Risks of Breast Cancer Recurrence

Jennifer Wider, M.D. Society for Women’s Health Research

Survivors of early stage breast cancer may be unaware of their risk for recurrence, according to a new survey conducted by the Society for Women’s Health Research, a national advocacy organization in Washington, D.C. Roughly 50 percent of the women polled were unaware of the statistics related to the continuing risk of breast cancer.

“Risk of breast cancer recurrence is very individualized,” said Dr. Ursula Matulonis, M.D., director of medical gynecologic oncology at the Dana-Farber Cancer Institute in Boston, Mass. “The risk of recurrence depends on several aspects of the cancer itself, which can be obtained from the patient’s pathology report.”

The earlier breast cancer is detected, the better the prognosis for the patient. Early stage breast cancers are typically smaller in size and confined to the breast tissue. A percentage of early stage cancers have spread to the lymph nodes. Depending on the type of tumor, treatments often involves surgery, radiation, chemotherapy and adjuvant or hormonal therapies.

“Women most at risk for recurrence are those who have cancer in their axillary lymph nodes compared to women who do not have cancer present in these lymph nodes,” Matulonis said.

Two-thirds of the early breast cancer survivors in the survey who had been treated with hormonal treatment post-surgery believed that they were “cured” of the disease. But statistics show that nearly one-third of women with hormone dependent, early breast cancer will likely experience a recurrence. There are many reasons why women may not be aware of the facts involving recurrence.

“Prognostic information is often not discussed or the information communicated is overly optimistic,” said Andrea Gurmankin, Ph.D., an assistant professor in Harvard’s School of Public Health and a faculty member in the Center for Community-Based Research at the Dana-Farber Cancer Institute. “Also, the health providers’ time with patients is so limited that it is difficult to communicate complicated risk information in a way that the patient can understand.” As a result, patients may leave the office unaware of their risk and the steps they need to take to lower the chances of recurrence.

But the doctor isn’t the only one in the picture. Patients play a role too and often neglect to ask about their risk of the cancer returning. “Many patients don’t ask for this information, don’t remember being told the information, or don’t understand the information communicated,” Gurmankin said.

According to the survey, women who have been diagnosed with early-stage breast cancer undoubtedly worry about the chance of the cancer returning. Many women feel that they are not getting the proper information that they need to make educated decisions for disease prevention.

There are many steps patients can take to maximize their chances of getting the necessary information. “Patients can bring a list of questions with them to their appointments to ensure that they remember their questions,” Gurmankin suggested. “It is difficult to remember everything to ask in the midst of often scary and overwhelming discussions about one’s health and prognosis. When asking questions of providers, patients need to keep asking until they are sure they understand the answer.”

The fact that the information may be complicated gets compounded by the frequent use of medical language which is often difficult for a patient to comprehend. In addition, the conversation between doctor and patient is often sensitive and stressful, making it easy to forget pertinent information. “Patients should ask their provider if they may tape record the conversation, so that they don’t forget what was said and so they can process the information on their own time and with the help of loved ones, if they wish,” Gurmankin said.

More information on the breast cancer risk recurrence survey and patient-physician communication can be found on the Internet at http://www.lifeabc.org/, a public education Web site sponsored by the Society for Women’s Health Research to aid discussion of this important health issue.

© May 26, 2005 Society for Women’s Health Research