Hello eta,
I'll start by going over the risks of a first occurence of breast cancer:
BRCA1 and BRCA2 are tumor suppressor genes that, when working
properly, help repair damage to DNA (a process that also prevents
tumor development). In 1994, it was found that women who carry
mutations of BRCA1 or BRCA2 are at higher risk of developing both
breast and ovarian cancer than women who do not have these genetic
mutations. Currently, women with BRCA1 mutations account for 5% of all
breast cancer cases.
Less than 1% of the population carries the BRCA1 and/or BRCA2 mutated
genes. It is estimated that 5% of all breast cancers are caused by
mutations or defects in the BRCA1 or BRCA2 gene. ?Of these, about 85%
of women with a defect in the BRCA1 and BRCA2 gene will develop breast
cancer, about 7 times greater that women without the BRCA1 and BRCA2
gene mutations.?
http://www.cancer.org/downloads/STT/CAFF2003BrFPWSecured.pdf
A National Cancer Institute study came up with different numbers: 56%
of women with the gene mutation will develop breast cancer. Whichever
number you choose to believe, the chances are greater for women with
the BRCA genes!
http://www.cals.ncsu.edu/course/gn301/breastcancer.html
?The often-cited "one-in-eight" statistic means that for a female who
is born today and lives to be 85 years of age, her lifetime risk of
developing breast cancer is one in eight (or approximately 12.8%).
This statistic is based on population averages. Each woman's breast
cancer risk may be higher or lower, depending upon a several factors,
including family history, genetics, age at first menstruation, and
other factors that have not yet been identified. Also, the
"one-in-eight" statistic does not take into account specific age
groups or races, which may influence breast cancer risk.?
PSL Group
http://www.pslgroup.com/dg/133c96.htm
The lifetime risk of any particular woman getting breast cancer is
about 1 in 8 although the lifetime risk of dying from breast cancer is
much lower at 1 in 28. If a woman is found to carry either mutation,
she has a 50% chance of getting breast cancer before she is 70.
Oncolink University of Pennsylvania
http://www.oncolink.upenn.edu/types/article.cfm?c=3&s=5&ss=33&id=8320
Dr. Sandhya Pruthi, MD, a Breast Health Specialist at the Mayo Clinic,
estimates that 20% of women who carry BRCA1 mutations will develop
breast cancer by age forty, 51% by age fifty, and 87% by age sixty.
http://www.imaginis.com/breasthealth/genetic_risks.asp
The chance of getting breast cancer if you have BRCA1 is about 56?87%,
while with BRCA2 it is about 37?84%.
http://www.breastcancer.org/res_news_asco_0500_2.html
?BRCA1 and 2 Genes. Inherited mutations in genes known as BRCA1 or
BRCA2 are now believed to be responsible for 30% to 50% of hereditary
breast cancers, ovarian cancers, or both in families with a history of
these cancers. The risk each carries appears to be as follows:
About half of BRCA1 carriers will develop breast cancer by age 70.
According to one study, about 37% of BRCA2 carriers develop the
disease. (These percentages are even higher in some studies.) BRCA2
genes may confer an increased risk of breast cancer in men as well as
in women (which is still very low).?
Reuters Health
http://www.reutershealth.com/wellconnected/doc06.html
??breast cancer patients with one of these cancer-causing genes don't
have a risk of early relapse. They respond very well to treatment
immediately following therapy, but begin developing second tumors long
after therapy has been completed, up to 10 years or more after
original treatment.?
http://www.eurekalert.org/pub_releases/1999-10/YU-Bcrr-011099.php
============
Recurrence:
============
While having the BRCA1 and BRCA2 genes seems to increase the chances
getting breast cancer, for the first time, they don?t seem to increase
the chances much of a recurrence.
?The five-year, disease free survival rate for BRCA1 carriers with
breast cancer was 49%, essentially identical to the 51% survival rate
seen in women with breast cancer who do not carry the gene.? The
Lancet (1998;351:304-305, 316-320)
Personal MD
http://www.personalmd.com/news/a1998013005.shtml
?Most recurrences occur within five years, but can also occur up to 10
years and after. It should be noted that one study suggested that the
risk factors for a first breast cancer do not necessarily place a
woman at any higher risk for recurrence. (Women with a first cancer,
however, do have a higher risk for a new cancer in the opposite
breast.)?
http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/06BreastCancer/doc06severity.html
?If you have BRCA1 or BRCA2 and you want to prevent the onset of a new
breast cancer (whether you?ve never had breast cancer or you have had
the disease), then preventive or "prophylactic" breast removal can
reduce this risk by 85?90%. Preventive or "prophylactic" breast
removal in women with BRCA1 or BRCA2 can reduce the risk of developing
breast cancer by 85?90%.This is an important risk reduction, because
after a diagnosis of one breast cancer in a woman with a genetic
abnormality, the risk of her getting a new breast cancer is
approximately 3% every year (for example, 15% over 5 years). Without
BRCA1 or BRCA2, the risk of developing a new breast cancer after one
episode of breast cancer is only 1% per year. ?
http://www.breastcancer.org/res_news_asco_0500_2.html
There are three types of recurrences, one of which is not a true
occurrence after all, but seems to be included in any estimates.
