Thursday, September 16, 2010

How many months after treatment would breast cancer metastasize to other parts of the body

How many months after treatment would breast cancer metastasize to other parts of the body?
If you make a graph and number months after treatment which month number would get most of the hits lets say on a scatter gram? So if it is typically 18 months after treatment would that be typically when most cancers reoccur? I am trying to stay positive but I want to also make these times her best.
Cancer - 3 Answers
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1 :
Dave, there is no answer for this. I saw many hundreds of women with breast cancers. There was no month in my experience that would show a concentration of "hits' on a scatter diagram. I've seen metastatic disease show up clinically one year, 2 years, 5 years, 10 years and even 20 years after the original primary cancer was treated. No two people were the same. Obviously - when it does recur - the metastatic disease had been there all of the time but had been dormant or too small to be clinically evident. A billion breast cancer cells makes a tumor mass only ~1cm in diameter. We cannot see a million residual cells on any scans or imaging studies. So when follow up scans are all negative - that is terrific - but there could still be millions of residual cells somewhere in the body that we just cannot see because they are too small to show up. The chances improve with each passing disease free year, but these women are never really out of the woods entirely. We often use the five year disease free interval as a bench mark, but that is not always safe with breast carcinomas. If metastatic breast carcinoma does eventually show up, it must have been there since the original diagnosis. You (you and your wife) went through adjuvant chemotherapy hoping to knock out any cells that remained. You didn't know for sure if they were there are not. You don't know whether the chemotherapy succeeded in eradicating every last cell if there actually were residual cells that had spread via the bloodstream. With adjuvant chemotherapy we are treating disease we cannot see on the chance that it may be there and might be reponsive to the chosen combination of chemotherapy drugs. We make a best "guess" based on many studies trying to find what gives people the best chance for a long disease free survival. When metastatic disease eventually does show up, it is just that it has grown large enough to finally be detected. We have to remember that malignancies always begin as microscopic disease. Added note - $375,000 and counting - WOW ! ! Costs have truly gotten way out of hand. It was much less in the 1980's and 1990's when I was in practice - perhaps one third of that amount for the treatment you describe. Too many people are taking excessive profits these days, and I don't mean just the doctors. Drug company profit taking is just too much. Health insurance company profit taking is also excessive. We must have health care reimbursement reform in the USA. Medicine should not be such a high profit business - it shouldn't be a business at all. These are people's lives we are dealing with. $375,000 is ridiculous.
2 :
Thank goodness for Spreedog. There's no need for any further answers to this question really. Dave, I know it's scary, I've been there. Well, I'm still there - as Spreedog says, metastasis can occur after many years of remission. All I can to is reassure you that the worry does get less as the statistical likelihood of metastasis or recurrence grows smaller. That, and send my love and best wishes to you and Becky.
3 :
The tone of your question suggests that anxiety is creeping into your family's life as the months go by. This is very natural and understandable. You need to be emotionally strong and face this uncertainty with determination. I realize that is easy for me to say and hard for you to do. The awful thing about cancer is the waiting and the fear. The patient and family wait for the next checkup with hope that everything will be OK, but fear that it won't. Every 3 months, 6 months, or whatever schedule the patient is on is feared and awaited. Furthermore, every bump on the skin, cough, and headache brings with it possibilities that you don't want to think about. Waiting and fear . . . I understand completely and sympathize immensely. It is my understanding that cancer recurrence may happen at any time, but tends to present itself within the first 3 to 5 years after diagnosis. Generally speaking, once the patient is out of that danger zone then their risk of recurrence is steadily declining. 'Spreedog' generally has the best clinical answers on the YA Cancer forum, so I would regard his comment as thorough and accurate. Best wishes for many sunny days ahead.



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