My mother has breast cancer. What signs to watch for relapse?

Question

Hello doctor,

My mother, aged 56, was recently diagnosed with hormone-positive breast cancer.

The biopsy report showed ER/PR positive, HER2 negative, and surgery has been advised. So, my concerns are:

After the operation, how do doctors decide whether chemotherapy is necessary or if hormonal tablets alone are enough?
Her calcium level was a bit low, and we heard long-term hormone therapy can cause bone loss. Should she start vitamin D and calcium supplements now?
Also, how long does hormone therapy usually continue, and how frequently should she do follow-up scans or blood tests to check for recurrence?
Are there any signs we should watch for early relapse?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I hope you are doing well. I am really sorry to hear that your mother has been diagnosed with breast cancer. I completely understand how stressful this is for both the patient and the family. I wish her a full and fast recovery, God willing.

The decision whether chemotherapy or hormonal therapy is needed depends on what we find after the surgery. After removing the tumor, we look at its size and check if there are any positive lymph nodes.

If there are lymph nodes involved and the tumor is larger than two centimeters (0.78 inches), we usually recommend adding chemotherapy followed by hormonal therapy, especially since the tumor is ER (estrogen receptor) and PR (progesterone receptor) positive, meaning it will respond to hormonal treatment.

But if the tumor is smaller than two centimeters and the lymph nodes are negative, then chemotherapy is not usually needed; only hormonal therapy is given.

There is also an important test we can do on the tumor itself called Oncotype DX. It studies the DNA (deoxyribonucleic acid) of the cancer cells and tells us how aggressive they are and the risk of recurrence.

For patients over 50 years old, if the Oncotype DX score is zero to 25, chemotherapy is not needed. If the score is above 25, then we recommend chemotherapy in addition to hormonal therapy to lower the risk of the cancer coming back.

Since your mother’s calcium and vitamin D levels are already low, she should start taking calcium and vitamin D supplements now, because hormonal therapy can weaken the bones. Hormonal treatment usually continues for at least five years.

For follow-up, she should get a few tests regularly:

Do a mammogram every year.

Do a DEXA (dual-energy X-ray absorptiometry) scan every one to two years to check bone density.
If she ever develops symptoms like pain in bones, persistent cough, shortness of breath, or abdominal pain, she should do the proper scans to rule out recurrence.
Also, if there is any other family history of breast or ovarian cancer besides your mother, both your mother and you (and your sisters) must consider doing BRCA (breast cancer) genetic testing.

If your mother tests positive for a BRCA mutation, that result will help guide targeted treatment options in case the cancer ever comes back in the future.

So, the BRCA test is important, especially if other relatives in the family have had breast or ovarian cancer. The best treatment plan for your mother would be surgery and hormonal therapy.

Follow up after seven days.

I hope my explanation was clear and helpful. Please feel free to ask me any questions at any time. I am here to help you.

Thank you.