Breast cancer can reappear 15 years after successful treatment, study claims

"Older women are a vulnerable population at risk of developing and dying from breast cancer; however, screening mammography remains underutilized in these women", wrote Bethany L. Niell, MD, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues.

This risk is much higher for women whose breast cancer had spread to the nodes when first diagnosed but even for those with the best outlook (no spread to the lymph nodes and small tumours), there was a 10% chance of cancer spread over 15 years.

Research suggests ten years of hormone therapy may be more effective at preventing recurrence and death.

He added: This study does show, though, why women with oestrogen receptor positive breast cancer should at least consider taking anti-oestrogen therapy beyond five years and may also help motivate women who are experiencing side-effects to persist with treatment.

Every patient received treatments such as tamoxifen or aromatase inhibitors which block the effects of oestrogen or shut off the hormone's supply.

They found that in women who were cancer-free and in therapy for 5 years, a substantial number saw the cancer spread throughout the body over the following 15 years.

Women with tumours on four or more lymph nodes faced the highest risk of recurrence.

"It is remarkable that breast cancer can remain dormant for so long and then spread many years later with this risk remaining the same year after year and still strongly related to the size of the original cancer and whether it had spread to the nodes", said lead author Hongchao Pan, from the University of Oxford.

There is a steady risk of breast cancer recurring decades after initial treatment, according to a large meta-analysis.

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Aromatase inhibitors, which will only work in women who are postmenopausal, are even better at reducing the risk of recurrence.

Life-threatening side effects are rare with these therapies, but they can impact patients' quality of life.

These include menopausal symptoms, osteporosis, joint pain and carpal tunnel syndrome.

These women had a 40 per cent risk of a distant cancer recurrence over the next 15 years.

Professor Richard Gray, one of the lead authors from the University of Oxford, said that treatment has improved since numerous women were diagnosed so recurrence rates would be somewhat lower for today's patients.

Looking at overdiagnosis in older women, the authors highlighted research that shows benefits outweigh the risks until the patient is 90 years old.

Scientists analysed the progress of 63,000 women for 20 years.

It is likely that these findings and others like them will be used to advise longer treatment plans for women with more aggressive ER-positive tumors.

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