Category Archives: Breast Cancer

Surgery after Lumpectomy: Is it Possible to get All the Cancer out on the First Try?

Breast Cancer, Uncategorized
Amrita Ford, MA, Cancer Prevention and Treatment Fund

Lumpectomy, or partial mastectomy, is the most common surgery for invasive breast cancer.[1]   It is performed in 60-75% of new breast cancer cases each year and has been in use for 30 years. Also called breast-conserving surgery, lumpectomy removes the cancerous tumor while preserving as much of the breast as possible.[2]  In an attempt to preserve the size of the breast, however, a doctor may accidentally leave behind a small amount of cancer. That’s why almost one in every four lumpectomies is followed by additional surgery, according to a February 2012 study published in the Journal of the American Medical Association.[1]

These repeat surgeries (also known as re-excisions) include women with ductal carcinoma in situ (DCIS), an early noninvasive form of breast cancer that if left untreated can develop into invasive breast cancer.

Experts believe that some women are having additional operations they may not need and others are missing out on surgery that could help prevent a recurrence of breast cancer.

During a lumpectomy, surgeons remove the cancer, along with some surrounding normal breast tissue. They then send the surgically removed tumor and surrounding rim of healthy tissue to a pathology lab. A pathologist will examine the tumor and breast tissue under a microscope, and if no cancer cells are found near the edges of the healthy tissue, it is called a clear margin.[2]

However, surgeons differ widely in their interpretation of the pathology results and disagree on how big of a margin there should be between the cancer and the healthy tissue. This results in re-operation rates for individual surgeons that range from 0 to 70%.[1] Some surgeons consider a lumpectomy successful as long as there is a clear margin between the cancer and normal tissue. Other surgeons prefer a wider margin, sometimes up to 5-10 millimeters, and if there is less, they will operate again. Differences in surgical training or a surgeon’s confidence in removing tumors may explain why surgeons treat margin sizes so differently and why there is a lack of standardization. Rates of repeat surgery also vary from one hospital to another, ranging from 1.7% to 20.9%. That means the number of surgeries a patient will undergo depends in part on her surgeon and the hospital where she receives treatment. The variation between hospitals may be explained by differences in the operating technique of surgeons, or the way in which different pathology teams analyze tissue specimens.

In the study, almost half of the repeat surgeries were done in women with clear but less than 1 millimeter margins, indicating that the surgeries may not have been necessary.[1]
Additional surgeries can be emotionally and physically taxing for patients, as well as an added financial burden. Many women who have repeat surgery subsequently undergo total mastectomy (removal of the entire breast), so the decision to operate again is a significant one. For patients who had a clear margin between tumor cells and healthy tissue, the factors that influenced the decision to operate again were the particular hospital, an unknown cancer diagnosis prior to initial surgery (versus a preoperative diagnosis like invasive ductal carcinoma, for example), and tumor size (very small and very large tumors were more likely to be re-operated).

On the other hand, 14% of patients in the study without clear margins did not undergo an additional surgery, despite being at an increased risk for breast cancer recurrence later on.1 Patients who had evidence of cancer left behind were more likely to be operated on again if their final diagnosis (based on the pathology report after the first surgery) was lobular cancer or if cancer cells were found in their blood or lymphatic vessels. Also, patients who had a lumpectomy based on an unknown cancer diagnosis were more likely to have additional surgery. Other factors may have played a role in the decision not to operate again, such as specific pathological features of the tumor, clinical characteristics of the breast cancer, and the patient’s wishes, but this study did not look at those factors.

