Relative Risk change?

Mausie

Hello!   

I am a 71 y.o. woman. 

I was diagnosed Sep 2006 with 2.5 cm ER-/PR-/HER2+++, 0/4 + sentinel node negative. I had lumpectomy, followed by chemo, then radiation, then a year of Herceptin. 

Sep 2013, they found another cancer, 1 cm ER+, PR+, HER2 negative, in the same breast as previous cancer, but at different location, not near the first one. (4 o'clock vs 12 o'clock) No nodes could be found. I had another lumpectomy and now I am on tamoxifen.  They said this was a completely different cancer, histologically, than before. 

My question is, what does that do to my relative risk? I cannot find any information about this. Do they consider the first one as "cured", or do they consider this new tumor a recurrence of the same cancer, but with changed status? 

Thanks for any information. 

Mausie 

Bren-2007

Hi Mausie,

I'm afraid I can't help you with the statistics.  I'm lousy in math. But it sounds like it's a new primary tumor, not a recurrence.

Check with "Beesie" as she is very knowledgeable about the statistics, including recurrence and mortality rates.  You can PM her and I know she will respond as quickly as she can.

I am so sorry you are faced with this again.

Sending lots of hugs,

Bren

Mausie

Hello Bren, 

Thank you for your kind reply, and for referring me to Beesie. 

I will try and figure out how to get in touch with her. 

I appreciate your efforts!  All the best to you too!

Hugs, Mausie

Bren-2007

Hi Mausie,

You can find "Beesie" by doing a search of her screen name - Beesie - and then you click on her name and it should give you the option of sending her a PM (private mail) note.

Or if you post your question in the Stage I or DCIS forum, she should see it there.  We recently had a very long involved discussion about statistics.  I'll see if I can find it for you.

hugs and best wishes,

Bren

Bren-2007

Mausie ... click on the link below and it should take you to that discussion.  It would be good to post your question there, as many people are posting to that topic.  It's in the Hormonal forum.  I'll bump the topic up for you and let Beesie know to be on the look out for you.

http://community.breastcancer.org/forum/78/topic/8...

Beesie

Mausie, I'm not sure how much help I can be but let me try.

If this cancer had been located in the same place in your breast as your earlier diagnosis, it would be possible that this could be a recurrence. Sometimes a recurrence of an earlier cancer can have a different hormone status.  There are tests that can be done at a very fine level on the genetic make-up of the cancer to determine if it is actually the same cancer or not. However in your case, that probably wasn't thought to be necessary.  Since the hormone status is so completely different (different ER status, different PR status and different HER2 status) and because the location of this cancer isn't in the same place as the original diagnosis, your doctors probably feel pretty safe in assuming that this cancer is a new primary and therefore is not a recurrence.  And if that's the case, it means that you remain "cured" of your original cancer (as much as any of us can ever know that we are "cured").

Since you are 7 years out from your first diagnosis, and particularly because that cancer was ER-/PR-, your risk of recurrence relative to that diagnosis is probably very low at this point.  Most recurrences of ER-/PR- cancers happen within the first 5 years.  So this means that any recurrence risk that you face now is probably almost entirely related to your new diagnosis.  The good news is that a 1cm ER+/PR+/HER2- cancer has a very favorable prognosis.  You didn't provide information about the grade of your tumor, so inputting your data into CancerMath, the results indicate a 15 year mortality rate of 3% for a grade 1 tumor, 5% for a grade 2 tumor and 7% for a grade 3 tumor.   http://lifemath.net/cancer/breastcancer/therapy/index.php

Did you have an Oncotype test done?  That would provide recurrence risk data that is more specific to the genetics of your particular tumor. 

As for whether you have a greater risk now to be diagnosed with breast cancer again, i.e. a third new primary, honestly I don't know.  Having had a hormone negative cancer the first time did put you at greater risk of having a second primary (of any hormone status).  But now that you have a second cancer that is hormone positive, I don't know if your risk is any higher than it was before, or the same, or possibly lower (now that you've had this second diagnosis).  I've been checking to see if I can find any studies on this, but so far, no luck.  I'll keep looking and if I'll post again if I find anything. 

Hope that helps!

Mausie

Dear Beesie, 

Thank you so much for this considerable and valuable reply. I appreciate the time and thought that went into it. Yes, I forgot to mention that both cancers were grade 3. Overall, the picture you paint is very positive and that is uplifting. Thanks for that!  I have been so worried; worried about the first ER/PR negative cancer coming back and then with this second one, I thought I was doomed. Thanks so much for these answers!  I too, could not find very much information, and I know how to search for research articles!  Thanks again, and good luck to you too!  

Mausie 

Mausie

Thanks Bren, for pointing me to Beesie!

She answered my question and I am feeling much better about my prognosis. 

Thanks for your help!

Good luck to you too!

Mausie