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Medical Forum / Diseases and Disorders / Breast Cancer / July 2008statistics
One thing I find interesting (maybe puzzling) about the statistics...we talk about recurrence risks, both local and remote, this per cent and that percent; but supposed one in every 9 women (some stats say one in 8) will have breast cancer in her lifetime (I believe that is industrialized countries); so that is better than a 10% risk already, even if someone has never had it. My oncologist told me, way back when, that my risk of return was one half of one per cent every year (so 5% in 10 years, 15% in 30 years). But there are so many variables that statistics are meaningless; we don't even know why some people's immune systems "fail" at warding off cancer in the first place...there are myriad factors (environmental, nutritional, genetic). It's all probability and conjecture. so why am I so fixated on it? LOL. > One thing I find interesting (maybe puzzling) about the statistics...we talk > about recurrence risks, both local and remote, this per cent and that > percent; but supposed one in every 9 women (some stats say one in 8) will > have breast cancer in her lifetime (I believe that is industrialized > countries); so that is better than a 10% risk already, even if someone has > never had it. True, and you and I are 2 in 16 (18) who got it in our lifetime. Assuming we are truly cured now, do we have the same 1 in 8 chance of getting new bc as anyone? Or a higher chance because of some un-known factor that brought on the first? I recently read (on a Norwegian site) that for testicular cancer, chemo seems to have a preventive effect in the healthy testicle, at the same time as it has a curative effect on the cancer. I don't know, and don't know if anybody knows, if there is a similar effect from chemo on breast tissue. I read somewhere that Zometa used to ward off bone mets may have such a protective effect in the breasts. I believe that Tamoxifen is being used to prevent breast cancer in some high-risk women who do not have the disease. I was treated with chemo before my mastectomy, and at the time of the operation, no live cancer cells were found in either the breast or the lymph nodes. I like to believe that any tiny, undetected cancers in the other breast - or elsewhere - also bit the dust - although there is no way of knowing for sure. > My oncologist told me, way back when, that my risk of return > was one half of one per cent every year (so 5% in 10 years, 15% in 30 [quoted text clipped - 4 lines] > > so why am I so fixated on it? LOL. My oncologist is /really/ fixated, and can go on and on about lowered % points.... It's just not that meaningful to me, since I don't even know why I got bc in the first place - I don't have a single one of the known risk factors. So much for statistics :-/ Ixia True, and you and I are 2 in 16 (18) who got it in our lifetime. Assuming we are truly cured now, do we have the same 1 in 8 chance of getting new bc as anyone? Or a higher chance because of some un-known factor that brought on the first? yes, and is breast cancer the "same" as stomach cancer? or totally different, such that our risk for one is different from the other, or? Cancer schmancer, supposedly...but does a woman who has both breasts removed lower her risk of remote recurrence, even though "remote recurrence" by its very definition exempts the breasts? is "remote recurrence" also in the lymph nodes remainining near the "bad" breast area? what about the chest wall, or the bone "near" where the cancer was? Is brain cancer totally unrelated? My stepfather had a tumor in his leg. It was removed, intact. Two years later he got lung cancer. Supposedly not related. I read recently about a little girl with her third cancer diagnosis, all "different" kinds in different places; but clearly, wasn't something up with her immune system or exposure? dunno. I was treated with chemo before my mastectomy, and at the time of the operation, no live cancer cells were found in either the breast or the lymph nodes. wow, makes one wonder if the mastectomy was needed. My oncologist is /really/ fixated, and can go on and on about lowered % points.... It's just not that meaningful to me, since I don't even know why I got bc in the first place - I don't have a single one of the known risk factors. So much for statistics :-/ I guess I had two: no baby before age 30, and menstruation for more than 30 years. but isn't there a subtraction effect for the NON-risks (exercise, no extra weight, no meat, blah blah). again, dunno. Ixia Responses interspersed. > True, and you and I are 2 in 16 (18) who got it in our lifetime. > Assuming we are truly cured now, do we have the same 1 in 8 chance of > getting new bc as anyone? Or a higher chance because of some un-known > factor that brought on the first? The first would be the best meaning you could apply to the word "cured". In practice the second is true, your background risk is higher, for the reason you give, and you are considered to be 'cured' when your risk drops close to the base level for bc survivors. (Which is I think about twice as high as for the population at large) > yes, and is breast cancer the "same" as stomach cancer? or totally > different, such that our risk for one is different from the other, or? A bit of both. Some risk factors apply to several cancers, others are specific to