Local : This is where the cancer cells reappear in the original site.
Doctors believe this is not a true occurrence, but a failure to remove
all cancerous cells. This form is not very common.
Regional: A more serious reappearance of cancer, indicating a spread of cancer.
Distant : The most serious, as this indicates the cancer has
metastasized to other areas, such as brain, liver, bone marrow, and
other organs.
http://www.imaginis.com/breasthealth/bcrecurrence.asp
and
http://bcresources.med.unc.edu/advanced.htm
So, you see, there are no hard statistics for recurrence in women with
or without the gene, as risk factors are based on such a broad set of
factors. Predicting chances of a recurrence is not an science, and
is far from definite . Some studies have used the age of 85 as an
average and others used an age of 110 as normal life spans of women!
Some factors that preclude arriving at a hard number for recurrence of
breast cancer are: estrogen levels, pregnancy, breast density, breast
feeding, alcohol consumption, oral contraceptives, hormone replacement
therapy (HRT), environmental factors, diet and mental health. If the
original breast cancer was of an aggressive form, there is a greater
chance of recurrence than other women.
From BreastCancer.org
1.Your first and most important consideration is to effectively treat
the breast cancer that you were diagnosed with. Prevention of a future
breast cancer is a separate but related issue.
2.If you have BRCA1 and you choose a prophylactic ovary removal after
you?re finished having children, then you are already protecting
yourself from both breast and ovarian cancer. Let?s suppose your risk
of developing a new breast cancer is 50% over the course of your
lifespan. If prophylactic ovary removal reduces that risk by
approximately 60%, then you?re down to a 20% remaining risk (when you
take away 60% of a 50% risk, you have 20% left). If tamoxifen reduces
that 20% risk by 45%, then you have a remaining risk of 11% (take away
45% of the 20% remaining risk, and you?re left with an 11% risk). And
if you are taking care of yourself and having regular mammograms and
careful breast examinations, then you?re increasing the odds that any
possible breast cancer will be found as early as possible, when it is
most curable. So, if you take all of the above actions to reduce your
risk, is prophylactic mastectomy necessary?
Let?s look at the numbers again. Mastectomy can reduce breast cancer
risk by nearly 90%. If you start with the same 50% risk of breast
cancer and reduce that 50% by 90%, you are left with a 5% risk. But
you can also shrink your risk (to 11%) in ways that may not feel as
extreme.
http://www.breastcancer.org/res_news_asco_0500_2.html
I could not explain this any better:
·?Consider, for example, the case of two women who both develop breast
cancer at the age of 50. The first woman gets regular mammograms and
clinical breast exams, while the second woman does not have any type
of regular screening. The first woman's breast cancer is discovered by
a mammogram when she is 58. She receives treatment that turns out to
be ineffective, and she dies at the age of 68. The second woman's
breast cancer is discovered when symptoms of her breast cancer appear
at age 65. She receives treatment that turns out to be ineffective,
and she also dies at age 68. The first woman may seem to survive
longer than the second woman because the time from her diagnosis to
her death was longer (10 years vs. 3 years). However, this is just an
artifact of earlier diagnosis. Both women developed cancer at the same
point in their lives and died at the same point in their lives.
The JAMA article's findings are consistent with the phenomenon
described above. Over the years, we have succeeded in detecting many
types of cancer earlier and earlier. As tools are developed that can
detect a type of cancer earlier, the 5-year survival rate for that
cancer will appear to increase, regardless of whether patients are
actually living longer. Moreover, the incidence rate will also
increase because more and more cancers are diagnosed at the
subclinical (producing no symptoms) stage. This explains why cancer
incidence and survival rates have increased proportionately from
1950-1995. The authors argue that, unlike survival and incidence
rates, mortality rates will decrease only if real advances are made in
the treatment and/or prevention of cancer. For this reason, they
state, 'To measure true progress in the 'war against cancer,'
physicians and policymakers should focus on mortality.' The breast
cancer mortality rate in the U.S., in fact, has decreased during the
last decade, primarily in White and Hispanic women (see Wingo PA, et
al. J Natl Cancer Inst 1999;91:675-90)."
