Saturday, August 30, 2008

Definition of Stage IV Breast Cancer

By Ray Lam

Stage 4 breast cancer, or advanced breast cancer, has metastasized to other tissue including bone tissue, lung tissue, or the liver. When breast cancer has overwhelmed the body's natural defenses and spread this far by the time the cancer is first diagnosed, the 5-year survival rate drops to 16%-20% in the United States (American Cancer Society).

Up to 5% of white women in the U.S., and up to 9% of black women have advanced breast cancer spread to distant tissue at the time of first diagnosis (SEER). This difference is usually attributed to poverty and lack of health insurance.

In one clinical trial published in 1997, women in complete remission after induction chemotherapy were treated with high-dose chemotherapy or no further treatment. At 5 years from diagnosis, 24% of the women treated with immediate high-dose chemotherapy survived without disease recurrence, compared to only 8% of the women who did not receive further treatment.

The 3-year survival rates were 38% for those receiving the standard chemotherapy, and 32% for those receiving the high-dose chemotherapy. Twelve percent of those in the standard-dose group had no progression of disease, compared with only 6% in the high-dose group. Furthermore, there were more side effects in the high-dose therapy group, including one treatment-related death.

Early detection is clearly the most important factor in breast cancer survival rates. Breast cancer detected at Stage 1 while it is still localized to the breast has a survival rate of 98%-100%, while metastasized breast cancer first detected at Stage 4 drops down to 16%-20%.

One strategy to improve outcomes is to increase the effectiveness of induction therapy so that patients have significant reduction in the number of malignant cells in the body before high-dose chemotherapy.

North American white women have the highest rates of breast cancer in the world, but the 5-year survival rate for all stages (Stage 1, Stage 2, Stage 3, and Stage 4) combined is 88% for the U.S. A recent study found European countries have lower 5-year breast cancer survival rates, with England at 77.8% and Ireland at 76.2% (Lancet Oncology).

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