access to the medical journals online,
Tina x
optimism v pessimism I’m quoting Mole here…
“In the NICE guidelines it says more than half of women with primary breast cancer go onto get secondary breast cancer. When I said this at my breast cancer support group I got told this was out of date information”
Recently I discovered the stats here:
seer.cancer.gov/csr/1975_2003/results_merged/topic_survival_by_year_dx.pdf
(pages 7/8/9 cover breast cancer).
The figures here certainly approach 50% (survival-rate) over 20 years, so NICE guidelines are reasonable, if you view things in this context. But these stats goes right back to patients diagnosed in the 70s, and that is unlikely to reflect how well we do.
I agree over-optimism is far too common-place, but I also think it is just as easy to come to overly-pessimistic conclusions.
How much improvement is being made? Nor enough I don’t know whether Mole’s figures of 50% going on to get mets. are accurate or not but as I said in an earlier post what concerns me is how hard it is to get this information. I don’t think specialists who work in the cancer field are agreed about whether real progress in combatting breast acncer has been made or not.
What I do know is that roughly 42,000 people (mainly women…300 of these are men) are diagnosed with bc in the Uk each year and nearly 13,000 die of bc each year (mainly women…about 100-150 are men). Breast cancer is I think the single highest killer of young women. Black women and working class women diagnosed with breast cancer are more likely to die than their middle class and white counterparts with similar kinds of breast cancers.
None of this is acceptable and nor is the silence which surrounds the huge numbers of women diagnosed with secondary breast cancer every year, all virtually who will go on to die before they should.
I count myself lucky that so far I have lived without mets. but with a poor prognosis at diagnosis I think I am utterly realistic that I’ll probably die of breast cancer long before I should…I am 57 and could have expected a life well into my 80s before diagnosis. I won’t get this, and nor will many many of us posting on these forums. I reckon between a third and half of us will die of breast cancer…that’s as many as one familiar name in 2, or optimistically 1 familiar name in 3 us will die prematurely of breast cancer. Even if its 1 in 4 thats far far too many.
Yes treatments are improving and hormone and chemo therapies and targetted therapies such as herceptin are keeping many alive longer than they could have expected 5 years, 10 years, 15 years ago. But none of these treatments works infallibly or even works that well at all. Many of us go through horrible treatment for no benefit cause the cancer may not ever come back irrespective of treatment.
We do not speak often of these realities…it is as though to speak of the figures, the losses, the deaths is to damn ourselves to interminable pessimism and I am not suggesting that at all.
I want more reserach, I want evidence based research at the cutting edge of science, I want the kind of research suggested in the article KathyF originally told us about. I don’t think that research into diet and ‘lifestyle’ will make much difference to the huge numbers going on to get secondary breast cancer and indeed I think that pressure for such research (often from patients and the alternative medicine lobby) can divert scarce resources from the areas where it is most needed.
If all there was to breast cancer was primary cancer then surgery would sort it…WLE or mastectomy, reconstruction or not,… no therapies with side effects, no ovary removal bringing infertility etc etc. and it would hardly be a disease which would preoccupy us that much. But breast cancer is cancer…its about a disease which when it metastesises kills and kills in very very large numbers in the west.
I have never had anywhere near a 95% chance of surviving breast cancer and nor do many many of us using these forums.
Jane