Salted peanuts, citrus fruits and vinegar – they’re all back on the menu!

I am both relieved and happy to report that the two dreadfully painful mouth and tongue sores that I’d had for the past couple of weeks have gone.

The sores were a side effect of one of the two new drugs that I started taking just over three weeks ago for the secondary breast cancer that’s in my bones and bone marrow.

I made it very clear in my previous post just how awful these sores were. These past few days, though, I’ve been eating salted peanuts again – a favourite snack to accompany a pre-dinner drink. Not just that, I had an orange earlier today for the first time in almost three weeks. Finally, I am happy for my husband to start putting vinegar in the salad dressing again! 

Everything is back on the menu. At least it is for the moment. Mouth sores can come and go while you’re taking this drug – everolimus (Afinitor) – so we’ll enjoy this mouthsore-free period for as long as it lasts. I’ve been mouthwashing assiduously with the two rinses the oncologist prescribed for me. I guess I’ll continue to do so as a preventative measure.

Also this past week, I had the stitches taken out from the two wounds I have from the skin lesion removal procedures I had a few weeks ago. The wound on my right calf has healed beautifully but the one on the sole of my right foot has not. There has been a certain amount of discomfort associated with the “non-healing” and it means I’ll be off the tennis courts and off the bike for yet another couple of weeks. 

In case you’re wondering, yes, it was indeed painful having the stitches removed, especially those in my foot. I had to ask the nurse who was removing them to stop two or three if not four times so I could take a breather. In the end, the nurse had to call in one of the doctors – an expert in stitches removal apparently- to finish the job.

How painful was it? Well, as we all know, pain is very hard to measure objectively. However, I suspect that if it had been a person very close to me who’d been having this done, he might have fainted! He knows who he is – it’s not hard to guess his identity! – and he’s ok with me writing that. I did check!

I was due to get the results of the biopsies they did on the removed tissue on Thursday this past week, but instead I got a phone call to say the report’s not available yet.

Away from the medical stuff, we’ve been continuing to enjoy the easing of the pandemic-related lockdown restrictions. 

We’ve been out and about, enjoying the late Spring. Indeed we had a very eventful experience just a couple of days ago, during a trip to the beautiful space in southwest London that is Richmond Park.

I can’t remember the last time I was in the park without my bike; regular readers of this blog will know that it is a great place for cycling.

This time, however, my husband and I were on foot. We were going specifically to see the annual display of camelias, azaleas and bluebells in an area of the park called the Isabella Plantation. (There were lots of other flowers too, but I’m afraid my flower-identifying knowledge is extremely limited.)

Walking though the park after we’d seen the flowers, we came across a family of Egyptian geese.

When we first encountered this charming group, there were eight goslings and the mother was trapped inside a small enclosure in the park (photo on the left).

The father was outside the enclosure, unable to help. Both adult birds were clearly distressed – there was lots of squawking and heavy breathing. 

As it turns out, I was instrumental in facilitating the release of the mother, upon which the family hotfooted it towards the nearest pond (photo on the right). It’s a long story but the “rescue” was enabled by the actions of two helpful but distinctly underwhelmed members of the Metropolitan Police who had the misfortune to be in the area at the time!

The pond was about a ten-minute waddle from the enclosure. We followed, taking photos. It was all very cute and exciting.

A happy ending, you may be thinking. Sadly, it wasn’t so. On the way to the pond, disaster struck! To my horror, a big crow swooped down and snatched one of the goslings. As a result, only seven of them made it to the pond. In just a few seconds I went from feeling like a hero to feeling responsible for the death of a gosling. Nature can indeed be cruel.

As for the flowers in the Isabella Plantation, what can I say other than that they are an absolute delight.

In other developments, we’ve booked another couple of trips away over the next month or so – one to Manchester with friends and one to Wales to stay with some very good friends. We’ll catch up with some relatives while we’re in Manchester and, in Wales, I’m very much looking forward to seeing my teenaged goddaughter. That is despite the fact that she has said that, as well as looking forward to seeing me too, she “can’t wait to beat you at chess”. Mmm.

May 17th is an important day in England in terms of the restrictions easing. Museums and art galleries can open again, you can once again eat inside at pubs and restaurants, hotels can fully open again and you can stay overnight with relatives or friends. I’ve already bought tickets for a couple of exhibitions, one of which I’ll enjoy with an old friend who’s coming to London for the day the week after next. Also, tomorrow evening, I’ll be eating inside, at a (hopefully well-ventilated) pub restaurant, with friends, for the first time since last summer.

