Stage 0 breast cancer usually refers to a condition known as ductal carcinoma-in-situ (DCIS). This is a precancerous condition. Given time, this condition if untreated may progress to form a frankly cancerous tumour which is described as invasive breast cancer. With the further passage of time, it will progress from a small cancer (stage 1) to a larger cancer with spread to the surrounding lymph nodes (stage 2 and 3) and eventually spread to other organs such as the lungs, liver, bones and brain through the blood stream (stage 4).
All stages of invasive breast cancer, from stage 1 to 4, has the ability to travel to other parts of the body outside the confines of the breast, take root and lie dormant, eventually to reactivate and grow in those areas causing a relapse. That is why in most cases of breast cancer relapse, the disease does not recur in the breast but in other organs. In such situations, the cancer is considered advanced and incurable.
Fortunately, in the pre-cancerous stage of DCIS (as is the case under consideration), the tumour cells have yet to acquire the ability to travel and spread through the blood stream. Thus, there is no possibility of the disease relapsing in other organs in future causing death. In other words, the long term survival form DCIS (stage 0 breast cancer) is practically 100%. The long term outlook of your relative is therefore very optimistic.
While the risk of the disease spreading and causing a relapse in other organs is absent, there is still a significant risk of a new breast cancer developing in the opposite breast. A new breast cancer, if it does form, may either be of the same stage 0 or it could develop as a higher stage cancer. This is particularly true of your relative who has both a personal as well as a family history of breast cancer.
Women are at much higher risk of developing breast cancer compared with men because the female hormones in women has a stimulatory effect on the transformation of normal breast cells into breast cancer cells. This may potentially be the underlying cause of breast cancer development in your relative. A laboratory test may be performed on the breast cancer tissue that was removed 3 years ago to see if the cancer cells respond to the stimulation of female hormones. This test may still be performed even though the surgery was performed 3 years ago as local hospitals have a practice of preserving and storing all tumour tissue removed during surgery for 5 or more years.
If the test shows that the cancer cells are responsive to female hormones, you relative may consider taking an anti-hormonal treatment to reduce the stimulatory effect of the body's female hormone on the opposite breast thereby reducing the risk of a new cancer forming in that breast. Studies have shown that such a proactive treatment may reduce the risk of a future breast cancer by 50-70%.
If your relative has any female siblings, they are at high risk of developing breast cancer as they now have 2 first degree relatives (mother and sister) with breast cancer. They should consider consulting an oncologist to discuss preventive treatment as I have described.
An active lifestyle with regular exercise and a healthy diet may reduce the risk of future breast cancer relapse. The probable explanation is that such a lifestyle is associated with a lower rate of obesity. As the fat tissue in a woman's body is capable of converting substances in the blood into female hormones, this may lead to a greater stimulatory effect on the transformation of normal breast tissue into breast cancer. Avoiding obesity, in this case, is therefore particularly important.
Surgical removal of a cancerous breast lump while conserving the breast is usually the preferred treatment if such a surgery can be performed with a reasonable cosmetic outcome. Such a breast conserving surgery is usually followed by radiotherapy to the affected breast. The long term survival from breast cancer in such an approach is similar to total removal of the breast (mastectomy) and is better for the patient's self-image and psychological health.
This article was contributed to Tab A Doctor by,
By Dr Wong Seng Weng, Medical Director, The Cancer Centre, a subsidiary of the Singapore Medical Group
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