Cancer Care

Last fall, Elizabeth Edwards was the guest speaker at a Boston conference sponsored by NEWSWEEK and Harvard Medical School. She was in the midst of a tour promoting her recently published book, “Saving Graces.” Although Edwards spoke in detail about the greatest trials in her life, especially the death of her 16-year-old son in a car accident and her struggle with breast cancer, she conveyed an inspiring optimism about her future. That optimism reappeared today when she and her husband, presidential contender John Edwards, announced that her cancer has returned, this time to her bones. Still, she told a crowded press conference: “I don’t look sickly. I don’t feel sickly.” Despite the devastating news, the couple vowed to continue campaigning. “This is the most extraordinarily unselfish woman I have ever known,” her husband said, with a touch of awe in his voice. Her doctor is waiting for the results of some tests taken this week before starting treatment. To find out more about what Elizabeth Edwards and other breast cancer survivors might expect, NEWSWEEK Senior Editor Barbara Kantrowitz spoke with Dr. Jo Anne Zujewski, investigator in the Division of Cancer Treatment and Diagnosis for the National Cancer Institute (NCI). Excerpts:

NEWSWEEK: Let’s start with a definition. What is metastatic breast cancer? My understanding is that there are two kinds: metastatic cancer found at the time of the original diagnosis, which constitute about 10 percent of cases, and metastatic cancer diagnosed later (in a recurrence). Can you explain?
Jo Anne Zujewski: Clinically, the most important distinction is whether the breast-cancer cells are confined to the breast and lymph nodes—this is sometimes referred to as early-stage breast cancer—or if they are in distant sites, such as the bone, liver, lungs. Patients who have breast-cancer cells in distant sites are said to have advanced breast cancer—whether or not the cancer was detected at the distant sites at first diagnosis—or later.

Cells from malignant tumors can spread to other parts of the body by breaking away from the original or primary tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis. When breast-cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast-cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor “distant,” or metastatic, disease.

What percentage of women diagnosed with breast cancer have a recurrence after treatment?
This depends upon the stage of diagnosis; breast cancer can reoccur years after the initial diagnosis. NCI data shows that 89 to 90 percent of women who have an initial diagnosis of breast cancer are alive without disease five years after a diagnosis. However, since breast cancer can reoccur later—sometimes decades later—I would estimate that in the long term, about 30 percent of women will have a recurrence. This is hard to estimate as our treatments keep getting better, so data we have from 20 years ago do not apply to women diagnosed today. I find the NCI SEER data on the trends in breast cancer [comparing 1975-2000 data] very interesting and encouraging. [Click here to view the data.]

Is recurrence more likely when malignant cells are found in lymph nodes?
Yes. Tumor cells found in the lymph nodes are a negative prognostic factor, which would lead to a diagnosis of Stage II or III disease as opposed to Stage I. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. A doctor will monitor recovery and check for recurrence of the cancer.

What treatments are available for breast cancer that has spread to the bones?
We consider treatment based on the cancer cells. It could be hormonal, chemo or biological—herceptin or lapatinib—depending on the tumor type and the woman’s symptoms. However, bisphosphonates, which are given for bone health, have been shown to decrease the risk of pain and fracture, so these are often given to women with cancer in the bones.

Source : www.newsweek.com