I’m well aware that we’re far from being out of the woods on the pandemic front – variants of concern, localised spikes in cases here in the UK, the tragic situation in India, etc. However, I’m determined, safely, to make the most of our newly returned freedoms while we have them. I’d like to have been able not to write the last four words in that previous sentence, but I’m sure I’m not alone in thinking that restrictions will come and go depending on how the situation evolves. That said, I tweeted recently that I intended to “carpe the sodding diem” out of this summer. That’s still my plan, the pandemic and my health allowing. 

I am, of course, also well aware that we still don’t know how much protection the vaccines give to people such as myself who have compromised immune systems. I won’t be diving in for big hugs with all and sundry and I think I’ll be steering clear of full-capacity cinemas and theatres for some time to come. I did feel uncomfortable on the London Underground the other day; while almost everyone was wearing a mask, it was much busier than it’s been in the past few months.

Back to medical practicalities. I’m less than one week away from finishing my first 30-day cycle of this new line of treatment. On Wednesday I go to the hospital for blood tests and a chest x-ray; the latter is to see whether there’s any damage to my lungs (another potential side effect). I see the consultant on Thursday for the blood test and x-ray results and to discuss how things are going.

This latest treatment consists of a combination of two drugs – everolimus and exemestane (Aromasin). I take one tablet of each every day. It may still be too early to tell whether they are having an effect as it can take some time for this to show. Other than the mouth sores, the only side effect I’ve noticed is the odd night sweat, similar to those many women get when they’re going through the menopause. They are not pleasant – who wants to have to change out wet nightwear at 2 or 3am? Finally, I wouldn’t be surprised to hear my haemoglobin level has dropped further.

We shall see. For now, though, I’m off to suck on a lemon.

An update

In the grand scheme of things, I’m quite relieved at the results of my latest round of blood tests.

I met the oncologist earlier this week to discuss the results of the tests I’d had done the previous day. The best I could have hoped for was for my tumour marker to have stayed at the level it had jumped to in December. I figured that was unlikely given that it had risen by a whopping 20% between the November and December blood tests. In the event, it went up by around another 10%.

On the upside, on the blood front things are good. The secondary breast cancer that has spread to my bones has also infiltrated my bone marrow and so reduces my body’s ability to make healthy blood. It was therefore good to hear that my haemoglobin count is up from last month and is again within the normal range, albeit at the very lower end. My neutrophils, while still below the normal range (they’ll never be there again), are 40% up on last month. That means I’m a little better placed to face any infection that comes my way – a positive in the current climate.

Once again, it’s swings and roundabouts. The tumour marker is up but bloods are ok.

With the pandemic still on the rampage, every effort is being made to minimise the number of trips patients on treatment make to hospital. For example, every other appointment with the consultant over the past nine months has been on the phone rather than in person. In fact, I may have had more over the phone than not. Some people don’t like this way of communicating but it’s fine by me. In addition, for my next two rounds of treatment, I’m going to self-inject at home the bone strengthening drug (denosumab/Xgeva) that I have at the start of every new cycle. It’s usually done by one of the oncology nurses at the day treatment unit at the hospital. I did it myself last month at the unit under supervision and that too was fine.

The fact that the marker is going up indicates that there is increased cancer activity somewhere in my body. That’s what happens with secondary cancer. It eventually outwits every possibly treatment. While these latest results were far from disastrous, you do have to be practical. The oncologist therefore discussed with me what drug(s) I might move onto if the scans I’m to have in seven weeks show signs that the cancer has progressed to the extent that we need to change to another treatment. The scans could show any number of things. While you can’t predict a precise course of action in advance as you don’t know what you’ll see, you can be thinking of what might need to happen under various scenarios.

The discussion was quite sobering. But let’s not pre-empt things. That decision – if indeed a decision needs to be taken – is eight weeks away. In the meantime, I carry on with my current treatment and just get on with things.

One of those things is reporting my health status daily on the Covid Symptom Study app – covid.joinzoe.com – that is used to study the symptoms of COVID-19 and track the spread of this virus that is causing such devastation and unimaginable heartache to so many. (On a personal level, next week will see the funeral of a good friend’s husband who died from COVID-19 just after Christmas. His death was heartbreaking on many levels.)

