When Jamie LaScala turned 40 in 2015, she didn’t think she needed a mammogram yet, but a friend encouraged her to go.
“I was right on the cusp of when you’re supposed to start getting mammograms,” LaScala, now 49, told .com. “My best friend had been insisting because, sadly, she had friends in her neighborhood who were starting to be diagnosed.”
She was stunned when her first mammogram came back abnormal. “There was no breast cancer in my family,” she said.
That led to a diagnosis of stage 3 triple-positive inflammatory breast cancer, “a fairly rare and aggressive subtype,” LaScala explained. “At 40 I was too young to be diagnosed and I was very surprised.”
He started chemotherapy immediately and responded well. She then underwent a mastectomy and radiation therapy. She is now undergoing hormonal therapy and has no signs of the disease.
But with the passage of time has stopped undergoing regular examinations to detect possible relapses. (These exams are usually only recommended for about five years.) Like many other patients, she continues to worry about the cancer coming back.
“In my case, if something comes up that worries me, we check it, but it is not a periodic examination,” he explained. “There is an element, of course, of lack of control.”
Since her diagnosis, LaScala has become a patient advocate and has participated in a clinical trial that seeks to help prevent the recurrence of breast cancer, something experts still don’t fully understand.
Most women with breast cancer, about 90%, are diagnosed with “just a lump in the breast or in the breast and lymph nodes in the armpit,” Dr. Angela DeMichele tells .com. one of those responsible for the CLEVER study, in which LaScala participated. These cases may be in stages 1 to 3.
About 70-80% of these women will be cured by current therapies, including chemotherapy, radiation therapy and anti-estrogen treatments, added DeMichele, co-director of the 2-PREVENT Breast Cancer Translational Center of Excellence at Penn Medicine’s Abramson Cancer Center.
In the other 20-30%, the breast cancer will return as stage 4, also known as metastatic, when the cancer has spread to other parts of the body beyond the lymph nodes near the breast. Metastatic breast cancer is much more difficult to treat; According to the American Cancer Society, approximately 31% of patients survive more than five years.
But predicting which patients will have stage 4 cancer again it can be difficult.
“The problem is we don’t know who those women are until it happens,” DeMichele said. “When that cancer comes back, it does so in the lungs, liver or bone – somewhere outside the breast – and it is incurable.”
What’s more, data show a recent increase in women being diagnosed with breast cancer at younger ages. And breast cancer in young women, especially under age 35, is more likely to come back, according to the Mayo Clinic.
Risk factors for cancer returning
Many women with breast cancer want to have a double mastectomy for fear that the breast cancer will come back in their breasts. But the biggest concern is that the cancer will come back in the bones, liver or lungs, since metastatic disease is much more difficult to treat, explained Dr. Eric Winer, director of the Yale Cancer Center.
To find out which patients are most likely to have a metastatic recurrence of breast cancer, doctors take into account several factors related to the patient’s cancer.
- Cancer in the lymph nodes
In early-stage breast cancers, if the cancer has spread to a lymph node, that may be an indicator of future metastatic disease, Winer explained.
‘If it has moved to a lymph node, it is already telling you that it wants to travel,’ added Dr. Arif Kamal, chief patient officer for the American Cancer Society.
Stage 0 and 1 breast cancers do not involve spread to lymph nodes, meaning that early detection is still useful in preventing recurrent metastatic disease.
- Cancer grade
While cancer stage refers to its degree of spread, cancer grade measures how abnormal cancer cells are compared to healthy cells, according to MD Anderson Cancer Center.
“Does it look angry under the microscope? Does it look like a problematic cancer?” Kamal said. “At the grade, we look at how fast it is dividing and how abnormal it looks.”
- Cancer subtype
Inflammatory breast cancer, like the one LaScala had, and triple-negative breast cancer are more likely to come back, according to the Cleveland Clinic.
- Tumor size
Kamal noted that a larger tumor – 3 centimeters versus 1 centimeter – could increase the risk of metastatic breast cancer in the future. This is because doctors suspect that a larger tumor has lived longer in the body, he explained.
