Very frustrated with this part of BC

Where are you reading that Dhanno? I didn't even know stage 1 could return as stage 4. How is that possible, unless the tumor was very high grade/proliferation rate was high? Then I could see yes it could return as more aggressive since it was aggressive to begin with.

Can you maybe post what you read? tami

I don’t recall where I read it but there was something recently posted about how cells from some tumors can spread out in other ways bypassing the lymph system entirely.

I was diagnosed stage IV de novo but was shocked since the lump appeared overnight and I reacted so fast, having all the tests and results in less than two weeks. Sadly, I was naive to think that an immediate response to the lump = early detection.

Oh well, we do what we can and the rest is luck, faith, whatever...

Not all of it is so readily capable of detection by the usual means.

"BSGI has the highest sensitivity for the detection of invasive lobular carcinoma with a sensitivity of 93%, whereas mammography, sonography, and MRI showed sensitivities of 79%, 68%, and 83%, respectively."

Source: https://www.ajronline.org/doi/10.2214/AJR.07.3827

Dhanno: part of the problem in your questioning stage 1 to then stage 4....is that many women have mastectomy and it spreads via the bloodstream. There are no breasts to mammo, no insurance will pay for studies unless you have symptoms or increase in tumor markers. For women that had lumpectomy and radiation, it does not necessarily mean it shows any growth in the breast but shows up in the bones or organs. They don’t scan for our peace of mind. I would have risked the radiation if I could have had ct scans after mastectomy. My lung mets were found accidentally while looking for infection in implant

Cancer, in my humble opinion is a metabolic disease. It is also the luck of the draw, or lack of luck. Our DNA replicates millions of times in our life times, the older we get, the more injurious we are to our bodies, the more replications to our cells. With all those replications, there is bound to be mistakes, or mutations as they are called. Most of the time those mistakes die, but when the mistake is involving a metabolic issue or fails to engage for some reason in cell death, we have cancer. Those cells grow out of control, or could, if activated. So even if you do everything right, you can still get cancer.

As far as it metastasizing, I believe that cells slough off and settle within the body and sit silent, I also believe inflammation triggers a sleeping cancer cell to grow. Lots of things cause inflammation. I also believe that biopsies can also release cells and cause inflammation. I know everyone gets biosies and that most medical professionals do not believe biopsies cause spreading of cancer, so believe what you want. I am pretty sure my cancer was spread to my lymph nodes after my needle core biopsy. It grew to 2.6cm within 9 days and burst the lymph node and prior to the biopsy, there was no evidence it was in my lymph nodes.

What I am doing to limit my possibility of my bilateral breast cancer from metastasizing to stage 4 is, I limit my sugar and carb intake, I fast once a month for a week, only water and black coffee. The study I read was from Dr. Longo of California. Any surgery I have now, I insist on ketorolac preincision, it is an anti inflammatory. There is a study here on our site regarding those Drs. and the studies regarding ketorolac. I have had a port placed as well as bilateral DIEP and my surgeons have accommodated me. I just wish I had known about this before my bilateral mastectomy.

I don't know if what I am doing is working, but I believe it does and I have had several reasons to believe I was a high risk for stage 4 with lesions found on my liver, adrenals and lungs. My Drs have no idea what my lung lesions were in my upper right lung, both lesions attached to blood vessels that disappeared after 6 months. My liver and adrenal lesion are assumed to be cysts and adipose tissue. But they keep scanning them, with no change.

Dhanno:

I was reading about this the other day. I won't lie. Cancer cells are intelligent little MFs and it's scary. Typically the women in question did not have a local recurrence. They had a distant recurrence which grew from micrometastasis.

The science of cancer spread

Key points from that article...

• Only a small number of cells in a tumor contribute to metastasis. They are special cells.
• They change the microenvironment through cell signaling, of the distant sites they will spread to, to make it hospitable to them possibly years before they spread. You could be two years from having a palpable mass in your breast and your lungs could have already received a phone call "Hey lungs, my babies want to move in with you someday. Can you fix the place up for them?"
• To spread through the blood stream, they have to recruit normal cells to help them in, again through cell signaling, and have to undergo a series of changes to survive in it and evade the immune system.
• They can go straight through red blood cells without damaging them.
• They must get out of the blood stream within three days or they can die.
• Once they manage to get out, they can hunker down next to the blood vessel wall and go dormate for decads.
• In a dormate state they are often immune to chemotherapy.
• They often remain immune to previous chemotherapy when they wake up.

That being said, in people who's cancer was treated at an early stage only to have it reoccure as stage IV, either...

1. They had no micrometastasis initially but treatement failed to get all of the primary cancer and they later developed it.
2. Treatment got all of the primary cancer but they already had micrometastasis which the treatment failed to get all of.
3. Some combination if 1 and 2.

1. The treatment really got all of the cancer including any micro metastasis.
2. The treatment did not get all of the micrometastasis but the cells remained dormate or suppressed or were destroyed by the immune system, or died on their own.

urdrago - I was told that when recurrence happens is dependent in part on hormone status. TNBC, if it's going to recur, tends to happen in the first 1-3 years. On the other hand, studies show that ER+ cancer has a fairly steady rate of recurrence to 20 yrs and beyond.

And the five year, ten year time frames have more to do with funding for clinical trials than actual milestones.