Prognosis Worrisome With Cancer's Return
Friday, March 23, 2007
Elizabeth Edwards's chance of surviving five years is well below 50 percent if her experience is similar to that of other women whose breast cancer has returned within five years of its original discovery and treatment.
That is the conclusion of numerous studies as well as clinical observation of oncologists. The pessimistic prognosis, however, is partly undercut by two caveats. Survival varies greatly for women with Edwards's diagnosis, and new drugs are helping extend their lives even when the disease is no longer curable.
The 57-year-old wife of John Edwards, a former senator from North Carolina seeking the Democratic nomination for president, Elizabeth Edwards announced yesterday that breast cancer cells had been found in a rib on the right side of her chest, as well as in other unspecified parts of her skeleton. Her physician, Lisa Carey, an oncologist at the University of North Carolina, said "it is possible" the cancer has spread to one of her lungs -- a finding that, if confirmed by further testing, would worsen her prognosis.
At a news conference in Chapel Hill, N.C., at which the couple answered questions, John Edwards acknowledged frankly that his wife's cancer "will not be cured now."
Surgery is not a treatment for "metastatic," or widely spread, cancer. In the coming months she is likely to undergo new rounds of chemotherapy in an effort to suppress the growth of the tumor cells. They could include traditional cell-killing drugs (probably different ones from what she took previously); drugs that block the effects of estrogen, a hormone that stimulates growth of many breast tumors; and a growing array of tumor-fighting antibodies and other "biological therapies."
Both Edwards and her husband were upbeat and said they would continue campaigning. She said she is "completely symptom-free." He likened her cancer to diabetes -- an incurable but treatable disease.
Data suggest, however, that her long-term prognosis is considerably graver than for people with diabetes and other chronic diseases.
A study published last year in the European Journal of Surgical Oncology reviewed the experience of 2,500 women treated at a large hospital in Sydney between 1989 and 2002. Of that group, 18 percent had a recurrence of their breast cancer, and the average time to recurrence was 2.3 years, slightly shorter than Edwards's. The most common site of relapse was bone, as was hers.
Among women with recurrences outside the originally affected breast or its nearby lymph nodes, only 13 percent survived five years or more. Women whose tumor reappeared in bone had a median survival of 2.4 years, longer than those in whom the tumor came back in either the lungs or liver.
Many experts emphasized yesterday the relative scarcity of data on survival of women whose breast cancer returns, as well as the wide range of biological responses when they undergo treatment.
"Everyone is an individual. We try not to focus too much on the statistics," said Barry R. Meisenberg, head of the division of hematology and oncology at the University of Maryland Greenebaum Cancer Center in Baltimore.
He added that "within 'average survival' are people who do much, much better than average and people who do much, much worse. And since there is no such thing as an average person, the statistic is not very helpful."
The most authoritative source of breast cancer statistics, the National Cancer Institute's Surveillance, Epidemiology, and End Results program, does not include information on the prognosis of women whose breast cancer recurs, said Brenda K. Edwards, one of its associate directors. It is too difficult to follow thousands of women in the database, many of whom live for decades and move numerous times.
A statement by Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said survival statistics for women whose cancer was widely spread at the time of original diagnosis "has no meaning in Ms. Edwards' case and should not be interpreted as a suggestion of her survival chances."
However, it is unlikely her prognosis would be better than those women, among whom 24 percent were alive five years after original diagnosis, and 13 percent were alive after 10 years.
Staff researcher Magda Jean-Louis contributed to this report.