Breast can­cer 'can re­turn 15 years after treat­ment ends'

Sunday Times (Sri Lanka) - - INTERNATIONAL -

Breast can­cer can resur­face after re­main­ing dor­mant for 15 years fol­low­ing suc­cess­ful treat­ment, a study has found. Women with large tu­mours and can­cer that had spread to the lymph nodes had the high­est 40% risk of it com­ing back.

Re­searchers writ­ing in the New Eng­land Jour­nal of Medicine said ex­tend­ing treat­ment with hor­mone ther­apy could re­duce the risk of it re­cur­ring.

Sci­en­tists an­a­lysed the progress of 63,000 women for 20 years. All had the most com­mon form of breast can­cer. This is a type fu­elled by the hor­mone oe­stro­gen which can stim­u­late can­cer cells to grow and di­vide.

Ev­ery pa­tient re­ceived treat­ments such as ta­mox­ifen or aro­matase in­hibitors which block the ef­fects of oe­stro­gen or shut off the hor­mone's sup­ply. Although after five years of treat­ment their can­cers had gone, over the next 15 years a steady num­ber of women found that their can­cer spread through­out their body - some up to 20 years after di­ag­no­sis.

Women who orig­i­nally had large tu­mours and can­cer that had spread to four or more lymph nodes were at high­est risk of the can­cer re­turn­ing the next 15 years. Women with small, low-grade can­cers and no spread to the lymph nodes had a much lower 10% risk of can­cer spread over that time.

Lead re­searcher Dr. Hongchao Pan, from Univer­sity of Ox­ford, said: "It is re­mark­able that breast can­cer can re­main dor­mant for so long and then spread many years later, with this risk re­main­ing the same year after year and still strongly re­lated to the size of the orig­i­nal can­cer and whether it had spread to the (lymph) nodes."

Doctors have known that five years of ta­mox­ifen re­duces the risk of re­cur­rence by about a third in the five years after stop­ping treat­ment. Re­search has sug­gested that ex­tend­ing hor­mone ther­apy to 10 years may be more ef­fec­tive at pre­vent­ing breast can­cer re­cur­rence and death. Aro­matase in­hibitors, which only work for post- menopausal women, are be­lieved to be more ef­fec­tive. But there are side ef­fects with hor­mone treat­ments which can af­fect patients' qual­ity of life. These in­clude menopausal symp­toms, os­teporo­sis, joint pain and carpal tun­nel syn­drome.

Prof. Arnie Pu­rushotham, se­nior clin­i­cal ad­viser at Can­cer Re­search UK, which funded the study, said that since the re­search be­gan, new drugs had been used to treat breast can­cer and those worked in dif­fer­ent ways to ta­mox­ifen. He said: "It's vi­tal that work con­tin­ues to bet­ter pre­dict which can­cers might re­turn.

Sally Green­book, from char­ity Breast Can­cer Now, said it was es­sen­tial that women dis­cussed changes in treat­ment with their doc­tor. "We urge all women who have had treat­ment for breast can- cer not to be alarmed, but to en­sure they are aware of the signs of re­cur­rence." (Cour­tesy BBC)

Breast can­cer cells are stim­u­lated to grow and di­vide by the hor­mone oe­stro­gen Those who had large tu­mours and can­cer that had spread to four or more lymph nodes were at high­est risk

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