Death of actress Shannen Doherty: what are the risk factors for breast cancer recurrence ?

Cancer du sein : quels sont les facteurs de risque de récidive ?

This weekend, we learned of the death of Shannen Doherty, famous for her roles in the series Beverly Hills and Charmed. In 2015, she made her battle against breast cancer public before announcing her remission in 2017. Unfortunately in 2020, the actress suffered a relapse of her illness. Why does breast cancer recur ? Are there risk factors ?

We speak of a recurrence of breast cancer when it reappears months or even years after the end of treatment. But this "relapse" can be:

Local: the cancer reappears in the same area as the original tumor; Regional: The cancer reappears near the original tumor, in the lymph nodes of the armpit for example; Remote: Breast cancer spreads from the original tumor to the lungs, bones, brain, or other parts from the body. This is metastatic breast cancer, often called stage 4 breast cancer, from which actress Shannen Doherty suffered. It is the most difficult form to treat because breast cancer is present in several areas of the body.

According to theAmerican Cancer Society, inflammatory breast cancer and triple negative breast cancer are at greatest risk of recurrence .

What are the causes of breast cancer recurrence ?

According to the Cleveland Clinic in the United States, breast cancer recurrence occurs when treatment fails to kill all the cancer cells. These breast cancer treatments are effective but “they can shrink breast cancer tumors so much that tests can no longer detect the weakened cancer cells. (Also) surgery to remove a tumor is not always 100% effective. Before surgery, cancer cells can travel from your breast to nearby lymph nodes, tissues, or the bloodstream."

What are the risk factors for relapse ?

The risk of recurrence is based on prognostic factors for breast cancer. These risk factors are decisive in the choice of treatment. Depending on their presence, doctors opt for this or that treatment. These include:

The age of the patient. "Breast cancer that affects younger women tends to be more aggressive, high grade and more advanced at the time of diagnosis with an increased risk of recurrence", notes the National Cancer Institute; The size of the tumor. The prognosis is better when the tumor is small; If breast cancer has spread to the lymph nodes, the risk of recurrence is greater; The grade of breast cancer. The Elston-Ellis histoprognostic grade is classified from I to III and is mainly based on the appearance of the cancer cells (tumor architecture) and the speed at which they develop (mitotic activity); The presence of local inflammatory signs (redness, heat, etc.); Overweight and obesity

Note: Most breast cancer recurrences occur within 5 years following treatment. But are not systematic, in most cases the cancer never returns.