ROJoson PEP Talk: Monitor Recurrence of Breast Cancer After Curative Treatment

ROJoson PEP Talk: Monitor Recurrence of Breast Cancer After Curative Treatment

1. June 1, 2024 1400H - 1500H Via Zoom Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management.

2. June 1, 2024 1400H - 1500H Via Zoom Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. May 18, 2024 marks the start of YEAR 4 of ROJoson PEP Talk. How long the PEP Talk will last will depend on our enthusiasm , discipline and perseverance .

10. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. My PEP TALK today is entitled: MONITORING RECURRENCE OF BREAST CANCER AFTER Curative TREATMENT

11. Contents What does “after curative treatment for breast cancer” mean? Why monitor breast cancer recurrence after curative treatment? Where are the sites of breast cancer recurrences after curative treatment? How to monitor breast cancer recurrence after curative treatment? What are ROJoson’s advice on how to monitor breast cancer recurrence after curative treatment? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals . Monitoring Recurrence of Breast Cancer After Curative Treatment

12. What does “after curative treatment for breast cancer” mean? At the time of the initial consult with a breast specialist, the breast specialist will determine the stage of the diagnosed breast cancer. He/she can use the categorization of Stage 1 to 4 (with 1 being earliest and 4 being most advanced) or use simple layman’s categorization: localized / locoregional / advanced stage. Based on the stage, the breast specialist determines the goal of treatment (whether curative vs palliative). He/she maps out the specific treatment plan based on the goal. Monitoring Recurrence of Breast Cancer After Curative Treatment

13. What does “after curative treatment for breast cancer” mean? A “curative treatment for breast cancer” means the treatment plan aims for complete remission with the hope of NO recurrence whatsoever. Strictly speaking, in the medical world, physicians do not talk / promise / assure a CURE outcome after treatment even in the earliest stage of cancer. They would use the word REMISSION instead of CURE. Because no matter what stage and treatment done, there is always a possibility of recurrence. Monitoring Recurrence of Breast Cancer After Curative Treatment

14. What does “after curative treatment for breast cancer” mean? What is the difference between CURE AND REMISSION from cancer? CURE means the cancer is completely gone and is not expected to come back. REMISSION means there is no evidence of residual cancer after treatment at the moment but cancer may still come back . Again, with the recurrence being possible, physicians do not talk of cure, but REMISSION. Monitoring Recurrence of Breast Cancer After Curative Treatment

15. What does “after curative treatment for breast cancer” mean? When oncologists say this or that cancer is still “ curable” - They mean that they can get rid of the cancer if proper treatment is administered early enough. The cancer has a good chance of being controlled completely and attaining complete remission. However, they still don’t guarantee cure. They guarantee “good chance for complete remission.” Monitoring Recurrence of Breast Cancer After Curative Treatment

16. What does “after curative treatment for breast cancer” mean? To repeat - A “curative treatment for breast cancer” means the treatment plan aims for complete remission with the hope of NO recurrence whatsoever. A curative intent or goal is usually aimed for Stages 1 and 2 breast cancers and local and locoregional stages. A non-curative intent or palliative goal is usually realistically aimed for the advanced stages especially those with distant metastasis or Stage 4. Monitoring Recurrence of Breast Cancer After Curative Treatment

17. Why monitor breast cancer recurrence after curative treatment? After a curative treatment for breast cancer, there is still a possibility of recurrence no matter what. The lower the stage, the lesser the risk of recurrence. Regardless of the stages, after an execution of a curative treatment plan, there must be a plan to monitor for recurrences. The commonly used medical term for monitoring is surveillance. Monitoring Recurrence of Breast Cancer After Curative Treatment

18. Why monitor breast cancer recurrence after curative treatment? The goal of breast cancer surveillance is to detect breast cancer as early as possible, prior to the onset of signs or symptoms of disease, to allow for earlier, less aggressive treatments, thus reducing the mortality and morbidity associated with a recurrence.   Monitoring Recurrence of Breast Cancer After Curative Treatment

19. Why monitor breast cancer recurrence after curative treatment? Whatever breast cancer surveillance strategies are recommended, the following should be considered: Effectiveness in detecting recurrence Risk of the detecting strategies Outcomes (whether they really prolong survival with a good quality of life) Costs of the detecting strategies Availability of the detecting strategies Monitoring Recurrence of Breast Cancer After Curative Treatment Note: in breast cancer, a strategy that can detect recurrence early may NOT necessary be equated to prolonging survival with a quality of life. Thus, usually a battery of test is NOT recommended.