The study suggests that whether breast cancer patients undergo repeat surgery following a lumpectomy depends not only on their clinical condition but also on their surgeon and where they receive treatment. While it suggests some patients are having too many surgeries, having a high rate of repeat surgery is not necessarily a bad thing and could mean a surgeon is especially diligent about removing all cancer cells. Similarly, a low re-operation rate could mean the surgeon usually performs lumpectomies correctly the first time, but it could also mean that he or she performs more mastectomies over lumpectomies initially or fails to provide additional surgery when it is needed. [3]

What Other Studies are Saying

The purpose of additional surgery following a lumpectomy is to reduce the chances of breast cancer recurrence or death from breast cancer. However, the long-term benefits of additional surgery are unclear. Some studies have shown that very small margins (less than 2 millimeters) between the cancerous area and healthy breast tissue lead to an increased risk of recurrence, so a second surgery would be a good idea. [4,5,6] A meta-analysis, which is a combined analysis of several different studies, concluded that wide margins of at least 10 millimeters are important for patients with ductal carcinoma in situ (DCIS) to lower the risk of recurrence.[7] However, other studies have found that larger margins (2 millimeters or greater) don’t reduce recurrence and are, therefore, usually unnecessary. [8,9] Even larger margins (5-10 millimeters) have not been conclusively linked to a reduction in breast cancer recurrence, especially if the patient undergoes radiation or other therapies following surgery to further decrease the chance of recurrence.

Meanwhile, other methods to reduce the number of repeat surgeries are being investigated. Physicians at the University of Michigan Comprehensive Cancer Center were able to reduce the number of repeat surgeries by having an on-site pathologist present in the operating room during lumpectomy surgeries. [10] The pathologist would examine the tumor and surrounding tissue immediately after their removal and give the results back to the waiting surgeon, who could at that point continue with additional surgery if necessary. Having an on-site pathologist reduced the percentage of patients requiring additional surgery from 25% to 11%. The on-site pathology lab, however, required a different approach for analyzing tumor and tissue samples called frozen section analysis. Frozen section allows samples to be analyzed in a short amount of time and involves freezing the specimen, cutting it, and staining it so it can be viewed under a microscope. The study found that frozen section analysis was just as accurate as traditional methods; however another study found it was slightly less accurate for analyzing the margins of patients with DCIS. [11] Although the approach increases surgical time for a lumpectomy and requires an investment from the medical center, both time and money will be saved in the long run if women are operated on fewer times.

The Bottom Line

There is no clear evidence whether a second surgery is a good thing for patients because it means the surgeon is being cautious, or a bad thing because women are undergoing two surgeries instead of one. Maybe surgeons could simply ask patients what they would prefer: Would they rather have more of their breast tissue, a bigger “lump,” removed during the first lumpectomy surgery in order to reduce the chance of a second operation, or would they prefer taking out as little breast tissue as possible (preserving the breast’s appearance more), knowing that if the margins aren’t clear, the surgeon will have to perform a second surgery? Judging from the available research, it seems likely that a woman will be more satisfied with the outcome of her lumpectomy if she has a say in whether to remove more or less breast tissue at the initial surgery.

References:

  1. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467-475.
  2. Breast Lump Removal. http://www.nlm.nih.gov/medlineplus/ency/article/002918.htm. Accessed February 13, 2012.
  3. Morrow M, Katz SJ. The challenge of developing quality measures for breast cancer surgery. JAMA. 2012;307(5):509-510.
  4. Dillon MF, McDermott EW, O’Doherty A, Quinn CM, Hill AD, O’Higgins N. Factors affecting successful breast conservation for ductal carcinoma in situ. Ann Surg Oncol. 2007;14(5):1618-1628.
  5. Kunos C, Latson L, Overmoyer B, et al. Breast conservation surgery achieving >or=2mm tumor-free margins results in decreased local-regional recurrence rates. Breast J. 2006;12(1):28-36.
  6. Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer. 2001;91(1):9-16.
  7. Wang S-Y, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst. 2012;507-516.
  8. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383-393.
  9. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46(18):3219-3232.
  10. Sabel MS, et al. Development of an intraoperative pathology consultation service at a free-standing ambulatory surgical center: clinical and economic impact for patients undergoing breast cancer surgery. Am J Surg. 2011.
  11. Cendán JC, Coco D, Copeland EM 3rd. Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005;201(2):194-198.

