Endocrine Therapy And Breast Cancer Recurrence

Endocrine therapy is typically used to prevent recurrent in breast cancer survivors, but it usually ended after five years because of side effects. A study has shown that recurrence rates steadily climb after cessation of such therapy, but that recurrence is also associated with the nodal status of the original cancer.  Abstract:

BACKGROUND:

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment.

METHODS:

In this meta-analysis of the results of 88 trials involving 62,923 women with ER-positive breast cancer who were disease-free after 5 years of scheduled endocrine therapy, we used Kaplan-Meier and Cox regression analyses, stratified according to trial and treatment, to assess the associations of tumor diameter and nodal status (TN), tumor grade, and other factors with patients' outcomes during the period from 5 to 20 years.

RESULTS:

Breast-cancer recurrences occurred at a steady rate throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status. Among the patients with stage T1 disease, the risk of distant recurrence was 13% with no nodal involvement (T1N0), 20% with one to three nodes involved (T1N1-3), and 34% with four to nine nodes involved (T1N4-9); among those with stage T2 disease, the risks were 19% with T2N0, 26% with T2N1-3, and 41% with T2N4-9. The risk of death from breast cancer was similarly dependent on TN status, but the risk of contralateral breast cancer was not. Given the TN status, the factors of tumor grade (available in 43,590 patients) and Ki-67 status (available in 7692 patients), which are strongly correlated with each other, were of only moderate independent predictive value for distant recurrence, but the status regarding the progesterone receptor (in 54,115 patients) and human epidermal growth factor receptor type 2 (HER2) (in 15,418 patients in trials with no use of trastuzumab) was not predictive. During the study period from 5 to 20 years, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% for high-grade disease; the corresponding risks of any recurrence or a contralateral breast cancer were 17%, 22%, and 26%, respectively.

CONCLUSIONS:

After 5 years of adjuvant endocrine therapy, breast-cancer recurrences continued to occur steadily throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status, with risks ranging from 10 to 41%, depending on TN status and tumor grade. (Funded by Cancer Research UK and others.).

If you are sick, would you trust a sick health care system

Let me answer the question. Let us say, I am diagnosed with cancer – would I trust our health care? I am unsure. The problem is that the health care system is sick itself. In addition to the pitfalls of the U.S. healthcare system, the U.S. Food and Drug Administration (FDA) seems to be dispensing placebo and toxins, rather than effective anti-cancer drugs. The shocking realization is that many FDA-approved cancer drugs do not work. A recent publication in the Journal of the American Medical Association is the source of this sobering realization. Here is what the authors wrote:
 
Our results suggest that the FDA may be approving many costly, toxic drugs that do not improve overall survival. Enforcement of postmarketing studies is therefore of critical importance.
 
Actionable
Dear FDA, researchers and profiting pharmaceutical companies, please stop pumping pseudoscience into the oncology clinics. By doing so, you are giving ammunition to the alternative cancer treatment proponents. No wonder that the recent Ty Bollinger’s documentary on cancer was watched by more than 800,000 people within the first month of its release on Internet. Laced with some anti-establishment emotions, this documentary contains a few true messages and warnings about our conventional cancer care. The ludicrously expensive new anti-cancer drugs that kill the patients and bankrupt their families, the blatant ignorance of our oncologists about diet and its effects on cancer initiation and progression, the stubborn refusal to research and incorporate century-old remedies, are all ammunition in the hands of the alternative cancer care network. The documentary is an absurd mixture of ignorance and truth that leads us to the denial of any conventional cancer therapy. The vehement negation of the values in the two systems – the conventional cancer treatment and its alternative counterpart  - is the wrong way to go. We should be able to extract the best of both approaches and integrate them. Above all, in our fascination with curing cancer, instead of preventing the birth of the enemy (i.e., the initiation of cancer), we are fighting the enemy at its optimal power (i.e., when the cancer is already established and has advanced). Although prevention is the best path, It seems that no one (mainstream or alternative cancer care proponents) is interested in following this direction.
 
And to answer my initial question: if I cannot prevent my cancer, if I am a cancer patient one day, I will seek a highly integrated cancer care system that includes the best of the mainstream and alternative medicine.