20. Where are the sites of breast cancer recurrences after curative treatment ? The more common sites of recurrences: Local recurrences - operative areas, breast, chest Regional recurrences - lymph nodes in armpits and neck (above collar bones) Distant recurrences Bones Lungs Brain / Liver / Skin and soft tissues Opposite breast (Note: a new cancer arising on the opposite breast is not a recurrence.) Monitoring Recurrence of Breast Cancer After Curative Treatment

21. How to monitor breast cancer recurrence after curative treatment ? By: Self Breast specialist with or without lab diagnostic tests Self – through symptoms monitoring and through breast self-exam Breast specialist – through clinical breast exam and lab tests as needed Monitoring Recurrence of Breast Cancer After Curative Treatment

22. How to monitor breast cancer recurrence after curative treatment ? Usually, 3 commonly practiced strategies in breast cancer surveillance: Symptom- and sign-based surveillance with selective lab tests as needed (depending on the risk of recurrence) Clinical examination and mammogram surveillance with other lab tests as needed (depending on the risk of recurrence) Battery of lab test surveillance ( mammo , ultrasound, bone scan, CT scan, PET scan, tumor markers, etc.) Monitoring Recurrence of Breast Cancer After Curative Treatment

23. How to monitor breast cancer recurrence after curative treatment ? Symptom - based surveillance (patient self-monitoring system): Look and feel for common alert symptoms of recurrences: Mass on the operated areas, opposite breast, armpits, neck and other parts of the body Intractable headache – possible brain Intractable bone pain – possible bones Intractable cough – possible lungs Intractable abdominal pain – possible liver Monitoring Recurrence of Breast Cancer After Curative Treatment Intractable – prolonged or longed duration - 2 to 4 weeks -and evidently not due to causes other than a recurrence

24. How to monitor breast cancer recurrence after curative treatment ? Sign - based surveillance (breast specialist clinical examination - monitoring system): PHYSICAL EXAMINATION searching for signs of recurrence looking and palpating for mass that would indicate a breast cancer recurrence evaluating a patient for recurrence with inputs from history or interview for symptoms of recurrence Monitoring Recurrence of Breast Cancer After Curative Treatment The minimum areas to be examined by the breast specialists are the following: 2 breasts / areas; 2 armpits; 2 areas of the neck above the collar bones; and right upper quadrant of abdomen.

25. How to monitor breast cancer recurrence after curative treatment ? Usually, 3 commonly practiced strategies in breast cancer surveillance: Symptom- and sign-based surveillance with selective lab tests as needed (depending on the risk of recurrence or suspicious for recurrence) Clinical examination and mammogram surveillance with other lab tests as needed (depending on the risk of recurrence) Battery of lab test surveillance ( mammo , ultrasound, bone scan, CT scan, PET scan, tumor markers, etc.) Monitoring Recurrence of Breast Cancer After Curative Treatment ROJoson Personal Practice

26. How to monitor breast cancer recurrence after curative treatment ? Usually, 3 commonly practiced strategies in breast cancer surveillance: Symptom- and sign-based surveillance with selective lab tests as needed (depending on the risk of recurrence or suspicious for recurrence) Clinical examination and mammogram surveillance with other lab tests as needed (depending on the risk of recurrence) Battery of lab test surveillance ( mammo , ultrasound, bone scan, CT scan, PET scan, tumor markers, etc.) Monitoring Recurrence of Breast Cancer After Curative Treatment Recommended by NCCN and ASCO

27. How to monitor breast cancer recurrence after curative treatment ? Annual mammography and physical exams are recommended surveillance strategies for people who have been treated for curable breast cancer. More intensive follow-up in people with no symptoms has not been proven to improve outcomes.  The American Society of Clinical Oncology (ASCO) does not recommend routine screening for cancer at distant sites . Monitoring Recurrence of Breast Cancer After Curative Treatment https://www.cancer.net/cancer-types/breast-cancer/follow-care-and-monitoring

