October 1, 2008

Sorry, but Your Cancer Has Returned For Many Patients, the War Doesn’t End When First – or Even Second – Battle Has Been Won



Diagnosed with cancer in her left breast in 1988 and then in her right in 2005, Cathy Holland beat both. When doctors told her that she had esophageal cancer in 2006 and throat cancer a year later, she beat those, too.

"I have made it a lot farther than a lot of people," the 56-year- old Jacksonville woman said. "There are a lot of people that get cancer, and you blink your eye and they're gone."

Holland is part of a relatively new breed of breast cancer patient. Advancements in cancer detection and treatment in recent years have made it possible for some patients with aggressive breast cancer to be treated as if it were a chronic illness, experts say.

"Although most patients still will die from metastatic disease, there is suggestive evidence that patients in later decades have more favorable survival, indicating that new therapies may be having a survival impact," concluded researchers with the University of Texas M.D. Anderson Cancer Center in 2002 after reviewing 20 years of patient records.


Cancer is called "metastatic" when it shows up in another part of the body. If it returns, breast cancer tends to crop up in the liver, chest wall, bones, lungs or brain.

The University of Texas research showed that 90 percent of women diagnosed with metastatic breast cancer in the 1970s died within five years. Of those diagnosed in the latter half of the 1990s, the death rate dropped to 60 percent.

Controlling metastatic breast cancer is a balancing act, said Fauzia Rana, a University of Florida oncologist based at Shands Jacksonville.

"If you give too much treatment, it may be toxic, and you're not going to prolong life," she said. "If it [breast cancer] comes back in the system like in the bone, the liver or the brain, you just have to control the symptoms rather than curing the disease. It's not going to go away."

But doctors still have many tools at their disposal.

Many patients will go onto a drug that blocks estrogen, a female hormone that promotes the development of breast cancer. Another popular drug interferes with HER2, the cancer-feeding protein found in about one out of five women with breast cancer. More aggressive types of chemotherapy also can be used.


Many of the women who join clinical trials are in this stage, Rana said, because they tend to be more willing to try new therapies compared with those in earlier stages.

For her part, Holland has avoided trials.

"I wasn't to the point where they can't do anything else," she said.

Holland is cancer-free now but acknowledges that it may return anytime. She has developed her own way of dealing with the uncertainty - hoping for the best.

"I figure there's nothing you can do about it other than feel miserable and feel terrible," she said. "If you're miserable for the rest of your life and you don't die from cancer, you [still] die from old age."

Studies show that breast cancer patients face a higher risk of developing cancer again than healthy people. New tests, though, are allowing women with early-stage breast cancer and their doctors to pinpoint that risk down to a percentage point, said Edith Perez, director of the breast cancer program at the Mayo Clinic in Jacksonville.

Both tests, Oncotype DX and MammaPrint, use tissue taken out during surgery to determine the chances of the cancer spreading. If the risk of return is above about 5 percent to 7 percent over a decade, Perez recommends her patients get additional therapy, such as chemotherapy.

"We don't want to give unnecessary medicines to patients, but at the same time we don't want to miss patients who would have benefits from them," Perez [email protected], (904) 359-4083

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