Late recurrences possible in cancer

Dear Dr. Roach: I just read another sad story about a woman who had breast cancer, fought it and seemed to win, but after five years, it came back and took her life. The same sequence of events happened to my wife two years ago. She fought the second round of cancer for a year and a half. What is this connection between the initial breast cancer occurrence and it coming back five or six years later even more widespread? Is screening stepped up during that period? — Anon.

I am very sorry to hear about your wife.

With most cancers, no evidence of disease five years out from diagnosis usually means a cure, that the person will not have a recurrence of that particular cancer, although people who’ve had one cancer are at a higher risk of developing a second, unrelated cancer. Breast cancer is one of the exceptions. Late recurrencesare possible. I have seen 20 years afterward, and there are reports of longer.

Although the reasons why breast cancer seems to hide for many years are not known precisely, we do know some risk factors for recurrence: Larger tumors are more likely to recur. Those with positive lymph nodes are at high risk, and women with estrogen receptor positive, progesterone receptor positive and HER2 negative tumors are more likely to experience recurrence.

Screening is absolutely appropriate in women who have had breast cancer. There is not a consensus about the type and frequency of screening, but many experts choose yearly mammography. Breast MRI has been considered, but it has not been proven to be better in women with a history of breast cancer.

A healthy lifestyle, including exercise, a diet with fruits and vegetables, abstinence from smoking and minimal alcohol intake, has been shown to reduce cancer risk in women with a history of breast cancer.