Free Fast Facts on Ductal Carcinoma in Situ (DCIS) for Medical Professionals

Breast Cancer

The Cancer Prevention and Treatment Fund has developed a free “Fast Facts for Medical Professionals” on ductal carcinoma in situ (DCIS).  Fast Facts is a one-page, double-sided, color fact sheet summarizing the NIH State-of-the-Science Consensus Statement on DCIS and the latest research on long-term outcomes of DCIS treatments.  It provides a quick overview of what is known and not known about DCIS.  It is useful for any professional who may need to discuss a DCIS diagnosis or treatment with patients, such as physicians, nurses, navigators, and social workers. It was approved and funded by a grant from the D.C. Cancer Consortium through the Department of Health, Government of the District of Columbia. To request free copies of Fast Facts on DCIS, write info@stopcancerfund.org or call 202-223-4000.

To view, download, or print our DCIS Fast Sheet, here is a PDF of Fast Facts on DCIS for Medical Professionals.

Are Silicone Breast Implants Safe for Cancer Patients?

Breast Cancer
Cancer Prevention and Treatment Fund

Women with breast cancer often choose mastectomy because they don’t want to ever have to think about the cancer again.  Unfortunately, the latest research shows that if they get reconstruction with silicone gel implants, they are likely to have many complications and need additional surgery.

Everyone agrees that breast implants are not lifelong devices.  In fact, about half of reconstruction patients have their implants removed within 8-10 years.  Even more women have leaking implants or other problems that require removal, but are reluctant to undergo surgery again.  Those women were not counted by the companies that did the research.

There are two manufacturers that make breast implants in the U.S, and both got FDA approval to sell their silicone implants on the condition that they conduct 10-year studies on more than 40,000 women with implants.  One company, Mentor, is doing a very poor job and that is why in August 2011 consumer advocates and public health experts asked the FDA to rescind approval of Mentor silicone gel breast implants. Mentor started their study of 40,000 women but within 3 years they lost track of 79% of their patients.  In comparison, Allergan lost track of just over 25% of their reconstruction patients in the first two years.

When so many patients drop out of a study, it raises a lot of questions. Did the companies lose track of the patients because the patients did not stay in touch with their surgeon?  Did patients stop going to the doctor because their implants were removed?  Did they drop out of the study because they died or got very sick, or because they were so happy with their implants and their lives that they didn’t want to be bothered going back to the plastic surgeon or filling out questionnaires? Patients tell our organization that plastic surgeons are very enthusiastic about staying in touch with patients who are satisfied, but not with patients who are having problems. Some patients report being “fired” by their doctors, who let them know they are no longer welcome! When that happens, the research findings are biased and don’t provide accurate information about safety.

Another problem with the studies is that most did not ask about many of the complications that women with leaking implants tell us about.  For example, in August 2011, women who got their breast implants in the last few years told the FDA that they suffered from joint pain, hair loss, memory loss, and other autoimmune symptoms.  Instead, the studies asked women if they had been diagnosed with rare diseases or other types of cancer. Most women with implants assumed that the joint pain, memory loss, and fatigue they experience are from getting older, but when their implants were removed they felt younger and healthier than they had in years.

The huge number of patients who “dropped out” of these studies, and especially the Mentor studies, are such a problem that these results would not be publishable in any peer-reviewed journal. If a company can’t provide solid scientific evidence that their implants are safe for long-term use, we believe they should not be allowed to sell them in the U.S.

More Surgery and Other Problems from Implants

So what does the newest research data show?   Only the better studies can tell us anything about safety, so we relied on only the few “Core studies” where at least 60% of the patients were followed up for at least 8 years.  However, if women were taken out of the studies when their implants were removed, these complication rates are lower than they really were.

The Allergan Core Study followed 98 reconstruction patients who got implants for the first time.

Within 4 years, 41% had another operation to fix an implant problem.  The most common complications and reasons for reoperation were dissatisfaction with how they looked, capsular contracture (painful hardening of the breast), hematoma (build-up of blood outside a blood vessel), or seroma (build-up of liquid). One in four patients had at least one implant removed. Other common complications included breast pain, infections, and swelling.

