ER/PR+ tends to metastasize in three rather than five years?

Jiffrig

My BS mentioned that my type of cancer tends to metastasize or not in three years rather than five. Has anyone else heard this? I have kind of spot checked some diagnoses and this does seem common

Georgia1

Honestly I have not heard this. Maybe others who are more knowledgeable will chime in.

marijen

jiffrig, yes I have noticed that too but also only spot checked. I am at three years from dx now so good luck to me.

Celand

I have heard that this type of cancer tends to recur within 3 years.

letsgogolf

I have never heard this about ER+, PR+, HER2-. I have read and been told the exact opposite. My understanding is that we instead need to worry about late recurrence.

moth

Are you talking specifically about metastatic recurrence or any recurrence?

There was a long term study on recurrence published in 2016. Biggest risk is in first 5 years for both ER+ and ER-.

ER- tends to recur early in the 5 yrs; ER+ risk of recurrence seems to stay pretty steady for ever

"Patients with ER-positive breast cancer maintain a significant recurrence rate during extended follow up. Strategies for follow up and treatments to prevent recurrences may be most efficiently applied and studied in patients with ER-positive disease followed for a long period of time."

https://www.ncbi.nlm.nih.gov/pubmed/26786933

wrenn

I remember reading that triple negative has a high relapse rate in first 3 years.

klvans

My MO said triple negative tends to have the most risk the first 2 years, with up to 5 years quite risky. Thereafter it tends to go down dramatically for triple negative. The positive cancers are also at the most risk the first 5 years, but that risk is lower than for triple negative. The risk of recurrence doesn't go down as much after 5 years as it does for triple negative, but then it's not as high to begin with.

wrenn

Just curious. How do you measure the years? Is it from date of diagnosis (this doesn't make sense to me since it was there before that date), date of having it removed (surgery) or date you finish treatment?

Meow13

I have recently read that er+ and pr- may behave more like triple negative in regards to recurrence. Not sure there is enough data to substantiate this. Especially high er+ and pr absence. Still alot to learn.

But every year that goes by without recurrence is a positive outlook for the future.

Lita19901

Meow, I read something recently that said that progesterone acts as a BC inhibitor, or at least until the cancer figures out how to block it.

Meow13

Lita, that sounds like article I read. That the progestrone receptors help dial back the estrogen therefore putting the brakes on.

Racy

As patients with hormone positive cancers generally take hormone therapy for at least five years, it is my understanding that this delays recurrence. It is more likely to occur after hormone therapy ceases.

I have seen many cases on this site that followed that pattern, with some recurring within months of stopping hormone theapy and some a decade or more later.

Outfield

There's nothing magic about 3 years or 5 years for ER+ breast cancer. That's a misunderstanding that may have originally been propagated by the use of 5-year survival as a measure of success of a treatment in clinical trials. The risk of recurrence for ER+ breast cancer appears never to go to zero.

This is an approximation (because cancers can be complicated and can be mixtures of aggressive and less-aggressive cell populations), but it's a useful concept. With cancer in general, aggressive (fast-growing) cancers tend to recur faster than indolent (slow-growing) ones, but after a certain amount of time it's the indolent ones that are more likely to recur. If you think about it, that makes sense. If a person had a very aggressive cancer and has made it (I'm picking a random number here, so as not to bring in the "3" and "5" thing) 17 years, it's highly unlikely that the cancer will return because, being fast growing, it would have made its presence known much earlier if there were any of it left. A tiny amount of slow-growing, indolent cancer could hang around for that long without being noticed. So if a person has a cancer recur many years later, it suggests that the original cancer was slow-growing.

What the take home from this is that because your BS made a statement that they think your cancer, if it recurs would be more likely to recur earlier, it means that for some reason your BS thinks that you had a fast growing tumor. That seems a little odd looking at your Dx specifics, which don't suggest something aggressive. But overall, it's kind of an odd thing to say anyway since ER+ cancer just hit the news in a major NEJM paper last year showing disappointingly measurable recurrence rates as far out as 20 years after stopping endocrine therapy http://www.nejm.org/doi/full/10.1056/NEJMoa1701830, and the authors comment even in the abstract that recurrences occurred "steadily" throughout the follow-up time period. Of course, that doesn't predict any one person's risk because each individual has factors that make their cancer more or less aggressive, but it does tell us that for ER+ cancer as a whole group, there is no finish line where you can be sure you're done with it. So even if your BS does think you had an aggressive cancer, why they mentioned 5 years as a comparison is a mystery.

Honestly, if you want to know about your risk for recurrence, you should talk to a breast oncologist, not the surgeon.

Lita19901

Outfield - very interesting information! Thanks so much for sharing.

I also read an article a few months ago that addressed recurrences that happen during estrogen deprivation therapy. Apparently, BC can actually start making its own estrogen that isn’t affected by Tamoxifen and the AI’s. It astonishes me how smart BC is

Jiffrig

I think what she was saying to me is that most ER+PR+ cancers tend to show up in 3 rather than 5 years. But the danger of reoccurrence is always there, just diminished as time goes on. No, mine is not aggressive but just as a general rule this is a characteristic timeline. It is interesting to note how many stage IV do occur within 3 years amongst our members

Sophiemara

I've always read that as a general consensus BC which comes back within the first 2 years tends to be super aggressive and related to triple neg, which has no treatment post chemo/rads.

HER2 tends to have herceptin (for a year) post chemo/rads and intermediate risk of recurring years 4-5.

ER/PR+ from the literature appear to be slow burners and maybe this is connected to the fact that people get given hormone therapy for atleast 5 years (now up to 10 years). So maybe its this what potentially causes ER/PR+ to reoccur later (5 years+)..when hormone therapy has been completed.

Insideout2

The posts on reoccurrence has been informative.

Thanks for sharing.

Traveltext

Thanks Outfield, a clear summary of the latest thinking on this always popular topic.