particular tissues. > Cancer schmancer, supposedly...but does a woman who has both breasts removed > lower her risk of remote recurrence, even though "remote recurrence" by its > very definition exempts the breasts? is "remote recurrence" also in the > lymph nodes remainining near the "bad" breast area? what about the chest > wall, or the bone "near" where the cancer was? Is brain cancer totally > unrelated? Not much, no, the risk of metastasis, or remote recurrence, is mostly determined by history preceding surgery, so the type of surgery has little effect, if mostly affects the risk of local recurrence or new primaries. Spread to the lymph nodes or chest wall is considered "local". "Remote" generally implies transport through the bloodstream. Breast cancer metastases to the brain are not uncommon, but that is not the same thing as brain cancer. In "brain cancer", cancerous brain cells are growing as a primary tumour in the brain, in "breast cancer metastasised to brain", it is cancerous breast cells growing in the brain, which look quite different under the microscope (unless both are extremely poorly differentiated). The reason why this or any other metastatic cancer is usually fatal is that if cells have travelled that far around the body, they are circulating freely and have already invaded other tissues, but have not yet grown sufficiently to become symptomatic. Chemotherapy will destroy these as long as they remain small and accessible, but the longer they have to establish themselves, the more likely it is that they will survive to kill the patient. > My stepfather had a tumor in his leg. It was removed, intact. Two years > later he got lung cancer. Supposedly not related. I read recently about a > little girl with her third cancer diagnosis, all "different" kinds in > different places; but clearly, wasn't something up with her immune system or > exposure? dunno. Lots of possibilities. It could be a genetic risk factor, it could be an environmental one, it could be an immune system problem, eg some underlying disease, or it could be just the statistical antipode of winning the lottery jackpot. Last I heard, adding up all known risk factors only accounted for about 30% of cancers, many cancers still appear to strike at random. The biggest risk factor by far is simply surviving everything else and getting old. Tim Jackson > Responses interspersed. > [quoted text clipped - 9 lines] > drops close to the base level for bc survivors. (Which is I think about > twice as high as for the population at large) Interesting. Thank you! I never knew exactly what "cured" means. Ixia > I was treated with chemo before my mastectomy, and at the time of the > operation, no live cancer cells were found in either the breast or the > lymph nodes. > > wow, makes one wonder if the mastectomy was needed. It wasn't, form a medical point of view. My oncologist wanted a lumpectomy, warning me that I might have bad margins or a recurrence "But you might get lucky! You can always have a mastectomy later. A local recurrence will not influence your mortality." The surgeon and radiologist did not favor the lumpectomy. In the end it was up to me, and I decided on the mastectomy. I had a lot of time to think about it, while I was on chemo, and I have not regretted it. I have had problems with that breast since I was in my twenties, and enough was enough, by far. As I said before, I was initially planning a diep flap reconstruction this month, but I have put the plans on ice. At this point I can't see myself /choosing/ more misery, but perhaps I'll change my mind as time passes. Ixia The surgeon and radiologist did not favor the lumpectomy. In the end it was up to me, and I decided on the mastectomy. I had a lot of time to think about it, while I was on chemo, and I have not regretted it. I have had problems with that breast since I was in my twenties, and enough was enough, by far. me too! That boob was ALWAYS triggering re-exams, and new looks, and concerns, and biopsies! Never ANYthing on the other one! Both are (were) fibrocystic but only the left one was "red flag" city. so I still worry that the chest wall on that side will sprout something, even with mastectomy concluded. I know how you feel about diep flap. it's more SURGERY and down time and anesthesia and drains and pain pills and possible complications. I had a blood clot after my second breast surgery, necessitating an immediate third. then I had two nipple reconstruction attempts, neither of which really worked. it's sad but....what does one do? it's all relative! As I said before, I was initially planning a diep flap reconstruction this month, but I have put the plans on ice. At this point I can't see myself /choosing/ more misery, but perhaps I'll change my mind as time passes. Ixia > > I have had problems with that breast since I was in my twenties, and > > enough was enough, by far. [quoted text clipped - 4 lines] > the chest wall on that side will sprout something, even with mastectomy > concluded. I know. Mine did. Turned out to be nothing, but still... I can tell that my oncologist is disappointed that I went with mastectomy. As a woman she is dedicated to allow women to keep their breasts, unlike back in the "dark ages". Before the operation she said, with some passion: "Your breast is not the enemy, cancer is!" In theory I agree with her, but I simply could not deal with more prodding and poking and