Early Breast Cancer
Understanding Early Breast Cancer
Breast cancer is the most common cancer among women (excluding skin cancers) and is the second leading cause of cancer deaths among women worldwide. Globally, more than 1.2 million people will be diagnosed with early breast cancer this year. 4
The term "early breast cancer" refers to breast cancer in stages 0, I and II at the time of diagnosis. With stage 0, the cancer is non-invasive, meaning it has not spread to surrounding normal tissue (sometimes called carcinoma in-situ). In stage I cancer, the tumor is two centimeters in size or smaller and has not spread outside the breast. And, in stage II, either:
- There is no tumor in the breast, but cancer is found in the axillary lymph nodes (nodes under the arms); or,
- The tumor is two centimeters or smaller and has spread to the axillary lymph nodes; or,
- The tumor is two-to-five centimeters and has spread to the axillary lymph nodes; or,
- The tumor is larger than five centimeters and has not spread to the axillary lymph nodes or, 5
- The number of lymph nodes involved with cancer is not more than three. 6
In early breast cancer, the tumor is usually removed surgically, either with breast-conserving surgery (lumpectomy) or by removing the breast (mastectomy). Based on new technologies for early detection, between 70 and 75% of women diagnosed with breast cancer are possible candidates for lumpectomy.7 Research shows that women with early-stage breast cancer who have breast-sparing surgery along with radiation have similar survival rates to those who have a mastectomy. 8
But despite these promising results, microscopic deposits of the disease, undetectable by current diagnostic tools, may sometimes remain behind. These deposits may, after several years or even several decades, develop into a clinically detectable recurrence of the disease. For patients who are considered at intermediate or high risk for recurrence, health care professionals will often offer post-surgical treatment (adjuvant therapy) as an option to help reduce this risk. However, recent research indicates that some women who are considered at "low risk" could also benefit from adjuvant cancer therapy. 9-14
At present, women with breast cancer have numerous treatment options available to them. However, this report only focuses on women with early breast cancer who have received standard adjuvant hormonal therapy, tamoxifen, which in North America is the most commonly prescribed adjuvant therapy.
A retrospective observational study conducted in British Columbia revealed that since the introduction of adjuvant therapy into standard clinical practice, there has been a trend toward superior outcomes in women with breast cancer treated with adjuvant therapy compared to women treated in earlier decades, before adjuvant therapy was widely practiced.15 Additionally, in a meta-analysis of more than 37,000 women who have been in randomized trials of adjuvant tamoxifen and/or chemotherapy, data showed that overall survival rates improved significantly when the use of adjuvant therapy became standard practice. 9 However, data show that many women still face the possibility of their cancer returning.
Added to these research findings, a new survey conducted by the Roper organization among 300 breast cancer patients reveals that women are worried about their risk of recurrence, but many have not discussed these concerns with their health care professionals. Also, risk communication research shows that even when patients have these discussions with health care professionals, there can be serious gaps in the communication process that leave women without the information they need.
Therefore, effective and comprehensive communication between patients and health care professionals is integral for conveying a woman's risk of recurrence and thus ensuring proper treatment of early breast cancer. However, a critical gap remains in the understanding of, and communication about, risk of recurrence in women with early breast cancer after they have successfully been treated with surgery. This lack of understanding factors into patient and health care professional treatment decisions, and warrants further exploration to ensure long-term patient health and survival.
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