Within 10 years, 72% of the women underwent at least one additional operation to correct implant problems and 54% had at least one implant removed.  One in four had serious capsular contracture and 23% complained of asymmetry. Other complications, such as breast pain, ranged up to 7% each.  However, 27% of the implants were ruptured, affecting approximately half the women. The number of women affected by ruptured implants is much higher than the percentage of implants ruptured, because most women have two implants (but only rarely do both implants rupture at the same time).

The Mentor Core Study followed 251 reconstruction patients.

After 3 years, 27% had another operation to fix and implant problem (for the same reasons as listed above).   Almost 13% had an implant removed.  One in ten had serious capsular contracture and up to 7% reported other complications such as asymmetry.

Within 8 years, 39% had another operation to fix an implant problem and 23% had an implant removed.  More than one in seven suffered from serious capsular contracture. However, 14% of the implants were ruptured, affecting approximately one in four women.

Why are the complication rates less high for Mentor?  There are a few problems with the Mentor statistics.  For example, some common complications, such as asymmetry, are not reported for the cumulative 8 year data.  Also, Mentor complications were reported at 3 and 8 years, compared to 4 and 10 years for Allergan.  In addition, Mentor lost more women to follow-up in their study.  Those that had problems may have been more likely to drop out of the study or be dropped from the study when their implants were removed.

Allergan

Mentor
Common Complications 4 years(98 patients) 10 years(44 patients) 3 years(251 patients) 8 years(151 patients)
Reoperation 41% 72% 27% 39%
Removal/replacement 25% 54% 13% 23%
Capsular contracture (III/IV) 14% 25% 9% 15%
Swelling 7% 7% – –
Asymmetry 16% 23% 7% ?
Breast pain 3% 7% 2% 3%
Infection 4% 3% 5% 6%
Seroma 0% 2% 5% 5%

Women as Guinea Pigs: Tungsten in Breast Cancer Patients

Breast Cancer
Diana Zuckerman, PhD, Cancer Prevention and Treatment Fund

A medical device that was never tested in human studies has been recalled because it left hundreds of tungsten particles in the breasts of women being treated for breast cancer. See Riddled With Metal by Mistake in The New York Times.

The Axxent FlexiShield Mini, made of silicone and tungsten, was intended to protect healthy breast tissue from radiation during a new radiation technique for women undergoing lumpectomies to treat breast cancer.

Rather than requiring clinical trials and inspections, as is done for prescription drugs and less than 5% of medical devices, the FDA allowed the shield to be sold after reviewing it through the less stringent 510(k) process.  FDA spokesperson Karen Riley referred to this decision as appropriate in order to avoid “reinventing the wheel” for devices that are similar to those already on the market.  The shield was deemed by the FDA as “substantially equivalent” to an older shield made with lead; the new shield is made with tungsten and silicone, and left hundreds of tiny tungsten particles in the women’s breasts.

No one knows the health risks of tungsten in breasts, but at the very least, the particles interfere with the accuracy of mammograms because they show up on mammograms as white specks, which look just like small specks of cancer.  If the doctor assumes the specks are tungsten, not cancer, the women could have undiagnosed and untreated cancer, which could be deadly.  If the doctor assumes the specks are cancer, but they are actually tungsten, the women will have surgery that is not necessary.

This is a great example of why potentially dangerous medical devices should be subject to clinical trials and inspections (Medical Device Recalls and the FDA Approval Process).  Without those safeguards, it can take years to discover that a device is defective; meanwhile, thousands of patients can be harmed.  The tungsten problem was noticed quickly only because the patients were participating in a clinical trial of a new radiation technique-there were no clinical trials of the tungsten device.   Because the women were in a study of the radiation technique, the doctors did a 6-month follow-up with mammograms for all their patients, and that’s when they discovered the tungsten particles in the women’s breasts.

