Recurrence and Mortality Rate

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QUESTION: My cancer came back "locally" at the scar site but I didn't know what it was and was so caught up in my work that I'm afraid I let it go too long. My doctor took one look and knew exactly what it was. He has set up radiation beginning tomorrow and has scheduled me for a bone scan, CT, and pelvic among other things. My mastectomy was in May of 1999 and my chemo was complete in October, maybe November, of 1999. My tumor was in my left breast and the only reason I found it was because I was having pain. It was about the size of a marble when I found it and in the course of eight weeks it was 17 cm. My question is: With this bit of info, could you tell me what the mortality rate is for me?

I am 39 years old and I am a very strong person and I am supported by all the friends and family you could want and a husband that fell from heaven, but they still can't handle the thought that I could die. I really guess I just want someone to answer my question with a straightforward answer. Thanks for listening.

ANSWER: I'm sorry that you are struggling with recurrence after having gone through so much already. As discouraged as you feel, there are a lot of reasons to be hopeful. There are effective treatments available today, and many more coming soon. A local recurrence can happen on its own, or sometimes there can be a problem elsewhere in the body-so that's why your doctors are just routinely checking things out to make sure that it's contained. When cancer comes back, your doctor might want to get a biopsy to prove that it's a recurrence or to get additional information about the type of recurrence that it is. For example, if HER2/neu status is unavailable from your original tissue results, your doctors may want to know that in order to plan the best therapy options.

Surgery for a well-defined local recurrence can be very helpful, which is then followed by radiation therapy. If the recurrence is not well defined, then surgery may not have a role. If the area of involvement can be encompassed by radiation treatment fields, then radiation can be quite effective. It is very important to get a medical oncology consultation as soon as possible to identify the role chemotherapy, immune therapy (Herceptin [trastuzumab]), and anti-estrogen therapies might have. The sooner you get input from each doctor, the sooner you can coordinate the best sequence of treatments. Getting a second and even a third opinion on this question will be important-so that you can feel that you have the information necessary to make your best decisions.

It's great that you have such a terrific support network. It's very common for family to want to avoid any talk of your possibly dying from the cancer. They just can't or just refuse to imagine life without you being physically present. But it's on your mind and you want to be able to express that big fear and process it in a thoughtful way--even if there is still a good chance of beating this thing. There are people out there you can share these concerns with. A support group can be extremely helpful. Try the local chapter of the Wellness Community, American Cancer Society, or the Susan G. Komen Foundation. You can also talk with other women experiencing the same things you're experiencing in our discussion boards.

—Marisa Weiss, M.D.

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