It seems heartless to carry on writing about my own experiences having just written those previous two sentences, but the case is that I reported having a runny nose on the Zoe app, as it’s known, one day last week. While a runny nose is not a symptom of infection with the virus, I, together with any other household members, was “invited” via the app to take a test. It was all very efficient. The test kits were delivered the day after we requested them, we posted them back the following day and got the results – negative in the case of both myself and my husband – 36 hours later via text and email.

I reckoned the results would be negative but, with transmission rates as high as they are, you can obviously never be sure. Our two boys are back at uni and so it’s just my husband and me in the house. I work from home so it’s been a few weeks since I’ve been out for anything other than to exercise or attend hospital appointments. In my husband’s case, it’s for exercise or shopping. I now exercise on my own; I’ve even stopped the walks with friends that had become such a regular and welcome feature of life.

I’m feeling well on the whole and another thing that I’m doing now that I don’t meet up with friends for walks is go out almost every day either for a run or a bike ride. The reason is that I have signed up to a bit of a mad challenge that involves running and/or cycling a total of 192 miles between the beginning of January and the end of March. I could do it all on the bike but I’ve decided to do as much of it as I can on my own two feet rather than on two wheels. Running is so much more challenging than cycling, at least it is for me given the pace at which I cycle. I run incredibly slowly but I guess it still counts as running in that I do overtake people who are simply walking!

There’s no way I’d be running if a friend hadn’t suggested we both sign up for this challenge. Even after having signed up, I’ve had to come up with an incentive to get me out running. I wanted to listen to Transmissions, a multi-episode podcast that I’d heard was really good – about the iconic Manchester bands from the 1980s, Joy Division and New Order. I decided I would only listen to the podcast while running. It was a good plan and it works both ways. I’m loving the podcast so much that I go out running so I can listen to another episode and listening to the podcast makes the runs easier.

This has been a good week for running. I’ve got the week off work, so I’ve got no excuse really. I’m in the category of people for whom work has never been busier and I worked part, if not all, of each of the four working days between December 24th and 31st. It has been so relaxing to have a big chunk of time off. The house is very quiet now that the boys are away again. We had a lovely Christmas together. It’s usually just the four of us anyway on Christmas Day so in that sense at least it wasn’t so different from other years.

The photo above on the left is of me on the 25th, relaxing on the sofa with two of my presents after an almost two-hour spin on the bike – out to Richmond Park, a favourite destination around seven miles away.

The photo on the right was taken in our garden by my husband not long after the bells on New Year’s Eve.

Hogmanay, as we Scots say, normally makes me feel quite melancholic. This year, though, presumably because of all the sadness that 2020 held, it felt important to celebrate and look forward – both because of and despite what the future may bring.

It’s back

This is the blog post I hoped I’d never write. A lot of people who aren’t yet aware of my situation will be shocked and upset by it. There are so many people I’d like to break the news to on an individual basis but that’s just not possible. Whoever you are, thank you for reading.

It’s back. I’ve been diagnosed with secondary breast cancer. The primary breast cancer for which I was treated “with curative intent” in 2015/2016 has spread and turned up in my bones – most obviously in my spine* – and bone marrow.

The consultant oncologist who broke the news to me is the same doctor who treated me originally. She knew I knew this very well already but I guess she had no choice but to include it in the conversation; it was “treatable but not curable”.

So here we are, having recently started treatment following a diagnosis of secondary/advanced/metastatic/late stage/Stage IV breast cancer. Call it what you want, they all mean the same thing – a life-limiting illness with a very uncertain prognosis.

I was diagnosed formally on 30 April (though I knew it was coming) and I started treatment on 22 May. I’m on a new combination of powerful and aggressive drugs that are aimed at preventing the cancer from spreading any further for as long as possible. For some women, these drugs are game changers in terms of how long they keep the cancer under control. Like the consultant, we’re hoping they will result in a “durable clinical response” for me. We’re trying to be positive and to focus on the fact that I’m largely well at the moment and we hope treatment will keep me this way for a long time.

The good news is that “bone mets” from breast cancer can often be stabilised and managed for long periods of time, ie for a number of years or more. The fact that it’s also in the bone marrow complicates things. We can but see how it goes. The aim of treatment is to control the cancer, relieve symptoms such as pain, and reduce the risk of fracture – while at the same time trying to maintain a good quality of life for the patient.

