ROBERT SIEGEL, host:
We're going to hear more now on the recurrence of breast cancer. Joining us from Philadelphia is Dr. Lori Goldstein, who's director of the Breast Evaluation Center at Fox Chase Cancer Center.
Welcome to the program, Dr. Goldstein.
Dr. LORI GOLDSTEIN (Director, Breast Evaluation Center, Fox Chase Cancer Center): Thank you.
SIEGEL: And I'd like to ask you first, how common is it for breast cancer to recur in the way that it evidently has in the case of Mrs. Edwards?
Dr. GOLDSTEIN: Yes. Well, breast cancer recurrence is related to the stage of disease at the initial diagnosis. So those patients with more advanced disease or node-positive disease have a much higher risk of recurrence than those who had node-negative disease at the time of diagnosis.
SIEGEL: So the more advanced at first, the more likely a recurrence. And treatment limits the rate of recurrence?
Dr. GOLDSTEIN: Treatment given at the time of initial diagnosis of breast cancer has the potential to drastically reduce the risk of recurrence by about 35 to 45 percent, depending upon the characteristics and the stage of disease.
SIEGEL: Now, Mrs. Edwards today told the crowd in North Carolina what she had been told by her medical oncologist, which was once the cancer has turned up -in this case in a rib - it is not curable but it is treatable. And she used the example of diabetes. Can you just explain that a little bit more?
Dr. GOLDSTEIN: When a disease recurs outside the breast region, we think of it more of a chronic disease, in that we don't have the ability to rid the patient of the tumor but we have the ability to treat it. Such as patients with diabetes or heart disease who can be treated chronically and need adjustments in their treatment and can live many years with their disease.
SIEGEL: You say they can live many years with this disease. Typically, from what you've heard, the prognosis here would be good, very good, or what?
Dr. GOLDSTEIN: Well, patients who have bone-only metastatic breast cancer can live many years with the disease, so it's hard to qualify as good or very good. But right now she seems to be relatively asymptomatic with a low burden of disease, and hopefully it will respond and be amenable to the current treatments.
SIEGEL: Now, Mrs. Edwards said something very interesting today. She said that she went in for tests because she had had a pain in her side. The pain turned out to be related, I gather, to a cracked rib, which had nothing whatever to do with her cancer. But her visit to the hospital led to tests which turned up a tumor on another rib on the other side of her body. So the advance of the cancer is discovered entirely by accident.
And I guess the question that it poses to us is, if we've had a cancer and are worrying about it recurring, how often and how thoroughly can we go get examined and checked to see if it's popped up someplace else?
Dr. GOLDSTEIN: In general, the recommendations are to only do scans in the setting of new symptoms such as bone pain or something that's found on physical exam by the physician. So, in general, we only do annual mammograms and only use other diagnostic testing when there is a new symptom or something found on a physical exam by a physician.
SIEGEL: But as she said she now thinks of her broken rib or cracked rib as her lucky rib…
Dr. GOLDSTEIN: Right.
SIEGEL: …because the cancer itself, as it turns out, was totally asymptomatic. The bone pain that sent her to the hospital was utterly unrelated to it.
Dr. GOLDSTEIN: Right. So you're right. So this particular lesion or this problem in her rib with the bone metastasis may not have been clinically apparent for some time to come until it caused pain. And waiting until then would not have sacrificed her long-term survival.
SIEGEL: If you had a patient who were in Mrs. Edwards' situation and she said I am looking forward this year to taking care of my two little kids and crisscrossing the country by jet twice a week for the next 18 months, would you say, whoa, slow down a bit or go for it? You know, think healthy.
Dr. GOLDSTEIN: So she's relatively asymptomatic and she has a low of burden of disease and her treatment is all outpatient. There is no reason she can't go about her business as usual, taking care of her family, traveling with her husband. There may be days when she's not up to par. That's true for almost all of our patients. It's true for almost all human beings.
So I think that there's no - it doesn't sound as if there will be any compromise or medical recommendation to do anything but what she's up to doing.
SIEGEL: Well, Dr. Goldstein, thank you very much for talking with us today.
Dr. GOLDSTEIN: Thank you, Mr. Siegel.
SIEGEL: That's Dr. Lori Goldstein, who is the director of the Breast Evaluation Center at the Fox Chase Cancer Center. She joined us from Philadelphia.
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