Blood test may signal breast cancer's return
Doctors may benefit from a blood test in determining the best course of treatment for breast cancer.
June 6th, 2012
05:06 PM ET

Blood test may signal breast cancer's return

Early research suggests that an existing blood test could help determine which patients with early-stage breast cancer, who had their tumors surgically removed, may see their cancer come back. If further testing validates this new research, it could mean some women would get more aggressive cancer treatments than currently prescribed.

Doctors at the M.D. Anderson Cancer Center in Houston, Texas, took blood samples from 302 women with stage 1, 2 or 3 breast cancer right before they had their tumor surgically removed.  None of the women had been treated with chemotherapy. The patients' progress was followed for nearly 3 years (35 months).

According to the study published Tuesday in the journal Lancet Oncology, 25% of women whose cancer was confined to the breast had at least one circulating tumor cell in their 7.5 milliliter sample of blood (about the equivalent of half a tablespoon).  Normally a lymph node biopsy is used to determine the likelihood of the cancer coming back.

Researchers found 73 women (24%) had at least one circulating tumor cell; 29 women (about 10%) had at least two circulating tumor cells in their sample and 16 (5%) had at least 3 or more tumor cells in their blood sample.

Women with early stage breast cancer aren't usually thought to be at high risk for having their cancer come back, but some do and doctors don't know why, which is why lead study author Dr. Anthony Lucci says he and his colleagues decided to investigate this.

The study found that if a women had just one circulating tumor cell in her sample, she had a 4 times greater chance of dying, compared to a woman with no CTCs.

"If three or more tumor cells were found in a blood sample, the woman had an almost 11 times higher risk of dying from the cancer compared to those who didn't have any circulating tumor cells," says Lucci.

All in all, 31% of the women in this study found their cancer came back or died during the study period.

Lucci likens circulating tumor cells to seeds in a garden. If you dump a bag of seeds in the dirt, he says, the odds that one or several take hold and grow is much higher than planting just one seed.

"While the findings of an association between circulating tumor cells  and outcome in breast cancer is not novel," says Dr. Boris Pasche, Director of the Division of Hemotology and Oncology at the University of Alabama at Birmingham.  "The strength of this new paper is its capability to characterize the magnitude of the impact of CTCs on breast cancer outcome."   He says the other strength of this study is that the blood samples were taken just before surgery, giving a more accurate picture of where traces of cancer are outside the breast.

Once a tumor is removed, it's possible for cells to break off, thus skewing the accuracy of how much cancer is already circulating outside the breast.

According to a commentary in the Journal of the American Medical Association in March 2010, the first documented research on circulating tumors was conducted in 1846. Since then, studies have shown that looking for circulating tumor cells in patients, who've already seen their cancer spread, can be an important tool to determine how a patient does in the future.

This hasn't been proven to be the case for early stage breast cancer, where the cancer has not spread beyond the breast and it is something this new study doesn't do either.

However, Pasche, who was not involved with the research, says if the results are validated in larger clinical trials, this may lead to a new screening method for predicting which women may be more likely to see their cancer come back.

"This provides a new train of thought of how we should handle women with early-stage breast cancer because we could identify the women who have a high risk of recurrences and early death and treat them differently."   Pasche suggests those patients  get more aggressive removal of lymph nodes, they may be put on chemotherapy (something they may not normally be prescribed) and their doctors will probably have a much tighter follow-up schedule for them.

Lucci and Pasche say this type of screening is not yet ready for prime time, and M.D. Anderson already has further studies underway.

soundoff (18 Responses)
  1. Franca Aide

    Gud findings

    June 7, 2012 at 04:45 | Report abuse | Reply
  2. Franca Aide

    Gud findings,pls kip me updated on dis talk

    June 7, 2012 at 04:48 | Report abuse | Reply
  3. Mark Glicker

    Very unfortunate disease.

    June 7, 2012 at 07:36 | Report abuse | Reply
  4. Terry Dunlop

    The article only mentions testing for Stage I, II, and III. What about Stage 0? I was diagnosed with Stage 0 BC in 2001 in one breast and then again in 2004 in the other. Both times I was treated with simple mastectomies. Now, more than ten years after my initial diagnosis, I'm diagnosed with Recurrent BC with bone matastasis. NOW my blood is tested for tumor markers. According to this study, which I understand is in its infancy, had my blood been tested before my mastectomies I would not now be facing a life expectancy of 2-3 years. Since there's a possibility that this simple blood test can save or prolong lives, why not just do it?

    June 7, 2012 at 14:29 | Report abuse | Reply
    • Dr. Steve

      My condolences. Adopting a new test like this without understanding the implications is dangerous. It could be that circulating cancer cells are very common, even in in situ cancers like yours, and this would lead many women to get unnecessary chemo – and some of them would die because of it. It is studies like this that will incrementally improve cancer treatment for women, making it as safe and effective as possible. Keep in mind that the prognosis for stage 0 breast cancer is usually very good – over 95% of women are cured – and it ihas gotten markedly better over the past 30 years due to methodical studies like this – though I know that is cold comfort in your case.

      June 8, 2012 at 10:26 | Report abuse |
  5. hap

    oh ms. dunlap, my very heart goes out to you & to yours. i agree with you completely! just go ahead n give the dmn test! any preparedness is a helluva lot better that not knowing. im a 1 yr survivor this month. i live life everyday as i should, but always when it get close to c/u appts, my mind races as it does now! i want to know NOW! i want the test! and ms dunlop should've had the test! at least make it known n make it a choice to have.

    June 7, 2012 at 17:47 | Report abuse | Reply
  6. hap

    MS.DUNLAP, i sincerly apologize for not having the right words to give you comfort. you r a brave woman n no doubt an exceptionaly strong woman. you have to be, there is no choice to be anything other. i only wish you happiness, joy and peace. i know you will show cancer you have the tenacity to be here far more than what is expected. i hold you and yours in my prayers, with grace.

    June 7, 2012 at 17:53 | Report abuse | Reply
  7. Terry Dunlop

    Thank you for the responses to my post. Please know that I'm not feeling sorry for myself. I know my life is in God's hands and whatever he has in store for me is His will and I accept that. I am being treated. And I'm trying to understand how this happened. Dr. Steve, it's my understanding that those diagnosed with DCIS that later recurred were originally treated with lumpectomies and radiation. I was treated with mastectomies and told I was 99-100% cured. I've been unable to find any information about this happening to others and my doctor's shrug their shoulders when I ask. I'm praying this study can help other women.

    June 8, 2012 at 15:02 | Report abuse | Reply
  8. leah

    my mother in law recently discovered her breast cancer came back after 10 years. Now she will be getting a mastectomy soon. My question is to you that is there a posibility that her cancer might come back even after the mastectomy?

    June 15, 2012 at 12:32 | Report abuse | Reply
  9. Dr Johannes Uys

    Thank you for writing this post and thank you to all expressing their views and experiences. The very best to you all.

    July 31, 2012 at 09:07 | Report abuse | Reply
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    August 4, 2012 at 02:06 | Report abuse | Reply
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