How to cope with fear of breast cancer recurrence

Hello, I'm Rene Syler, an ambassador with Susan G. Komen For the Cure. And I'm someone who's seen breast cancer up close and personal. In my immediate family, my mother and father both had breast cancer. If you've had breast cancer, and you've been treated, and you've been declared cancer free, you might feel a sense of relief. But you might also fear a recurrence.

Joining me now is Dr. Anne Moore. She's the Medical Director of the Breast Oncology Program at Weill Cornell Medical College. Dr. Moore, thanks for joining us.

Thank you're Rene.

What are the chances of a recurrence of breast cancer. Are there statistics on that?

There certainly are statistics, and it really depends on the initial stage of the cancer and on the treatment. And, I think, fear of recurrence is probably the biggest problem our patients have after they have finished their primary treatment, whether it was surgery, or surgery plus radiation, or chemotherapy. I think that's what worries them the most, will this cancer come back?

But you also hear, a lot of times, people say, well, I'm past five years, the five year mark. Does that mean anything? Does that offer any protection once you get past five years?

Well, every year that passes after the diagnosis of breast cancer, the chance of a recurrence somewhere else in the body decreases. So even after two years, the chances of a recurrence have decreased.

But once someone has a breast cancer, aren't they at increased risk for developing the disease, say in the other breast.

If you've had breast cancer once, you are more likely than a woman who has not had breast cancer to get it in the opposite breast. I think the recurrences our patients fear the most are a spread to someplace else, such as the bone.

A recurrence is very different from a new breast cancer in the other breast, right?

That's right.

Is a recurrence more difficult to treat?

A recurrence is more difficult to treat. A new breast cancer, we just start from fresh, and that's a curable condition. If a breast cancer has spread someplace else in the body, we can't cure that with all our treatments, but we sure can give good treatment. Women can be up and around, feeling well for a long time. But it's not a curable condition. Women know that, and that's why they're so fearful.

We hear a lot about tamoxifen and aromatase inhibitors, what is their role?

Well, in women in whom the cancer is estrogen receptor positive, which is the majority of breast cancers, taking tamoxifen or, in older women, aromatase inhibitors with or following tamoxifen, decreases the risk of a new breast cancer by 30% or 40% and decreases the risk of recurrence of breast cancer and somewhere else in the body by 30% or 40%. So they have been wonderful, wonderful medicines for us.

And for women who are not ER positive?

For women who are estrogen receptor negative, which are the minority of women, but plenty of them, the hormone treatments such as tamoxifen or the aromatase inhibitors are not useful for them.

What do they use then, typically?

Well, typically, after their surgery, we will recommend chemotherapy for them, over a period of time, maybe three months, or four months, six months. And then we don't follow that with hormone therapy. And the chemotherapy has also decreased recurrences, particularly in the estrogen receptor negative women. So that's been a big advance.

Sometimes we hear about tamoxifen being prescribed to women to prevent breast cancer. What are your thoughts on that?

I think this has been another breakthrough for us. The large trials have shown that women who are at increased risk to get breast cancer, and that's women with a very strong family history or women who have had abnormal breast biopsies, predicting a higher risk for breast cancer, they will benefit from taking five years of tamoxifen. And these are younger women and older women. Both groups will benefit. More recently raloxifene has just been FDA approved for older women, from postmenopausal women, also to decrease the risk

As a physician, what do you tell your patients who come to you and they say, OK, we treated this cancer, but I'm scared that it might come back? What do you say to them?

I think it's very important that they tell us that they're scared that it might come back. Everybody gets a backache. Everybody gets a headache. For most of us, we're not worried that it's a brain tumor. It's a headache. And for most of our patients, it's just a headache. But if the headache persists, and they're worried about it, let us know. We can usually talk them out of the worry. If necessary, we can do testing. But we do know, we're very aware that that's the biggest fear. Whether they tell us that or not.

So you're trying to tell them to handle it a step at a time. And wait until you actually have something to worry about.

That's right.

Dr. Moore, thank you so much.

For more information, you can visit the Susan G. Komen For the Cure website at www.komen.org, or you can call their helpline at 1-800-I'm Aware. I'm Rene Syler.