Breast cancer can be dormant for years

Breast cancer can return 20 years after a woman is first diagnosed, women might be told to continue taking hormonal drugs for longer than the current five years, in a bid to stop tumours returning. Scientists analysed data from clinical trials involving different women, all of whom had the most common form of breast cancer caused by the hormone oestrogen.

Breast cancet patient received pill treatments such as tamoxifen or aromatase inhibitors which block the effects of oestrogen or shut off the hormone's supply. After five years of therapy, their cancers had gone and they stopped taking the drugs. But monitoring the women's progress revealed recurrences of the disease up to 15 years later – 20 years after initial diagnosis.

Women who started off with large tumours and cancer that had spread to four or more lymph nodes faced the highest risk of recurrence, they had a 40 per cent risk of cancer returning in a different part of the body over a period of 15 years after treatment. For patients diagnosed with small, low-grade cancers that had not spread the risk was 10 per cent.

Recent research has suggested that extending hormone therapy to 10 years may be more effective at preventing breast cancer recurrence and death, five years of tamoxifen reduces the risk of recurrence after treatment. Aromatase inhibitors, which only work for post-menopausal women are more effective.

However, some patients choose to stop the hormone treatments early because of side effects such as menopausal symptoms, osteoporosis, joint pain or carpal tunnel syndrome.This research shows that stopping hormone treatment at five years leaves women with an ongoing risk of breast cancer coming back in future.
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Breast cancer gene

Breast cancer is caused by complex interactions between a large number of genetic variants and our environment. The inherited component of breast cancer risk is due to a combination of rare variants in genes such as BRCA1 and BRCA2 that confer a high risk of the disease, and many genetic variants that each confer only a small risk.

The newly identified risk regions nearly double the number that are already known, thereby bringing the number of known common variants associated with breast cancer to about 180.
One in five women are in greater danger of getting breast cancer because of faults in their genes. Women are at risk of breast cancer if their mother, daughter or sister has breast cancer.

For one in five women, the errors written into their genes mean they have almost a third higher chance of getting breast cancer. An unlucky one per cent have three times the risk of the other 99 per cent of the population.

These gene changes now have the potential to be incorporated into existing models to accurately predict an individual's risk, and to improve both prevention and early detection of the disease. The study looked at 11.8 million single-letter 'spelling mistakes' in women's DNA which increase their risk of breast cancer.

The researchers discovered nine more variations affecting the gene BRCA1. In total, they have confirmed 107 genetic variants and discovered 72 new ones. The discovery allowed the team to calculate that one in ten women have a 70 per cent higher risk of getting breast cancer.

About 70 per cent of all breast cancers are fuelled by the sex hormone oestrogen and respond to hormone therapies such as tamoxifen.
Others, known as oestrogen-receptor negative, are not affected by the hormone and are more difficult to treat.

In a second study, the researchers found 10 new variants linked to these cancers, the two cancer types are biologically distinct and develop differently.
Breast cancer susceptibility is due to the effect of a large number of inherited genetic variants, each of which may only confers a slight increase in breast cancer risk, when the strongly predisposing genes such as BRCA1 and BRCA2 are not considered.

The study discovered 65 new variants, some of which are common, have each of which has only a small effect on breast cancer risk, but cumulatively they could be very important in altering a woman's risk of breast cancer.
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