What if the women hadn’t been in that study?  The tungsten shield was cleared by the FDA in June 2009, and when we checked on March 21, 2011, there was only one report of the tungsten particles on the public reporting system for medical device defects.  That report referred to four different patients with tungsten particles in their breasts, and was made by an unnamed nurse in June 2010 but not “received” by the FDA until January 2011. We don’t know what the delay was in reporting, but we know that more than four patients have already been diagnosed as having tungsten particles in their breasts due to the shield.  If the patients hadn’t been participating in a clinical trial of the new radiation technique, it could easily have taken many additional years before health professionals reported the problem for so many patients that the FDA noticed the reports.  FDA receives too many reports of medical device serious adverse reactions to study all of them so it can take a long time to come to their attention.

The breast cancer patients who had been exposed to the tungsten shield had undergone lumpectomies.  The surgeon therefore had removed the cancer but not the women’s breasts.  Now, a year later, those same women must consider mastectomies to rid their bodies of tungsten, not cancer–a problem that would not have happened if the device had been carefully tested in either animals or humans, and the manufacturing plant had been inspected, before the device was sold.

This is an example of what happens when FDA allows medical devices to be sold without solid scientific evidence.  When a medical device could cause this kind of damage, it should be carefully tested first to make sure it is safe before thousands of patients use it.  Before studying it on even one woman, the shield could have been tested on animals or perhaps in excised tissue.  Instead, patients paid for this dangerous device without it ever being tested-even on them.

FDA Review Indicates Possible Association Between Breast Implants and a Rare Cancer

Breast Cancer, Other Cancers
January 26, 2011

This FDA press release was published on January 26, 2011 and was copied from its original location here.

Agency requesting health care professionals to report confirmed cases.

The U.S. Food and Drug Administration today announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant.

The FDA is requesting that health care professionals report any confirmed cases of ALCL in women with breast implants.

In an effort to ensure that patients receiving breast implants are informed of the possible risk, FDA will be working with breast implant manufacturers in the coming months to update their product labeling materials for patients and health care professionals.

“We need more data and are asking that health care professionals tell us about any confirmed cases they identify,” said William Maisel, M.D., M.P.H., chief scientist and deputy director for science in FDA’s Center for Devices and Radiological Health. “We are working with the American Society of Plastic Surgeons and other experts in the field to establish a breast implant patient registry, which should help us better understand the development of ALCL in women with breast implants.”

According to the National Cancer Institute, ALCL appears in different parts of the body including the lymph nodes and skin. Each year ALCL is diagnosed in about 1 out of 500,000 women in the United States. ALCL located in breast tissue is found in only about 3 out of every 100 million women nationwide without breast implants.

In total, the agency is aware of about 60 cases of ALCL in women with breast implants worldwide. This number is difficult to verify because not all cases were published in the scientific literature and some may be duplicate reports. An estimated 5 million to 10 million women worldwide have breast implants.

The FDA notification is based on a review of scientific literature published between January 1997 and May 2010 and information from other international regulators, scientists, and breast implant manufacturers. The literature review identified 34 unique cases of ALCL in women with both saline and silicone breast implants.

Most cases reviewed by the FDA were diagnosed when patients sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites were fully healed. These symptoms were due to collection of fluid (peri-implant seroma), hardening of breast area around the implant (capsular contracture), or masses surrounding the breast implant. Examination of the fluid and capsule surrounding the breast implant led to the ALCL diagnosis.

The FDA is recommending that health care professionals and women pay close attention to breast implants and do the following:

  • Health care professionals are requested to report all confirmed cases of ALCL in women with breast implants to Medwatch, the FDA’s safety information and adverse event reporting program. Report online1 or by calling 800-332-1088.
  • Health care professionals should consider the possibility of ALCL if a patient has late onset, persistent fluid around the implant (peri-implant seroma). In cases of implant seroma, send fresh seroma fluid for pathology tests to rule out ALCL.
  • There is no need for women with breast implants to change their routine medical care and follow-up. ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants.  Although not specific to ALCL, health care providers should follow standard medical recommendations.
  • Women should monitor their breast implants and contact their doctor if they notice any changes.
  • Women who are considering breast implant surgery should discuss the risks and benefits with their health care provider.