biopsy after biopsy. It was bad enough before i got cancer, now it's just too much... > I know how you feel about diep flap. it's more SURGERY and down time and > anesthesia and drains and pain pills and possible complications. I had a > blood clot after my second breast surgery, necessitating an immediate third. > then I had two nipple reconstruction attempts, neither of which really > worked. it's sad but....what does one do? it's all relative! ouch... Stuff like that is exactly what I have no energy for at this time. Scarred, ugly and flat-chested is just fine, thank you! ;-) Ixia I can tell that my oncologist is disappointed that I went with mastectomy. As a woman she is dedicated to allow women to keep their breasts, unlike back in the "dark ages". Before the operation she said, with some passion: "Your breast is not the enemy, cancer is!" I wonder how she feels about all the prophylactic mastectomies out there....no enemy at all, just a potential one... ouch... yeah, and no tattoos. Stuff like that is exactly what I have no energy for at this time. Scarred, ugly and flat-chested is just fine, thank you! ;-) Ixia > > I can tell that my oncologist is disappointed that I went with > > mastectomy. As a woman she is dedicated to allow women to keep their [quoted text clipped - 3 lines] > I wonder how she feels about all the prophylactic mastectomies out > there....no enemy at all, just a potential one... If I understood her correctly, she was worried that I would not have the strength or guts for a diep flap after everything else. She was 100% right about that. - And worried that I would then freak out about having lost the breast, and get depressed. I'm not. One of her patients - who I did chemo with - initially had disease similar to mine. She decided on a double mastectomy, and planned for a diep/tummy-tuck and 2 new boobs. Instead she turned up with bone mets, and was back on chemo (when I met her). No hair, no tummy-tuck, no boobs. She had a very hard time :-( My oncologist has not said so outright, but I can tell she is worried my "theoretically cured" status might not last, and she wants my quality of life to be as good as possible. It is :-) I appreciate her concern. > yeah, and no tattoos. Do you need them? Ixia One of her patients - who I did chemo with - initially had disease similar to mine. She decided on a double mastectomy, and planned for a diep/tummy-tuck and 2 new boobs. Instead she turned up with bone mets, and was back on chemo (when I met her). No hair, no tummy-tuck, no boobs. She had a very hard time :-( oh that is so sad. Are you still in touch with her? My oncologist has not said so outright, but I can tell she is worried my "theoretically cured" status might not last, and she wants my quality of life to be as good as possible. It is :-) excellent! > yeah, and no tattoos. Do you need them? well, "need" isn't the term, but the original plan was to reconstruct everything and do the tattooing. the best person in this town is not just recommended by the physicians but is also a good friend of a friend/client of mine. But I'm not seeing much reason to do the tattooing, other than for the experience...just another chapter in the book, another thing to talk about, another adventure. but it has to be done AFTER the nipple is finished, and I think it's possible someone will figure out a better way to do the nipple, and I might try it, and then the tattooing would be later. Also, breast reconstruction such as mine more often needs redoing within 10 years, so....I'm on hold right now, really. any of us could find things changing at any time anyway, right? Ixia > One thing I find interesting (maybe puzzling) about the statistics...we > talk about recurrence risks, both local and remote, this per cent and that [quoted text clipped - 9 lines] > > so why am I so fixated on it? LOL. Try fixing on the other statistics - that (say) eight of nine womeon WON'T get bc. Or that if the recurrence rates after a particular treatment are (say) 15% that means that 85% of treated patients WON'T have a recurrence! Apply that principle to all the statistics you see and I think you'll realise that we do pretty well, really :-) Mary I do that all the time, spin it the other direction. but...sometimes we all slip. and remembering that we were already in the "minority" prize pool, we can't helping thinking, oh that could happen again. >> One thing I find interesting (maybe puzzling) about the statistics...we >> talk about recurrence risks, both local and remote, this per cent and [quoted text clipped - 21 lines] > > Mary >I do that all the time, spin it the other direction. but...sometimes we all >slip. and remembering that we were already in the "minority" prize pool, we >can't helping thinking, oh that could happen again. I have to admit that I never think about statistics - life's too full :-) And anyway I wouldn't remember or be able to work them out :-( Tim's the best authority on what statistics really mean! Mary > I have to admit that I never think about statistics - life's too full :-) for some, life is full of statistics. Both my brothers are scientists, and my son is a math genius. every event or thought is a statistic. and numbers are (to him) bliss. > And anyway I wouldn't remember or be able to work them out :-( > > Tim's the best authority on what statistics really mean! > > Mary |
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