After the initial shock of a breast cancer diagnosis, patients with early breast cancer are immediately faced with important decisions about their treatment plan, including how to manage their risk of recurrence. As they navigate a modern landscape of treatment options, these patients must also make decisions that could dramatically impact their quality of life.
In this episode of Breast Cancer Breakthroughs, we speak with two-time breast cancer survivor Michelle Beck about some of the difficult decisions she faced through her treatment and listen as experts Dr. Angela DeMichele and Dr. Ruth O’Regan explain the causes of recurrence and tools that can help patients better understand their risk.
What Causes Recurrence?
For decades, the cause of recurrence was a mystery. Doctors didn’t understand how a tumor could be completely removed then return and spread to other parts of the body years or decades later. Today, doctors understand that certain specialized cells within tumors can leave the breast and enter the bloodstream, where they can quickly travel to another part of the body.
These cells can also stop growing and shut down for a period of time. As Dr. DeMichele explains, after “hibernating” like a bear in a cave during winter, for reasons unexplained, they can also wake up and start growing and dividing again.
Making Difficult Treatment Decisions
Michelle considers herself lucky to have had her breast cancer caught early through a mammogram. At the age of 41, she received the news that she had stage 1, estrogen receptor-positive (ER-positive) breast cancer. Michelle’s early-stage diagnosis meant she had more options for treatment. But as she would find out, these decisions were difficult to make, and some came with a price.
Following her first diagnosis, Michelle decided with her doctor to undergo a lumpectomy and radiation. Unfortunately, her second diagnosis came four years later and presented even more challenging decisions for treatment. Michelle underwent a bilateral mastectomy and removal of both ovaries. She discussed the possibility of chemotherapy with her doctor, but she did not want to deal with its side effects.
Michelle took the OncotypeDx test, a commonly used tumor profiling test that estimates the risk of recurrence for those with early ER-positive breast cancer and determines if they will benefit from chemotherapy. The test results indicated to Michelle and her doctor that she likely would not benefit from chemotherapy, sparing her from the side effects that come along with it.
Balancing Treatment with Quality of Life
After her second diagnosis, Michelle’s doctor switched her medication from tamoxifen to aromatase inhibitors, an alternative treatment option aimed at preventing recurrence. There were three different types of aromatase inhibitors for her to choose from, and she tried them all. For Michelle, these drugs came with more drastic side effects that hit her almost immediately. “I felt like I turned into a 90-year-old woman overnight, and I could not do anything,” Michelle says. “I cannot express the lack of quality of life I was having because of this medication.”
Despite these challenges, Michelle found a silver lining when she discovered the Breast Cancer Index test – another tumor profiling test that predicts long-term risk of recurrence for ER-positive breast cancer. This test helps doctors decide if a patient will benefit from an extended course of hormone therapy. Michelle’s test results showed that she had a very low risk of recurrence, and she and her doctor agreed that she could stop taking the aromatase inhibitors.
“I was anxiously awaiting the test results. And when I got them, I sobbed in sheer relief,” Michelle says.
New Tools for Patients
Dr. DeMichele is familiar with stories of patients with early breast cancer like Michelle who struggle with the tough choices that come with treatment and prevention of recurrence. “As an oncologist, I spend a lot of time speaking with my patients about their level of risk and what I can recommend as enough treatment to have a good chance of eliminating the cells, but not so much treatment that they’re going to be left with life-long side effects,” she says.
Because the risk of recurrence is different for different types of breast cancer, doctors must tailor each treatment individually to minimize this risk for each patient. Tumor profiling tests like OncotypeDx and Breast Cancer Index tests are some of the newest ways to measure the likelihood of recurrence and determine the most appropriate treatment to reduce the risk. They also provide clear answers to patients when they are faced with difficult decisions.
“I love having the test results because making these decisions once you have a breast cancer diagnosis is impossible,” Michelle says. “I want to be able to have confidence in tests that are out there so I can really make the best decision for myself, and for the rest of my life.”