The FDA published its literature review in a document posted on FDA’s website site today titled “Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants: Preliminary FDA Findings and Analyses.”

The FDA also plans to provide an update on its review of silicone gel-filled breast implants in the spring of 2011. This update will include interim findings from ongoing post-approval studies for silicone gel-filled breast implants currently sold in the United States, adverse event reports submitted to the FDA, and a review of the scientific literature on these products.

Gene Test Will Help Determine Which Women with Breast Cancer Will Benefit from Which Chemotherapy

Breast Cancer
Blossom Paravattil, Megan Cole, and Brandel France de Bravo, MPH, Cancer Prevention and Treatment Fund

Chemotherapy can save lives, but some types of chemotherapy work better for some patients. In 2010, scientists from the European Breast Cancer Conference announced a new way to determine which breast cancer patients are likely to benefit from which chemotherapy treatments.

The scientists conducted a study called a meta-analysis that looked at four large breast cancer trials with a total of 3,000 patients.  Researchers found that having a defect in chromosome 17 (called CEP17) meant that the patient’s tumor was much more likely to respond to chemotherapy drugs called anthracyclines, in comparison to those without the defect.[1]

Anthracyclines are antibiotics that are used to treat cancer by interfering with the enzymes involved in DNA replication. DNA tells cells how to make copies of themselves. If the DNA gets damaged, the “instructions” can contain errors, which causes cells to multiply uncontrollably, resulting in cancer.[2]

The defect called CEP17 is on the same chromosome as other genes that are associated with breast cancer (such as HER-2), and a simple test known as the FISH (fluorescent in situ hybridization) can detect it. In the meta-analysis, researchers found that more than one in four breast cancer patients (27.5%) had this genetic abnormality or mutation, which is linked to poorer survival rates. The good news for women with CEP17 is that when they are treated with anthracyclines, they are about two-thirds more likely to survive and to not have a recurrence of cancer than women with CEP17 who receive other types of chemotherapy. Just as importantly, the researchers discovered that women who do not have CEP17 should not take anthracyclines, because it will not work for them.

Although there are many factors that determine whether chemotherapy will be effective,  a test to measure CEP17 can help physicians choose the most effective chemotherapy to improve a patient’s chances of survival. Chemotherapy has very unpleasant side effects, and choosing the most effective chemotherapy the first time (rather than trying different types of chemotherapy until one works) helps patients fight cancer more quickly and avoid the drugs that wouldn’t improve their chances of surviving cancer.   More studies are needed to better understand CEP17 and to improve treatment, but this is an important step forward.

References:

  1. Bartlett JMS, Munro A, O’Malley FP, Earle H, Poole CJ, Cardoso F, et al. Duplication of chromosome 17 CEP predicts for anthracycline benefit: evidence from an international meta-analysis of 4 adjuvant breast cancer trials for the HER2/TOP2A meta-analysis study group. 7th European Breast Cancer Conference (EBCC-7)
  2. U.S. National Library of Medicine (2010). What is DNA? Retrieved from <http://ghr.nlm.nih.gov/handbook/basics/dna>

Decisions in the dark: The FDA, breast cancer survivors, and silicone implants

Breast Cancer, New Cancer Research

Decisions in the Dark: The FDA, Breast Cancer Survivors, and Silicone Implants warns that industry-funded data indicates that reconstructive surgery patients experience substantially more complications, ruptures and a greater need for additional corrective surgeries than women who receive implants for augmentation purposes. The report also highlights FDA research showing that silicone implants interfere with mammography and may limit future breast cancer treatment options such as lumpectomy and sentinel node biopsy.

