prognoses of stage 3B breast cancer?

[janet482]

My sister-inlaw underwent a mastectomy in October 2007, also a massive amount of her lymph nodes were removed.  At the time of her surgery I was told she was stage 3B invasive carcinoma.
Because of suspected heart problems chemotherapy was delayed, her fist chemotherapy was January 31, 2008.  She has had 4 treatments of chemotherapy with 4 remaining, then radiation.

I am very concerned because of the delay in treatment.  After her treatments are completed how do we know the treatments have been successful?  Are her chances of recurrence higher than normal?

[Fernando Roque, MD]

Hi.  The purpose of those follow-up consultations with her oncologist after the treatment is completed, is precisely to determine if she remains cancer free, and to see if there is any metastatic recurrence.  The usual schedule of post-treatment follow-up is every 3 months for the first two years, then every 6 months for the next three years, and yearly for another 5 years to complete a ten year period.  During those consultations, a general physical and breast examination will be performed, as well as periodic mammograms.  Other procedures like CAT scans or bone scans will be done to confirm suspicions of disease recurrence.

By doing the surveillance, we are not actually being passive and “just wait to see if she dies within 10 years”.  The surveillance puts us in a state of alertness and readiness to intervene at the earliest sign that the cancer has reappeared. Furthermore, if her breast cancer is hormone receptor positive, she is most likely to receive additional maintenance hormonal treatment (e.g. tamoxifen or aromatase inhibitors for 5 years), to further reduce the risk of recurrence.  

[janet482]

Thank you for your response regarding my sister in-law, but, I would like to know if there is any way to find out if her cancer metastasized, or if she is cancer free after her treatment is completed?  Do we just wait to see if she dies within 10 years?
Respectfully, Janet

[Fernando Roque, MD]

Hi.  Adjuvant chemotherapy is usually given at around 5-6 weeks after surgery to allow time for the operative wound to heal.  A delay in the initiation of chemotherapy beyond this time could in theory, increase the risk of any remaining cancer cells to metastasize beyond the original site.  However, the question whether a delay in starting adjuvant chemotherapy would result in higher recurrence rates has not been formally studied, so we don't have any statistical evidence which definitely proves this.  

After your sister-in-law's treatment is finished, she needs to follow up with her doctor regularly for the next ten years or so, for surveillance purposes. Breast cancer can recur even at ten years after initial diagnosis.  We can reasonably say that the treatment is successful if she remains cancer-free beyond ten years.