It wasn’t inevitable, but anyone who follows this blog will know that I was at high risk of recurrence. Lord knows I wrote about it often enough. While I had in fact made peace with that, there’s very little I wouldn’t give for this not to have happened.

For a long time after finishing treatment for primary breast cancer, I lived in fear of it coming back. I worked very, very hard to get to a position where, while I thought about it often, I really no longer worried about it and just got on with living. Life was good; it was very good. I had conquered my fear and I was in a position of pragmatic acceptance that it might one day return. I’m really proud of myself for having got there. It wasn’t easy.

That mindset of acceptance is really helping me now. It’s a difficult time for us all but life goes on. We’ll aim to keep enjoying it and we’ll keep hoping for the best for as long as we can.

As always, writing helps. I’ve already got a few more posts in the pipeline – about my treatment, how I found out, how I’ve had to cancel big cycling plans I had for this year, etc. You know where to look if you want to read them. Wish me luck.

*As well as being in my bone marrow, the cancer is definitely in vertebrae T8, T9 and L4. There is also a lesion in my left-side rib area as well as “areas of less significant scattered bone disease”. My right hip hurts like hell sometimes but while I’m told there are no obvious signs of cancer there, it could well be related in some way to this new diagnosis – although, equally, it may not.

Recurrence 5: How would you know it’d come back?

Your active breast cancer treatment finished months ago. You’ve had follow-up reviews with the doctors who’ve been treating you and they’ve all signed you off. Your first mammogram since you were diagnosed – just over a year ago now – is booked for December. You’re told to get in touch in the meantime “if you’re worried about anything”, which basically means if you think your breast cancer’s come back.

I don’t feel abandoned like some people do. In fact I’d like to be out of the system even more than I am. I still have stuff going on that keeps me involved one way or another: six-monthly cycles of a bone-hardening drug to reduce the risk of recurrence and lower my risk of developing osteoporosis; occasional physiotherapy for the post-surgery underarm cording that’s still there; occcasional treatment for the lymphoedema I have in my reconstructed breast; and a consultation in either three or six months’ time with the plastic surgeon to check the reconstruction.

So how would you know your breast cancer had come back? Well, just as most primary breast cancers are found by women themselves rather than through routine screening (So you think you’re “breast aware”), most breast cancer recurrences are found by patients between hospital or clinic visits. You make sure you’re aware of the symptoms. If you have them, you get them checked out and you find your cancer has either spread (to your bones or your liver or your brain or your lungs or your lymph nodes or a combination thereof) or it hasn’t. If it hasn’t, I imagine you breath a huge sigh of relief and thank your lucky stars. If it has, it must be one of the worst pieces of news you could possibly get. Your best hope then will be that it hasn’t spread too widely and that treatment is available that will keep it under control for as long as possible. As you’ll know if you’ve read my previous posts on recurrence, recurrent/Stage IV/advanced/secondary/metastatic breast cancer can be treated and you might live with it for years, but it can’t be cured. It’s currently ultimately fatal.

Frustratingly, some of the general symptoms linked to recurrence – being more tired than usual, low energy levels, feeling under the weather, poor appetite, weight loss, back pain, headaches, etc – are also caused by common illnesses or ailments. They can also be similar to ongoing side effects of treatment you’ve had for primary breast cancer, such as chemotherapy or radiotherapy, and to side effects of ongoing treatment, including hormone therapy.

Essentially you’re encouraged to report any symptoms that are new, don’t have an obvious cause or don’t go away. Some women who’re not long out of active treatment panic at every ache or pain and head off to their GP or the breast cancer unit where they were originally treated at the slightest twinge. At the other end of scale, some women initially downplay or dismiss their symptoms only to find the symptoms persist and their cancer has indeed spread. Both approaches are understandable. Let’s see which camp I’ll fall into. I can tell you I’ve already had a lump under one of my scars checked out; it’s scar tissue, “nothing nasty”.

Better to err on the side of caution, I say, and to persist if you really feel something is wrong. A new report on diagnosis of secondary breast cancer from the charity Breast Cancer Care exposes what it says are “shocking failings” in the system– patients being diagnosed in A&E, facing avoidable delays and having concerns ignored by healthcare professionals. The report also says over half (58%) of people with incurable breast cancer did not know how to spot the signs and symptoms of the disease. The infographic here* is aimed at helping people who’ve been successfully treated for primary breast cancer recognize the symptoms.