National Breast Cancer Coalition
http://www.natlbcc.org/bin/index.asp?strid=374&depid=9&btnid=3
"These findings suggest that a woman who has a mutation in BRCA1 or
BRCA2 who is treated with breast-conserving therapy not only has a
high risk of local recurrence - 40 percent according to our study -
but also a high risk of developing breast cancer in the other breast
as well," Dr. Turner says. The scientists also found that it took
longer-an average of about eight years-for women with an altered BRCA1
or BRCA2 gene to relapse than it did women without the damaged gene
(slightly less than five years on average). They then carefully
examined the tumors using molecular and histologic analysis, thinking
these were old cancers that had returned. Instead, they found that
some of the tumors were actually completely new breast cancers. The
new cancers took an average of 8.5 years to develop."
PSLgroup
http://www.pslgroup.com/dg/133c96.htm
?The relevance of the BRCA1 or BRCA2 mutations to survival is
controversial. Some studies have suggested that these mutations offer
a survival advantage, while others suggest that they make no
difference or even worsen prognosis. Women with these genetic
mutations do have a greater risk for a new cancer to develop. Patients
with BRCA1 mutations tend to develop tumors that are hormone receptor
negative, which can behave more aggressively?
University of California Davis Medical Center
http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/06BreastCancer/doc06severity.html
Henry Ford Health System has an FDA approved ?Breast Cancer Recurrence
Gene Detection Test? and tests for the HER-2/neu gene at the
Josephine Ford Cancer Center. According to this site, and not taking
the BRCA1 or BRCA2 genes into account, ?One out of eight women
develop breast cancer in their lifetime. Although many will remain
disease-free after their initial treatment, about 20-30 percent will
experience a breast cancer recurrence.?
http://www.henryfordhealth.org/175.cfm
And
F2 Network
http://www.theage.com.au/articles/2003/12/05/1070351762439.html?from=storyrhs
and
http://www.henryfordhealth.org/171.cfm
An illustration
http://www.natlbcc.org/bin/index.asp?strid=585&depid=9&btnid=2
Tumor Markers are proving to be better at predicting cancer than BRCA1 and BRCA2
A number of other tests are now being used that better predict breast
cancer, primarily tumor markers. Tumor markers are simply substances
present in tumor cells, that may indicate if a cancer is likely to
spread or not.
The HER-2 protein, mentioned above at the Ford Health System, is
proving to be an effective test. HER-2 is a protein that is involved
with the development of breast cancer cells, and suggests the presence
of an aggressive form . Between 25 and 30% of breast cancer patients
have high levels of this tumor marker.
Angiogenesis Factors: VEGF is seems to be another indicator of
metastising cancers. When some forms of cancer grow, they produce
prolific blood supplies of their own, (angiogenesis) feeding and
nourishing the tumor. VEGF is a factor that allows researchers to see
if angiogenesis is occurring.
P53 gene: This is a tumor suppressing gene. High levels of this normal
gene, in a mutated form, may indicate an aggressive and growing
cancer. P53 is more likely to be found in women with the BRCA genes.
http://www.breastcancer.org/res_news_asco_0500_2.html
Additional Information:
All about BRCA1 and BRCA2 genes, including an illustration
http://www.au-kbc.org/research_areas/bio/projects/bcinfo/gen/bcgenetics1.html#1
National Breast Cancer Coalition
Here is some interesting reading regarding ?Chances?
http://www.natlbcc.org/bin/index.asp?strid=567&depid=9&btnid=2
A very well done document, Breast Cancer Facts and Figures 2003-2004,
from the American Cancer Society
http://www.cancer.org/downloads/STT/CAFF2003BrFPWSecured.pdf
Cancer.gov
Statistics (Esp. Page 5)
http://srab.cancer.gov/devcan/report1.pdf
?You can inherit a breast cancer gene abnormality from your mother OR
your father. If one of your parents has a gene abnormality, you have a
50% chance of inheriting the gene from him or her. If you do inherit a
gene abnormality, your risk of developing the disease depends on the
specific abnormality found, the pattern of its behavior in your
family, plus the uniqueness of your own body. The risk of breast
cancer in these families ranges greatly?from 40?80% over the course of
a lifetime.?
BreastCancer.org
http://www.breastcancer.org/cmn_who_indrisk.html
Chart on probability based on age (P.9)
http://www.cancer.org/downloads/STT/CAFF2003BrFPWSecured.pdf
Hope this helps you!
If any part of my question is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further.
Regards,
crabcakes
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