28. How to monitor breast cancer recurrence after curative treatment ? Usually, 3 commonly practiced strategies in breast cancer surveillance: Symptom- and sign-based surveillance with selective lab tests as needed (depending on the risk of recurrence or suspicious for recurrence) Clinical examination and mammogram surveillance with other lab tests as needed (depending on the risk of recurrence) Battery of lab test surveillance ( mammo , ultrasound, bone scan, CT scan, PET scan, tumor markers, etc.) Monitoring Recurrence of Breast Cancer After Curative Treatment NOT being recommended internationally

29. How to monitor breast cancer recurrence after curative treatment ? There are clinical studies that compare the use of battery of tests vs selective test approaches in breast cancer surveillance. Results of this trial support the view that a protocol of frequent laboratory tests and roentgenography after primary treatment for breast cancer does not improve survival or influence health-related quality of life. Routine use of these tests should be discouraged.(JAMA. 1994;271:1587-1592) Monitoring Recurrence of Breast Cancer After Curative Treatment

30. How to monitor breast cancer recurrence after curative treatment ? There are clinical studies that compare the use of battery of tests vs selective test approaches in breast cancer surveillance. Conclusions.  —Periodic chest roentgenography and bone scan allow earlier detection of distant metastases, but anticipated diagnosis appears to be the only effect of intensive follow-up, and no impact on prognosis is evident after 5 years. Periodic intensive follow-up with chest roentgenography and bone scan should not be recommended as a routine policy.(JAMA. 1994;271:1593-1597) Monitoring Recurrence of Breast Cancer After Curative Treatment

31. How to monitor breast cancer recurrence after curative treatment ? Monitoring Recurrence of Breast Cancer After Curative Treatment

32. How to monitor breast cancer recurrence after curative treatment ? Monitoring Recurrence of Breast Cancer After Curative Treatment LESS EXPENSE BIG EXPENSE

33. How to monitor breast cancer recurrence after curative treatment ? Usually, 3 commonly practiced strategies in breast cancer surveillance: Symptom- and sign-based surveillance with selective lab tests as needed (depending on the risk of recurrence or suspicious for recurrence) Clinical examination and mammogram surveillance with other lab tests as needed (depending on the risk of recurrence) Battery of lab test surveillance ( mammo , ultrasound, bone scan, CT scan, PET scan, tumor markers, etc.) Monitoring Recurrence of Breast Cancer After Curative Treatment ROJoson Personal Practice Recommended by NCCN and ASCO NOT being recommended internationally

34. What is ROJoson’s advice on how to monitor breast cancer recurrence after curative treatment? ROJoson TPORs Symptoms of patients (what they felt and observed) (regular, monthly at least, for life ) Signs from physical exams of physicians, particularly cancer specialists (regular at planned intervals for life) Laboratory diagnostic tests or procedures (as indicated – selective / not battery of tests) Monitoring Recurrence of Breast Cancer After Curative Treatment

35. Monitoring Recurrence of Breast Cancer After Curative Treatment Contents What does “after curative treatment for breast cancer” mean? Why monitor breast cancer recurrence after curative treatment? Where are the sites of breast cancer recurrences after curative treatment? How to monitor breast cancer recurrence after curative treatment? What are ROJoson’s advice on how to monitor breast cancer recurrence after curative treatment? Summary Take Away

36. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on “Monitoring Recurrence of Breast Cancer After Curative Treatment.” Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on “Monitoring Recurrence of Breast Cancer After Curative Treatment” as part of your health management. Monitoring Recurrence of Breast Cancer After Curative Treatment

37. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. This ends my PEP TALK today on: MONITORING RECURRENCE OF BREAST CANCER AFTER Curative TREATMENT

38. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

39. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

40. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

41. Monitoring Recurrence of Breast Cancer After Curative Treatment Empowerment objective - for laypeople to have an essential  understanding on MONITORING RECURRENCE OF BREAST CANCER AFTER A CURATIVE TREATMENT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!