Breast cancer recurrence occurs when the cancer comes back after treatment, and it is an unfortunate scenario that many face. Recurrent breast cancer may develop where it originally started, or it may spread to nearby lymph nodes or other areas of the body when it returns. It may also come back months or years after treatment has been completed.
In this article, we will discuss what recurrence risk assessment is in the context of breast cancer, from its importance to how it works. We will also explore how recurrence risk assessment is conducted, whether it is with the use of genomic assays, cancer biomarker testing, or other methods.
What is recurrence in breast cancer?
Recurrent breast cancer refers to a situation when breast cancer returns (or recurs) after treatment. It may come back in the same or a different form, in the same or different area of the body. There are several types of recurrence – local, regional, and distant.
Local recurrence refers to when the cancer returns, in the same place as it originally developed the first-time round. Regional recurrence refers to cancer coming back near the original tumor. This can be in nearby lymph nodes in the armpit or in the collarbone.
Distant recurrence refers to the spread of breast cancer that has spread to other parts of the body, such as the lungs, bones, or brain. In this situation, the cancer is metastatic and typically called Stage 4 breast cancer.
What is the rate of recurrence in breast cancer?
According to Cleveland Clinic, the potential recurrence of breast cancer varies depending on each patient’s individual characteristics. While it is largely uncommon, certain types of breast cancers may be more common. For example, according to the American Cancer Society, inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC) are most likely to return.
What is breast cancer recurrence risk assessment?
Recurrence risk assessment in breast cancer is used to estimate the likelihood of cancer recurrence after initial treatment. It is a process that involves looking at various factors, from tumor characters to clinical variables, to determine the risk of cancer returning locally, regionally, or in distant organs. This assessment is crucial, as it informs clinicians and guides them to make the best post-treatment surveillance decisions.
Patients that have a higher rate of breast cancer risk recurrence may also require more frequent follow-up visits and extra imaging studies, alongside more regular biomarker testing. This allows doctors to detect any signs of recurrence at an early stage.
How recurrence risk assessment works
Recurrence risk assessment typically works by identifying tumor characteristics and present biomarkers. This involves reviewing the size, grade, and histological subtype of the tumor, the presence (or absence) of cancer spread to the lymph nodes and other parts of the body. This allows clinicians to accurately determine the tumor’s aggressiveness.
Biomarkers are proteins or substances that act as indicators and provide information on the tumor’s biology, and some examples include hormone receptors (estrogen receptors and progesterone receptors), human epidermal growth factor receptor 2 (HER2), the protein Ki-67, the activity of the enzyme TK1, and cancer antigens 15-3 and 27.29. Measuring their activity levels can help clinicians predict the risk of cancer recurrence.
Additionally, genomic assays can be used. Examples include Oncotype DX, Prosigna, and MammaPrint. These can all provide information on the expression of multiple genes within the tumor issue. When risk assessment is being conducted, a genomic risk score is produced, which helps clinicians predict the likelihood of recurrence. This is particularly relevant for early-stage HR+ breast cancer.
To determine the risk of recurrence, other clinical variables such as patient age, menopausal status, and comorbidities must be assessed. For example, a younger age at cancer diagnosis, postmenopausal status, and certain comorbidities may be associated with a higher risk of recurrence of breast cancer.
Who performs recurrence risk assessments for breast cancer patients?
A range of factors must be examined to produce an accurate recurrence risk assessment for breast cancer patients. This means the process involves a multidisciplinary team of healthcare professionals, ranging from oncologists and pathologists to radiologists and other specialists. Their combined efforts provide an accurate and individualized assessment of recurrence risk for each patient.
Can breast cancer recurrence be prevented?
One of the most common questions surrounding breast cancer recurrence is whether it can be prevented. While research has shown that certain treatments may reduce the risk of breast cancer coming back for specific subtypes, there is no guarantee that breast cancer can be fully prevented from recurring. In fact, this is an area where experts are still trying to understand. In any case, patients with recurring breast cancer should know that it is not their fault should their cancer return. Regular screenings and check-ups can help pick up the recurrence of cancer early on, which can lead to better treatment outcomes.
Final words
Recurrence risk assessment is a vital part of post-treatment follow-up, and it is conducted by a multidisciplinary team of healthcare professionals. The process includes administering several types of tests to determine the cancer subtype and tumor size and aggressiveness, and it can provide valuable insights into the outlook of a patient’s quality of life post-treatment.
While there is currently no deep understanding of why breast cancer comes back to some people, it is important to understand that treatment can be effective, and your healthcare provider can recommend the best options for your situation, to increase your chances of beating cancer a second time.