- Cancer stage
“The risk of metastatic disease is higher in people with more advanced-stage cancers,” Kamal said. Cancers in more advanced stages have already spread to the lymph nodes, are more likely to cause a larger tumor and usually look “very aggressive” under the microscope, he added.
- Genetic mutations
Genetic mutations, such as a BRCA1 or 2 mutation or Lynch syndrome, can increase the risk of breast cancer recurrence.
In fact, many women with genetic mutations are recommended to undergo double mastectomies to avoid the recurrence of the disease in the same or opposite breast, since the risk is much higher.
People with several immediate family members who have had breast or ovarian cancer or any type of cancer before age 50 may also have a higher risk of cancer recurrence and therefore undergo a double mastectomy.
For the rest of the population with early-stage cancers, data tend to show that a lumpectomy and radiation has a survival rate equal to that of a double mastectomy, Winer explained.
Detection of “sleeping” cancer cells
When LaScala learned about a clinical trial at Penn Medicine with the goal of preventing metastatic recurrence of breast cancer, she wanted to participate. She hoped that by taking part in the investigation she could help herself and others.
“One of the emotional and psychological burdens of patients is the idea that they have already finished treatment. Now what?” he said.
For most people diagnosed with breast cancer, conventional treatments work well to prevent recurrence. “The problem was that we didn’t really know what to do (after) the end of that initial therapy that was designed to get a patient to the point where she doesn’t have any cancer,” DeMichele said, adding that the plan is usually the ” “watchfully wait.”
Regular scans to detect new cancers usually last about five years. Afterwards, patients wonder what awaits them.
In an effort to create a more active approach to preventing the disease from returning, DeMichele’s colleagues identified specialized cells that can escape the breast and enter the bloodstream and are not affected by treatment. These cells are in a “dormant or dormant state,” but can later reactivate and develop into metastatic breast cancer, he explained.
“One of the places they like to go is the bone marrow,” DeMichele said. “Once they reach the bone marrow, they find a very favorable place to bury themselves, stop dividing and hibernate.”
DeMichele and his colleagues wondered if there was a way to detect these dormant cells and treat them before they woke up and moved to other parts of the body and turned into cancer. They started a study to monitor the women’s bone marrow and treat those with the dormant cells.
For the study, LaScala underwent an annual bone marrow aspiration, the procedure by which researchers collect and analyze bone marrow cells. For several years, her tests were clear of dormant cancer cells, but then in 2018, researchers found some and gave her a drug to kill them, hoping to reduce the chance of her cancer coming back.
“The clinical trial I was trying two medications that are specific for these dormant cells,” DeMichele said. “We saw that both drugs were able to eliminate the dormant cells, and about 80% of those patients are doing very well.”
He noted that these treatments appear to work regardless of the type of breast cancer. But the therapies used in this phase 2 clinical trial are aimed at preventing the recurrence of an original breast cancer, and not a new diagnosis.
“(Recurrence) is what (most) people who have breast cancer die from,” DeMichele explained.
The trial is being expanded to phase 3 and is recruiting more patients. DeMichele hopes that more people will be interested in participating.
“Patients want this information. They want to be proactive,” he said. “Waiting for it to happen is what distresses people the most.”
DeMichele says that They hope to have the results of the trial in a few yearsand that they will also have to refine the testing protocol to make it work for patients if it is eventually widespread.
“We are still working on what the check-up would be like to be able to do these tests,” he said. “We’ll probably have to do several over a period of time to make sure they’re really clear.”
Advocate for others
LaScala has been an advocate for patients since her diagnosis, focusing on research and education. She often attends medical meetings where she learns about the latest in breast cancer research.
“I support and encourage our researchers because they truly dedicate their lives to helping improve patient outcomes,” he stated.
By sharing her story, LaScala hopes more patients will consider clinical trials as an opportunity to help expand knowledge about breast cancer and create innovative treatments.
“Part of this cancer journey is knowing that there are things we can’t control, but we can. we can do everything we can by ourselves and for other patients and continue to support ongoing research,” LaScala said.
“There are so many early (and late) phase trials that I can participate in (…) it was really eye-opening and exciting. That’s why I try to continue supporting the research.”