People are surprised to hear that generally the only routine follow-up test you have after treatment for primary breast cancer is an annual mammogram (or ultrasound too in my case – What does follow-up look like?). Mammograms don’t check for secondary breast cancer. They check, rather, to see whether you’ve developed a new cancer in the other breast or, depending on what surgery you’ve had on the breast that had the tumour in the first place, to see whether it’s come back there.

It’s quite hard to accept that there’s no way of knowing your cancer has spread before symptoms appear. There isn’t a test that can tell whether you have dormant cancer cells resting somewhere in your body, or that those dormant cells are about to activate and start spreading, or indeed have just begun to spread. No amount of tests will stop the cancer spreading and, as Cancer Research UK says, since no test can pick up microscopic cancer spread, a negative test doesn’t necessarily mean that there is no spread.

As I’ve said before (Recurrence 3), you do what you can to reduce the risk of your cancer recurring. You try to live healthily, you keep a watchful eye on your body, you comply with any ongoing therapy, and you go for your annual mammogram and ultrasounds and any other check-ups you’re offered. Ultimately, though, you have to learn to live with the fact that you’ll never know you’re going to remain cancer-free and that those symptoms, if they appear, could be very bad news indeed. At this stage, a year after my diagnosis and just five months out of active treatment, that still seems really unfair.

*This post is dedicated to Jo Taylor, a friend I met through the wonderful social media resource that is Twitter and who created this infographic to help raise awareness of secondary breast cancer. Jo is in her mid-4os, has secondary breast cancer and is a tireless campaigner on issues relating to the disease.  Jo (www.abcdiagnosis.co.uk and @abcdiagnosis on Twitter) has just undergone major surgery and deserves a massive shout-out. Recover and be well, Jo. 

Recurrence 1: So you think you know about breast cancer

The opening line of the first book in Lemony Snicket’s children’s book series A Series of Unfortunate Events is “If you are interested in stories with happy endings, you would be better off reading some other book”. I can’t remember what age our was older son was when he first started reading that book, but he stopped right there, after that first sentence.

That’s my way of warning you that this post – about breast cancer recurrence – is not an easy read. As someone who’s only very recently finished treatment for primary breast cancer, I can tell you that secondary breast cancer is not an easy subject. But as you’ll know if you’ve been following my blog since I was diagnosed last summer, I’m a firm believer in the whole “knowledge is power” thing. Here’s another warning… this is the first in a series of posts about recurrence. There’s lots to say.

If you’ve had breast cancer once, your risk of recurrence is essentially never zero. Having primary breast cancer is bad, but getting a secondary breast cancer diagnosis must be a whole lot worse. Primary or early-stage breast cancer is curable; secondary or late-stage breast cancer is not. I suspect a lot of people don’t know that, despite the fact that breast cancer has such a high public profile. You can live with secondary breast cancer, productively, and sometimes for many years , but it seems that median survival once you have it is just two to three years, and that hasn’t changed in decades. In England, only 15 out of 100 women will survive for five years or more after they are diagnosed with secondary breast cancer. In the UK alone, almost 12,000 women die of breast cancer each year.

When you finish your hospital treatment of chemotherapy, surgery and radiotherapy, you’re relieved and happy that it’s over. At the same time, though, you know you can never be sure your cancer has gone completely. As the US organization breastcancer.org helpfully points out, “even a single cell that escaped treatment” may be able to spread and grow into a tumour. In addition, women who’ve had one breast cancer have an increased risk of developing cancer in the other breast (known as second primary breast cancer) for at least 20 years compared with the general population.

Breast cancer can come back in or around the area you had it originally. That’s known as local or regional recurrence. Worse, breast cancer cells can spread from your first tumour in the breast through the lymphatic or blood system to other parts of your body, most commonly with breast cancer to your bones, or to your lungs, liver or brain. This can become apparent soon after diagnosis or many years later. The tiny “micrometastatic” cells leave the primary tumour early on, but the secondary spread they cause can lie dormant for years. When this “distant recurrence” happens, it’s called secondary, late-stage, Stage 4, advanced or metastatic breast cancer. It can be managed but it is not curable. You don’t die of primary or early-stage breast cancer, where the cancer hasn’t spread beyond the breast and the axillary lymph nodes; breast cancer kills when it spreads to other parts of the body.

