Cancer: Remission vs Cured

On Friday, 19 February 2021, I met with my oncologist discuss the results of my three-monthly screening for breast cancer. I asked her about remission vs cured and where I fit into the classification. She responded that she would classify me as cured. Her answer came as quite a shock. 

After I had time to ponder the news over the weekend, I decided to research the different meanings of being in remission and being cured. Based on my research below, I strongly question my oncologist's use of the word 'cured', especially since I am still on adjuvant therapy for the next ten years. "The goal of adjuvant therapy is to kill any cancer cells that may remain after primary treatment in order to reduce the chance that the cancer will recur." (Mayo Clinic)

I feel much more comfortable using the words 'complete remission' for now. As such, I think using #cancerwarrior is more appropriate than #cancersurviror. 

"The word cured refers to complete clinical remission of a cancer, regardless of the presence or absence of late sequelae of treatments. To correctly apply the word cured, the time from the cancer diagnosis must be such that the patient's risk of death does not, because of cancer, exceed that of a sex- and age-matched general population. In other words, a cancer patient can be defined as cured only when his or her life expectancy is the same as that of a sex- and age-matched general population." (Oncology research, 2015)

Another website defines remission as follows: "Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared. If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Still, some cancer cells can remain in your body for many years after treatment. These cells may cause the cancer to come back one day. For cancers that return, most do so within the first 5 years after treatment. But, there is a chance that cancer will come back later. For this reason, doctors cannot say for sure that you are cured. The most they can say is that there are no signs of cancer at this time. Because of the chance that cancer can come back, your doctor will monitor you for many years and do tests to look for signs of cancer's return. They will also look for signs of late side effects from the cancer treatments you received." 

I found this interesting study on breast cancer. It states that: "Although most people with breast cancer will not die of breast cancer, their comorbidities (eg, obesity, hypertension, hyperlipidemia, and diabetes mellitus [DM]) will most certainly affect disease-free survival (DFS) and, ultimately, overall survival (OS). In this review we address lifestyle changes, which are largely dependent on body mass index (BMI) and include diet and exercise, and review recommendations regarding these issues. Survivors of breast cancer represent a unique group who must be cognizant of the long-term side effects of their treatment protocols and be given information to encourage a proactive approach to their overall health."

The study above also reports on second primary malignancies (SPM). The most important risk factor for SPMs appears to be age at the time of diagnosis. The younger one’s age at diagnosis, the more likely the potential for the development of an SPM. It is estimated that an SPM will develop in 5% of patients within 10 years of diagnosis because chemotherapy has been linked, specifically, to the development of secondary acute myeloid leukemia (AML) and, more rarely, myelodysplastic syndromes (MDS). The most common sites for SPMs to develop are the pulmonary, gynecologic (endometrial and/or ovarian), colorectal, and integumentary (melanoma) systems. There appears to be a reciprocally elevated risk of skin cancer occurring after the development of breast cancer, and vice versa. Thus, concerns about SPMs and adjuvant radiation therapy in patients with breast cancer undergoing mastectomy with minimal nodal involvement will require future awareness and education for caregivers of survivors of breast cancer.

The most important thing for me now is to look after my health. I must eat healthily, get exercise, take my hormone-blocking medication exactly as prescribed, and go for my six-monthly screenings. I believe that, because my cancer was caught at a very early stage, the aggressive way in which it was treated will contribute to me being disease-free for the rest of my life.