BC have Different Long-Term Recurrence Risks

very interesting, and sobering.

Thanks again to cp for keeping us up to date and JohnSmith for the background link. As I approach the 5 year milestone, recurrence due to tumor dormancy has been on my mind...

excellent point, kayb...not sure why they didn't think of that...

Sorry. The link is fixed above, but here's the Abstract.
Metastasis Dormancy in Estrogen Receptor–Positive Breast Cancer

Abstract: About 20% to 40% of patients with breast cancer eventually develop recurrences in distant organs, which are often not detected until years to decades after the primary tumor diagnosis. This phenomenon is especially pronounced in ER+ breast cancer, suggesting that ER+ cancer cells may stay dormant for a protracted period of time, despite adjuvant therapies. Multiple mechanisms have been proposed to explain how cancer cells survive and remain in dormancy, and how they become reactivated and exit dormancy. These mechanisms include angiogenic switch, immunosurveillance, and interaction with extracellular matrix and stromal cells. How to eradicate or suppress these dormant cancer cells remains a major clinical issue because of the lack of knowledge about the biologic and clinical nature of these cells. Herein, we review the clinical manifestation of metastasis dormancy in ER+ tumors, the current biologic insights regarding tumor dormancy obtained from various experimental models, and the clinical challenges to predict, detect, and treat dormant metastases. We also discuss future research directions toward a better understanding of the biologic mechanisms and clinical management of ER+ dormant metastasis.

hi, kayb! I wouldn't call it self-serving (& why not discover more about your particular type of BC?) but just a natural tendency to find out what new research can shed light on treatments, survival rates, etc. I also feel like I'm a little bit in an odd area because of the PR- status of my tumor.

I don't often see too much info or research on ER+ PR- tumors

THanks ShetlandPony, I so just want to feel whole again

Ladies, I owe you an apology. I think my post above regarding cellular changes was irresponsible because I have no sources to cite and my onc's comments may not apply to all situations. It was something she said to me in answer to my asking her if I needed a mastectomy for the breast recurrence, stage iv. Her concerns and her recommendation for me to not have this surgery were for me with all my particulars, including the fact that I had been diagnosed with mets to three places. She said that mastectomy for stage iv was an area of discussion and that she was thinking of what she has personally seen in her practice. I do not believe there is a definitive answer on this question. *Plenty of oncs recommend reconstruction for their patients, especially stage I-III patients.*

As far as anesthesia, elsewhere on these boards there are discussions of the effects of general anesthesia vs. nerve block plus propofol. They mention some sources. But again, I don't know of any practice-changing studies.

https://community.breastcancer.org/forum/73/topics...

(Edited to explain that I deleted my previous post because of the concerns I mention in this post. It is an interesting topic, but I don't want to cause anyone more doubt or fear.)

Shetland Pony you are right on both counts. I have read about the cellular changes and the anesthesia in recurrence. However, I did not keep the references. I think my BS wrote a paper on the anesthesia, I tried to find it a while back. There comes a point where the cancer mutates and one thing I remember reading is it can mutate so it doesn't need estrogen anymore to survive. That's why AI's lose their efficacy.

Hi all, here's a thread on the topic of "Anesthesia and recurrence of cancer": https://community.breastcancer.org/forum/73/topics...

It has a bunch of review articles including the one JuniperCat just posted. Essentially surgery creates a wound, and a lot of the factors that are upregulated to heal wounds are the same ones that drive cancer growth (not coincidentally one of the nicknames for cancer is "the wound that never heals"). Also, there's the belief that primary tumors may suppress micrometastases and circulating tumor cells, and once they are gone that suppressive effect is, too. And there's concern that surgical stress inhibits natural killer cells that are our body's defense against cancer.

But of course surgery is vitally important in ridding ourselves of cancer, and to rebuild our bodies! So the point is not to scare anyone about surgery, but to encourage everyone to look at the available anesthetic choices and try and pick the ones that seem to counter the effects of surgery (like paravertebral nerve blocks, propofol, keterolac and other NSAIDs, etc.)