Everyone knows that one in eight women will develop breast cancer over the course of their lifetime. Thus the name of this blog. But how many women who’ve had a primary breast cancer diagnosis go on to develop secondary breast cancer? It’s seemingly not known with any real certainty but a commonly cited figure – in the US – is 20-30%. There appears to be no figure specifically for the UK, although I’ve seen one in five, “up to a third” and  “roughly 35%” all cited. It is known, though, that the earlier breast cancer is caught the less chance there is of it recurring. Most breast cancers are diagnosed at Stage 1 and women in this category have negligible risk of metastatic disease, even though they may have received radiotherapy and even chemotherapy. Some 5% of breast cancers are already Stage 4 at diagnosis.

It is also not known with any great certainty how many of the estimated more than half a million people in the UK who’ve had primary breast cancer are living with recurrent or metastatic disease. I’ve seen just one estimate, of 35,000, and I’ve only seen it used by one organisation, Breast Cancer Now. There’s no firm data in the US, but there’s an estimate of more than 150,000.

A big new report on secondary breast cancer notes that while there has been progress in the scientific understanding of the disease, there have been just modest improvements in outcomes. There have been incremental advances in survival and quality of life during survival but these advances are not realised by all women. The pace of innovation in this field, says the report, appears to have slowed in recent years in terms of treatment advances and clinical research. This is clearly an area where more attention is needed.

I decided to ask my oncologist for her thoughts on all this. She commented that part of the challenge is that there is no one-size-fits-all treatment for secondary breast cancer. Treatment depends among other things on the burden of the cancer in each patient. This, though, she said, is leading to there being a push towards individualising therapy for each patient with the disease in an effort to enable women to, as it were, “live alongside” their cancer. She also highlighted the fact that there is more focus on aggressive treatment for small amounts of secondary breast cancer that might be curable; perhaps small individual metastatic – “oligometastatic” – spots that can be removed by surgery or fixed with local radiotherapy. Lastly, she pointed to the existence or development of “exciting new therapeutic strategies” in fields such as immunotherapy, harnessing the patient’s own immune system to fight cancer.

So things are happening. Immunotherapy and targeted therapies – treatments that target specific characteristics of cancer cells – are the big hopes for the future. Potential new drugs are in clinical trials and research is under way into how and why metastasis happens and what it might take to stop it. But this all takes time.

In the meantime, breast cancer is the second most common cause of cancer death among women in the UK, killing around 1,000 every month. That’s around 12,000 a year (to be precise, 11,643 in 2012, along with 73 men). You might be wondering whether that’s a lot. Well it’s all relative, I guess. Lung cancer,  the most common cause of cancer death in women in the UK, was responsible for 16,067 female deaths in 2012. But compare it with, say, the number of deaths there have ever been in the UK of people with HIV/AIDS. The total number between 1980 and 2013 was 21,718. That’s less than the number of breast cancer deaths in two years. Makes you think, doesn’t it? In the early days, as everyone knows, HIV/AIDS was almost always fatal but thanks to advances in treatment it’s now treated as a long-term chronic condition. It would be good to think this might one day be the same for secondary breast cancer.

I bet much of this will come as a surprise to a lot of people reading this. Breast cancer in the public’s eye has gone from being a disease that was a sure death sentence to one that can be treated and cured and survived, with surviving meaning you’re free of the disease for ever after. That clearly couldn’t further from the truth for many women, and some men too. This quote (taken from an article on the report referred to above) illustrates perfectly the shift that has taken place: “In the 1970s, we had to fight the taboo against talking about breast cancer; now we have to fight the taboo against talking about how breast cancer can kill.”

In very broad terms, risk of breast cancer recurrence reduces over time, but it never completely goes away*. I think it’s important people know that. I think plenty don’t. I’ve heard it said that you only really “beat” or survive breast cancer if you die of something else. That sounds a bit melodramatic but at this precise moment, at just two-and-a-half months out of treatment, I can relate to that.

*April 2019 update: Since I wrote this, further evidence has emerged that with the type of breast cancer I had, ie estrogen-receptor positive, the risk of recurrence essentially stays constant for as much as 20 years.