June 2016 Ask the Expert: Long-Term Survivorship
Many people have decades of life ahead of them after breast cancer treatment is over. Though cancer is in the past, the experience of breast cancer, and the desire to do everything you can to lower your risk of recurrence, is part of your future.
In June, Living Beyond Breast Cancer expert Kathryn J. Ruddy, MD, MPH, answered your questions about long-term survivorship after a breast cancer diagnosis, from follow-up care and fear of recurrence to nutrition, exercise and stress relief.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
Seeking a local or online support group could be very beneficial for you. Your doctor may be able to recommend one, or you could call the American Cancer Society at (800) 227-2345 for suggestions. You may also want to consider sharing your experiences and feelings with at least a few of your more sympathetic colleagues so that they understand that you seek more support.
While duloxetine does work well for some patients, others do not get much benefit from it. Unfortunately, efforts to develop better treatments for chemotherapy-related neuropathy have not been as fruitful as we would like.
One more intervention that is currently under study for painful neuropathy is scrambler therapy. This involves sending an electrical current through electrodes placed near the painful area. The goal of scrambler therapy is to retrain the brain to interpret signals from those nerves as a vibrations instead of pain. But this treatment is not available everywhere, and its benefits are still uncertain.
The only large randomized clinical trial that showed that a particular diet reduced risk of breast cancer recurrence used a low-fat diet, not a low-sugar diet. In that study, the women who ate a low-fat diet ended up weighing less than those who ate a standard diet, and I believe the benefit came from the impact on weight more than from specific foods.
So while it is true that being overweight or gaining weight may increase the risk of recurrence of breast cancer, eating sugar really shouldn’t be a problem as long as you don’t eat so much that it makes you gain weight. We recommend a well-balanced, heart-healthy diet with plenty of fruits and vegetables to optimize your general health, but there is no reason you need to be afraid of sugar.
No, there is no time limit for reconstructive surgery, and the results would likely still be at least as good as if you had done the reconstruction immediately. There is no age limit for reconstruction either, though older women are less likely to choose reconstruction than younger women. The risks of any surgery do increase with age, particularly if you have heart problems or other serious medical issues.
You and your oncologist would generally weigh the expected benefits (which depend on the size and other characteristics of your original cancer) against the side effects you have experienced to date. Women whose cancers involved regional lymph nodes are likely to benefit more from the extended course of treatment.
The data are very mixed on how soy may impact the number of breast cancer diagnoses or a woman's prognosis after a breast cancer diagnosis. While we wait for additional research on this topic, I generally advise my patients that eating soy in moderation does not appear to be harmful, but I am less certain about the safety of high soy intake (such as multiple servings per day) for those with hormonally-sensitive tumors.
It is not common that those symptoms would develop after a long delay, so it makes sense to have a comprehensive workup for other potential causes (and it sounds like that's what you're doing). Problems with your thyroid or with the way your body is absorbing nutrients should certainly be ruled out, and you may also want to see a neurologist to help with your evaluation.
Research is still underway to find whether metformin could reduce risk of breast cancer recurrence. Because this drug can have side effects (such as diarrhea), I would not recommend it unless there are other reasons to do so (such as diabetes) until we have definitive data showing a benefit in breast cancer.
You’re not alone in your anger, and there are many psychologists and counselors who are experienced helping people who have had cancer cope with these feelings. Cognitive behavioral therapy can help and exercise may also have benefits. Please ask your healthcare providers to connect you with an expert on the emotional aftermath of cancer.