How is Recurrence and New Occurrence Rate Determined?

macdebbie

I had my lumpectomy Tues, which went great except for a nausea patch they gave me (which I told them I didn't want) that cause dilated pupils for 4 days.

I got my path report Thursday, and the news was all good - no lymph node involvement, 3mm size, clear margins. Grade ii (which I assume means 2?)., ER - 100%, PR - 97%, KI-67 - 3%, HER2/NEU negative, Stage PT1a, PN0 (sn).

How do they determine 1) Recurrence Rate (I assume recurrence rate is of the cancer in the same spot?), and 2) a New Occurrence Rate of another cancer in the same breast or the other breast?

I also had the Invitae genetic tests done and they were all negative for breast cancer mutations and any other type of cancer mutations.

My MO told me that he would send my tissue sample to Oncotype, but I think I read that they will not do that if it's under 5mm?

I'm a little worried because I had 2 "worrisome" areas in my right breast. The first one they did a biopsy under ultrasound, and when they did they biopsy the radiologist said that the mass disintegrated. Then the clip that they put in to mark the area migrated or got suctioned out, but after 4 more mammogram slides, they said it was not evident anywhere in the breast. The path report came back as a benign cyst. I'm not sure how confident I can be of that.

Will the radiation take care of any cancer cells that are maybe left in the breast that are microscopic? Is it possible that there are cancer cells in my bloodstream if I didn't have any positive lymph nodes?

I meet with my BCS this coming Wed. Is she the one who goes over the recurrence stats with me, or is that my MO?

MountainMia

Unless you ask, it's possible neither of your doctors will talk about recurrence stats.

I don't know if you will get Oncotype run or not. I don't know what the limits are there. You can use the Predict tool to get an estimate for yourself. It doesn't actually give risk of recurrence. It gives risk of death (overall survival, with death from breast cancer or any other cause) at 5 years, 10, and 15. https://breast.predict.nhs.uk/tool

Note the tumor size is in mm, not cm. You can show the results in a variety of ways. I encourage you to try them, so you can see what's most easily understood for you.

[Edited to add, Predict talks about "surgery alone." They explain elsewhere that this means EITHER mastectomy, or lumpectomy with radiation. Those are considered to be equivalent procedures. ]

The radiation therapy is to reduce the risk of recurrence within the breast. That would be a local recurrence. A NEW occurrence would be a new cancer, not related to this one. Talk to your doctors about this. However, you should probably assume that your risk of a new cancer is at least as high as your pre-diagnosis risk of a cancer would have been assumed to be. Unfortunately, we don't have "one and done" in breast cancer world.

Glad to hear your surgery went well.

Aklynna

Hello!

I have no information to answer your actual question, butcan speak to the oncotype. My tumor was exactly 5mm. My surgeon contacted the MO office directly and found that the tumor must be over 5 mm to have oncotype run. So I'm a no go on that! I have my appt tmw with MO and RO. Scared to death for both. Just want to say no thank you to all of this and rewind time to June 29th when I was blissfully unaware of ALL of this..

moth

you can use tools like Predict https://breast.predict.nhs.uk/tool

& lifemath http://www.lifemath.net/cancer/

Yes a single cell might have escaped but I think you'll see your specific odds of that *not* happening are awfully good. It can spread through blood or lymph & while we assume a negative sentinel biopsy means it hasn't gone there, it is not a guarantee.

Also remember that local or contralateral recurrence are not fatal. It is metastatic recurrence they're trying to figure out because metastatic breast cancer is the only one that's terminal. When you look at the 5,10,15 yr survival charts on those calculator sites, the ones who died developed metastatic disease.

I think your pathology is very good.

Hth & Best wishes