Breast Cancer Screening and Prevention

Preventing Breast Cancer Recurrence: What's Right for Me?

Summary & Participants

Women and their doctors sometimes have different perspectives on the treatment for breast cancer. Listen to experts discuss treatment goals and the impact these have on daily life.

Medically Reviewed On: June 18, 2008

Webcast Transcript

GENEROSA GRANA, MD: When a woman is newly diagnosed with breast cancer, all she wants to hear is that she will be cured, that this will be gone forever.

ANNOUNCER: The hope is: Surgery will get rid of the cancer for good. But even with early-stage disease, this is not always possible. So while doctors speak of "cure," they also describe the goal of therapy as reducing the risk of recurrence.

GENEROSA GRANA, MD: The majority of women with early-stage disease are cured of their cancer and are not destined to have a recurrence. If we look at a woman with a 5 millimeter breast cancer, which is a stage a breast cancer, 95 percent of those women will not have a recurrence and are considered cured.

But unfortunately, it's not 100 percent. Some of those women, small though the initial tumor may be, will still recur, and the biggest hurdle for us and for the patient is trying to get a handle on who is likely to have a recurrence and what strategies we can utilize to lower the risk of recurrence.

ANNOUNCER: Another goal with treatment for breast cancer is minimizing side effects and maintaining the best possible quality of life.

SUSAN BRAUN: When a woman or man is diagnosed with breast cancer, I think the treatment goals are very individual. Now fairly often a person hopes to be cured. They certainly hope for the best medical, physical outcome that they can have. But clearly the woman or the man who has been diagnosed with breast cancer is very concerned as well with what will this treatment feel like? What will be my quality of life, and not just short term, during treatment, but also long-term? What might be some of the long-term effects of this treatment?

ANNOUNCER: Quality of life goals effect choices women make about surgery.

GENEROSA GRANA, MD: A woman's decision of whether to pursue a mastectomy or whether to preserve her breast with a lumpectomy and post-lumpectomy radiation are very much affected by her thoughts about her appearance, her thoughts about what it will take to have radiation, her thoughts about reconstruction, her thoughts about femininity and all of those issues.

ANNOUNCER: After surgery comes treatment called adjuvant therapy.

CLIFFORD HUDIS, MD: The goal of adjuvant therapy is to kill cancer cells that might have spread beyond the breast and lymph nodes before the surgery took place. So they exist; they're out and about in the body. And we don't have a way of identifying exactly where they are so we have to treat with medicines that circulate throughout the body and kill cancer cells wherever they may be.

ANNOUNCER: One of these "systemic" treatments is chemotherapy. Chemotherapy is easier to take than in years past. But nausea and diarrhea and other sometimes difficult side effects do occur. How does a patient weigh reduced risk of recurrence against the cost of these side effects?

GENEROSA GRANA, MD: There have been some interesting studies that show that women are very willing to accept the side effects of chemotherapy for even small amounts of gain. In one old study now, there was a suggestion that women, for as little as a 1 percent improvement in odds of survival, would willingly accept chemotherapy.

ANNOUNCER: For women with certain types of cancer, hormonal therapy is another treatment used to ward off recurrence. Before menopause, tamoxifen is the appropriate drug. After menopause, women can choose either tamoxifen or drugs called aromatase inhibitors. Hormonal agents are generally easier to handle than chemotherapy. But here, too, patients must balance risk and treatment goals.

GENEROSA GRANA, MD: The most bothersome side effects, for women, associated with hormonal therapy tend to be the hot flashes and the night sweats that are associated with both tamoxifen and the aromatase inhibitors.

ANNOUNCER: Sometimes because of family or medical history, treatment goals may include minimizing risk of blood clots or uterine cancer. Then the risks-and-benefits balance tips toward one type of these hormonal agents, or the other.

GENEROSA GRANA, MD: On a more serious vein, uterine cancer appears to be increased with tamoxifen, as do blood clots, clots in the leg, clots in the lung and even stroke.

The aromatase inhibitors don't appear to have such an increase in those side effects. They, on the other hand, are associated with worsening osteoporosis and fracture risk.

ANNOUNCER: Treatment of early stage breast cancer involves surgery, powerful chemotherapy, and hormonal medicines taken for many years. Women may find it easiest to chart a course through these treatments if they maintain a clear focus on therapeutic goals and balance side effects with their quality of life.