Cancer is a disease that many people feel terrible when they hear it, but some cancers actually have a better prognosis and are not terrible. For example, thyroid cancer progresses slowly, many patients will not get sick for life, and some people even call it the shame of cancer. Although breast cancer is not as good as thyroid cancer, it is also a cancer with a relatively good prognosis.
Thanks to the proximity of the breast to the surface and the popularity of breast cancer screening, the early diagnosis rate of breast cancer is relatively high[1], coupled with relatively perfect treatment methods, the 5-year survival rate of breast cancer in developed areas can reach about 90% [2].
In addition to diagnosis and treatment, long-term standardized follow-up is also an indispensable part of the long-term survival of breast cancer patients.
What is follow-up? Why follow-up after cancer treatment?
Follow-up is simply a regular review of cancer survivors. In the follow-up, on the one hand, it is necessary to evaluate the side effects of treatment, and more importantly, to monitor whether the tumor has recurred. In this regard, follow-up can also be seen as a special kind of cancer screening for tumor survivors.
We all know that cancer is a disease that is easy to recur and easy to metastasize. Moreover, the metastasis of cancer cells is not limited to advanced tumors, and a small number of cancer cells leave the primary lesion in the early stages and lurk throughout the body [3].
These latent cancer cells cannot be removed by surgery and can only be eliminated by systemic therapies such as chemotherapy and targeted therapy, but it is inevitable that there will be fish that slip through the net. In particular, dormant cancer cells often have strong resistance to various anti-cancer therapies [4] and are easy to survive treatment, leading to cancer recurrence.
Moreover, with the current means of examination, whether it is CT, MRI or PET, or other tests such as tumor markers, it is impossible to find dormant tumor cells in the patient's body. Even in patients who have achieved complete remission and no visible tumors, there will be invisible cancer cells in the body, and there is a risk of recurrence. According to statistics, about 4.7% of breast cancer patients without tumors in the body after surgical resection will have local recurrence within 10 years, 3.0% will relapse regionally, and 15.0% will have distant metastatic recurrence [5].
In addition to the recurrence of the original tumor, cancer patients often have some high-risk factors for cancer in their bodies, and they are also high-risk groups for cancer. For example, about 2% to 11% of breast cancer patients will have breast cancer recurrence in the contralateral breast. Breast cancer survivors have a 2 to 6 times higher risk of contralateral breast cancer than the average woman who develops breast cancer for the first time [6].
Whether it is a recurrence of breast cancer or a new contralateral breast cancer, there are no symptoms at the beginning, and the patient himself is likely not to notice. Regular follow-up can help us detect these conditions in time, treat them in time, and obtain better results.
What should I do with breast cancer follow-up?
Cancer has different risks of recurrence at different times after treatment. In general, most cancer recurrences occur within 5 years of diagnosis, and the risk of recurrence after 5 years is low. This is also why 5-year survival is considered a marker of clinical cure in cancer treatment.
In the case of the most dangerous and high-recurrence triple-negative breast cancers in breast cancer, about one-third of patients will relapse, and common sites of recurrence include brain metastases, lung metastases, bone metastases, liver metastases, and in situ recurrences [7].
There are also different peaks for recurrence in different parts. Like bone metastases and liver metastases, recurrence rates have been slowly decreasing in the first 5 years, but there is a peak of bone metastases in the 6th year. Recurrence in situ, brain metastases, and lung metastases peak 1 to 2 years after diagnosis, and then gradually decline [7]. Overall, the peak recurrence in triple-negative breast cancer patients is the first two years after diagnosis, and the risk of recurrence after 5 years is low.
Recurrence rates of triple-negative breast cancer at different locations at different times
Depending on the risk of recurrence, cancer patients are also followed up at different frequencies at different times [8]:
In the first two years with the highest risk of recurrence, follow-up is recommended every 3 to 4 months;
In the 3rd to 5th years, the risk of recurrence begins to decrease, and follow-up is recommended every 6 to 8 months;
After 5 years, the risk of recurrence is very low, and follow-up once a year is enough.