The report reveals that:

  • After selling silicone breast implants to tens of thousands of mastectomy patients in the last 5 years, under the conditions that they participate in clinical trials, implant manufacturer Implant included only 80 mastectomy patients in their longitudinal safety study submitted to the FDA, and Mentor Corporation included 0 breast cancer patients in their only long-term study;
  • Industry-funded research reveals that reconstruction patients experience two to three times as many complications and additional surgeries as augmentation patients;
  • Most ruptures (86 percent) are “silent” and can only be detected with MRIs, yet Inamed included less than 30 women in their sample of breast cancer patients undergoing MRIs to determine rupture rates, and the medical societies for plastic surgeons do not advise women to undergo MRIs.
  • Research consistently indicates that reconstruction patients are not enjoying life more than mastectomy patients without reconstruction, and there is evidence they may be more likely to commit suicide; and
  • Breast implants can limit treatment options for later breast cancer.

View report

Tips for Preventing a Recurrence of Breast Cancer

Breast Cancer, Breast Cancer
Heidi Mallis, Cancer Prevention and Treatment Fund

Women (and men) who are diagnosed with breast cancer usually focus on treatment to destroy the cancer, and many don’t consider what changes they can make to prevent the cancer from returning. They may wish they had taken better care of themselves, but think it is too late to prevent cancer. It isn’t. It’s not just the surgery, radiation, or chemo that can keep you safe after a cancer diagnosis; there is growing evidence that there are a lot of other things you can also do that will help keep cancer from coming back.

Dr. Christopher Li at the Fred Hutchinson Cancer Research Center in Seattle found that female breast cancer survivors who were obese, had a history of smoking, and drank more than seven alcoholic beverages per week, were at an increased risk of developing a second primary breast cancer (“primary cancer” refers to the place where the cancer starts).[1] For patients diagnosed with breast cancer, recurrence most commonly occurs in the opposite breast (referred to as contralateral breast cancer), not the same breast where the cancer was initially treated.[2] It is estimated that one in 25 breast cancer survivors will develop a second primary breast cancer at least six months after their initial diagnosis.[3]

Li and his colleagues found that women who were obese, had a history of smoking, and drank heavily were seven times more likely to develop contralateral breast cancer than women with a non-obese body mass index (BMI), who did not smoke, and consumed less than seven alcoholic beverages per week.[4]

If you are wondering if you or someone you love is obese, it is possible to calculate BMI using the following formula:

[Weight (lbs)/height (in)2] x 703
Say, for example, that you wanted to calculate the BMI for a person who is 5’9” and weighs 200 lbs.

Weight = 200 lbs, Height = 5’9” (69”),
Calculation = [200/(69)2] x 703 = 29.5

The resulting BMI of 29.5 could be plugged in to the standard BMI reference table to determine the weight status of a particular individual. The Centers for Disease Control and Prevention (CDC) provides the following BMI guidelines:

BMI Weight Status
Below 18.5
Underweight
18.5 – 24.9
Normal
25.0 – 29.9
Overweight
30.0 and Above
Obese

From this table, you can see that 29.5 would be considered “obese.”

The Bottom Line

Maintaining a healthy weight through diet and exercise can prevent breast cancer, and can also prevent breast cancer from returning. Breast cancer survivors have a much higher risks—two to six times greater risk—of developing a second breast cancer than women in the general population have of developing a first breast cancer. The study by Dr. Li and his colleagues shows very clearly that many women can reduce that risk by quitting smoking, maintaining a healthy weight or losing weight, and avoiding excessive consumption of alcoholic beverages.

References:

  1. National Cancer Institute (2004). Metastatic cancer: Questions and answers. U.S. National Institutes of Health. September 1, 2004. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic. (Accessed September 25, 2009).
  2. Wedam SB, Swain SM (2005). Contralateral breast cancer: Where does it all begin? Journal of Clinical Oncology, July 2005; 23(21): 4585-4587.
  3. Kurian AW, McClure LA, John EM, Horn-Ross PL, Ford JM, Clarke CA (2009). Second primary breast cancer occurrence according to hormone receptor status. Journal of the National Cancer Institute, August 5, 2009; 101(15):1058-1065.
  4. CI, Daling JR, Porter PL, Tang MT, Malone KE (2009). Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. Journal of Clinical Oncology, September 8, 2009. http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.23.1597v1 (Accessed September 16, 2009).