Recurrence of breast cancer: avoid it, how long after?

60,000 women are affected by breast cancer each year in France. 15 to 20% of these cancers will recur 10 years after the first diagnosis. Can relapse be prevented? How ? Which breast cancers recur the most?

Breast cancer affects almost 60,000 women each year in France. Like all cancers, it can recur. “The risk of relapse is estimated at 0.5 to 1% per year, all life” says Dr. Paul Cottu, deputy head of the department of medical oncology at theCurie Institute. What is a “relapse”? Do some breast cancers relapse more ? Can these relapses be prevented? How ? Expert advice.

What is cancer relapse or recurrence?

The recurrence or relapse of a cancer is defined by the reappearance of cancerous cells, in the same place or in another region of the body (organ or tissue). When cancer recurrence in the breast itself (in the case of breast cancer) we speak of “local” recurrence or “localized”. When he recurs at a distance, we speak of “metastatic” cancer. “A recurrence can occur very soon after the end of treatment, but also after a long period of remission” recalls the National Cancer Institute (Inca). The risk of relapse and the severity of this depends in particular on the initial tumor sizeof the’lymph node involvement and treatments.

How many breast cancers relapse?

There is no no register in France listing relapses breast cancers. The figures are therefore estimates:15 to 20% of breast cancers recur 10 years after the first diagnosis“says Dr. Cottu.

“Why the cell goes to sleep, why it wakes up and how, still remains mysterious”

How long after the first diagnosis?

“The risk of relapse is linear over the lifetime, from 0.5% to 1% per year” immediately answers the oncologist. However “there is a more frequent risk of recurrence the first two to three years”.

Which breast cancers recur the most?

Those are the triple negative breast cancer who are most at risk of recurrence, with approximately 20 to 30% relapse. Triple-negative breast cancer is characterized by the absence of expression of estrogen and progesterone hormone receptors and the absence of overexpression of the growth factor HER2. So it’s not a hormone-dependent cancer. like 70% of breast cancers or cancer with overexpression of the HER2 gene.

Can a recurrence of breast cancer be cured?

“A relapse can always be treated but it is rarely cured” says Dr. Cottu. At least “not yet” adds Professor Alain Puisieux, director of the Institut Curie Research Center. “10 years ago, for certain cancers, there were no effective treatments in terms of healing, whereas now they are treated much more effectively. We are doing research to do better today.” It should also be borne in mind that “metastases does not mean death in the afternoon, rightly points out Dr. Cottu. Patients can live 20 years with their metastases and die of causes other than their cancers.

“The game is won at the beginning. Do the treatments.”

“The game is won at the beginning, answers Dr. Cottu immediately. That is to say by the early detection and the treatments. Do these treatments, it is very important. We never, ever prescribe lightly and their benefits are proven.” A healthy lifestyle is also (as always healthy) highly recommended. Have a healthy and balanced diet, preserve one’s sleep and to move. “L‘physical activity actually showed a small effect on reducing the risk of breast cancer relapse” confirms the doctor. And if the relapse occurs despite this “you will be in better health to face it” he argues.

Women aged 50 to 74 are invited every 2 years to organized breast cancer screening, even without symptoms and risk factors. This screening includes the performance of a mammogram and is fully covered by health insurance.

On the research side, scientists are working on the study of quiescent cells also called “dormant”. Their detection is an important issue in the fight against recurrences. “These are, for example, cells that wake up 20 years later without anyone knowing why, explains Dr. Cottu. Dormancy goes hand in hand with the dissemination of the cell. It should be possible to assess at the time of diagnosis whether there are already disseminated dormant cells but we do not yet know how to detect them. he continues. “We do not fully understand this phenomenon of dormancy. Why the cell falls asleep, why it wakes up and how, remains mysterious” testifies Professor Puisieux. The researchers are thus working on a better understanding of these cells and on their detection before they wake up. “We hope to be able to better see these cells with new tools (artificial intelligence for example) to better define the prognosis of the disease” concludes Dr Anne Vincent-Salomon, pathologist at the Institut Curie.

Source: Institut Curie press conference “20,000 women still relapse each year from breast cancer”, September 22, 2022.

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Recurrence of breast cancer: avoid it, how long after?

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