What should I do if I find abnormalities during follow-up?
The results of the follow-up are naturally good and bad, and the good results are all happy and continue treatment, but if the recurrence or progression of the tumor is found in the follow-up, the treatment plan is often changed.
Realistically speaking, the prognosis of breast cancer patients who have relapsed is relatively poor, but there is still hope of living longer. Especially now, cancer treatment methods are changing rapidly, even for recurrent triple-negative breast cancer, there are also effective treatments such as immunotherapy, PARP inhibitors, and the latest breakthrough therapies - antibody-coupled drugs that target Trop-2. Timely treatment after tumor recurrence can still prolong the patient's life and improve the quality of life.
For example, the antibody-coupled drug gosartozumab, which targets Trop-2, can achieve a significant effect of two times longer than chemotherapy in patients with relapsed or refractory triple-negative breast cancer, and the median overall survival is doubled [9]. Timely treatment after tumor recurrence can prolong the patient's life and improve the quality of life.
Follow-up should not be nervous, and the mentality should be put at ease
For cancer patients, every follow-up visit is like a verdict, which is inevitably stressful. Approximately one in five patients have been shown to develop moderate or severe anxiety at follow-up [10,11]. Excessive stress not only reduces a patient's quality of life, but also reduces the body's immunity and even increases the risk of cancer recurrence [12].
For the tension in the follow-up, cancer patients should relax their minds on the one hand, and on the other hand, they can also relieve the tension through sports, music, communication with relatives and friends. If necessary, you can also seek the help of a professional psychologist.
bibliography:
[1]. Iqbal J,Ginsburg O, Rochon P A, et al. Differences in breast cancer stage at diagnosisand cancer-specific survival by race and ethnicity in the United States[J]. Jama, 2015, 313(2): 165-173.
[2]. Siegel, R. L.,et al. (2022). "Cancer statistics, 2022." CA: A Cancer Journal forClinicians 72(1): 7-33.
[3]. Hüsemann Y,Geigl J B, Schubert F, et al. Systemic spread is an early step in breastcancer[J]. Cancer cell, 2008, 13(1): 58-68.
[4]. Park S Y, Nam JS. The force awakens: metastatic dormant cancer cells[J]. Experimental &Molecular Medicine, 2020, 52(4): 569-581.
[5]. van Maaren M C,de Munck L, Strobbe L J A, et al. Ten‐year recurrence rates for breast cancer subtypes in theNetherlands: a large population‐based study[J]. International journal of cancer, 2019,144(2): 263-272.
[6]. Chen Y, ThompsonW, Semenciw R, et al. Epidemiology of contralateral breast cancer[J]. CancerEpidemiology and Prevention Biomarkers, 1999, 8(10): 855-861.
[7]. Pogoda K,Niwińska A, Murawska M, et al. Analysis of pattern, time and risk factorsinfluencing recurrence in triple-negative breast cancer patients[J]. Medicaloncology, 2013, 30(1): 1-8.
[8]. https://www.esmo.org/content/download/6593/114959/1/EN-Breast-Cancer-Guide-for-Patients.pdf
[9]. Bardia, A.,etal. (2021). "Sacituzumab Govitecan in Metastatic Triple-NegativeBreastCancer." New England Journal of Medicine 384(16): 1529-1541.
[10]. Lampic C,Wennberg A, Schill J E, et al. Anxiety and cancer-related worry of cancerpatients at routine follow-up visits[J]. Acta Oncologica, 1994, 33(2): 119-125.
[11]. McKenna M C,Zevon M A, Corn B, et al. Psychosocial factors and the development of breastcancer: a meta-analysis[J]. Health Psychology, 1999, 18(5): 520.
[12]. Conley C C,Bishop B T, Andersen B L. Emotions and emotion regulation in breast cancersurvivorship[C]//Healthcare. Multidisciplinary Digital Publishing Institute,2016, 4(3): 56.
Source | Boom cancer circle