reoccurrence concerns

[Jeep65]

I am 3-negative, which I understand is part of the basal-cell subtype classification.  Quick facts:  age 64, white female in excellent health; diagnosed in April 07; lumpectomy followed by a modified radical (R) mastectomy in May  07.  Nothing in margins; nothing in lymph nodes.  Entered a clinical trial evaluating the efficacy of Avastin in post surgical, node-negative, non-metastatic patients.  Received 6 courses of Taxotere, Cytoxan, and Adriamyacin (plus Avastin) three weeks apart.  Now on only Avastin for the remainder of the year.

My question:  Just how aggressive is this cancer?  Given the above aggressive treatment, what are the numbers on reoccurrence and survival?

My oncologist says that I'm "cured".  The optimist in me would like to believe that; the realist wants data.   I'm physically very active (dressage, tennis, etc.) so how do I tell the difference between a routine little pain and something that I need to get checked out?

thx

[Fernando Roque, MD]

Hi. You have early stage breast cancer which has been adequately treated and you have an excellent chance for a cure.  But to say that you are actually "cured" only months after finishing treatment is a little premature, I think.  Breast cancer can recur up to ten years after it is first diagnosed.  You need to follow up with your doctor regularly for the next 5 years, and possibly up to 10 years.  If you have not had a recurrence during that time, then it would be safe to say that you are indeed cured.

As for your cancer's aggressiveness, there are several factors which would suggest a more aggressive disease.  Among the more important ones are the following:

1.  Breast cancer occurring in younger women.
2.  HER-2 positive breast cancer.  HER-2 is a receptor found in the surface of breast cancer cells.  
3.  Estrogen Receptor (ER) negative and Progesterone Receptor (PR) negative
breast cancer
4.  Extensive metastases to axillary lymph nodes at the time of diagnosis.

I do not know the ER, PR and HER-2 status of your cancer so I have no idea of your tumor's aggressiveness. But considering your age, and the fact that you do not have any lymph node metastases, I am inclined to say that your cancer may not be as aggressive.

Survival rates would vary with the stage of the disease.  In general, for Stage 1 disease, the 5-year survival rate (after adequate treatment) is from 98 - 100%. In Stage 2A cancer, the 5-year rates are 88-92% and 76-81% for Stage 2B.  The recurrence rate would vary with the type of treatment done.

I hope the information helps.

[riley180]

Data from patient groups are hard to apply to individual cases especially when there are so many subgroups possible (consider hormone receptor positive yes/no, lymph node positive yes/no, mastectomy yes/no), so I hope this sheds some light and not more mud and confusion.
Consider one series with 256 women, only 41 were triple negative and were lymph node negative. At 5 years, survival was 75%. No recurrence rates given. There is Japanese data in their women (but this includes lymph node positive disease, the cases which were both triple negative and lymph node negative was only 36 women from a total of 793), 5 year recurrence free rates (for all of them) were 77%, and 5 year survival rates were 86%.
There is a large cohort of women  (482 women) who ALL had triple negative disease, however they were not treated with mastectomy (so again the data will not perfectly fit your case, and it is likely their estimates would be better than yours, unless you were actually a candidate for breast conservation but preferred mastectomy), and after 7 years, there were 10 relapses at lymph nodes, 77 distant organ metastasis, and 69 deaths, which translates to something like 82 % recurrence free at 7 years and 86% survival at 7 years.
Your actual estimates are likely somewhere in between. I commend you for participating in the trial, because as you may have surmised from the length of this comment, we really need more information to obtain better estimates.
Regarding the little pain and having pain checked out, generally if it is persistent and progressive and cannot be attributed to certain activities– best to have it checked out.