This is the risk of cancer recurrence

“My goal now is to do what I can to be cancer-free. Even though I’ve finished chemotherapy, My road to healing and full recovery is long“. Princess of Wales Kate Middleton said these words in the video in which she announced that she had completed her chemotherapy treatment.

“Any cancer, even if it is at an early stage, can reappear,” he admits to EL ESPAÑOL. Jesus Garcia-FoncillasDirector of the Department of Translational Oncology at the Jiménez Díaz Foundation and President of the ECO Foundation. As the American Cancer Society also states, “there is no way to guarantee that cancer will never come back,” even after treatment is completed.

In Kate Middleton’s case, since the cancer she was diagnosed with in February this year is unknown, this is not possible. estimate a risk of recurrenceWell, it depends on each type. “It can vary depending on its biology, the stage at which it is detected or the aggressiveness of the tumor cells,” he says. Rodrigo Sanchez-Bayonaoncologist at the 12 de Octubre Hospital in Madrid and scientific secretary of the Spanish Society of Medical Oncology.

For García-Foncillas too It is “very important” to define whether the tumor already has metastases at the beginning or lymph node involvement. “Fortunately, there are now tumors with metastatic spread for which we cannot find any macroscopic evidence of disease.” This does not mean that they will not recur, since there could be microscopic disease that is causing them to recur.

Higher risk cancers

Among the cancers with the highest recurrence rates are pancreatic cancer, melanoma, glioblastoma and ovarian cancer. In patients with the latter type (in particular, epithelial carcinoma) the risk of relapse can be 85%as some studies suggest. In synovial sarcoma, a tumor that forms in the soft tissues of the body, and in bladder cancer, up to half of those diagnosed may be at risk of recurrence.

The reason why some cancers have a higher recurrence rate varies. For example, in pancreatic cancer, This may be due in “many cases” to late diagnosis.; as happens with melanoma. “Although it is usually treated successfully at an early stage, there is also a risk of relapse, especially in patients with more advanced tumors,” says Sánchez-Bayona about this skin cancer.

With immunotherapy, The recurrence rate of melanoma is 40%. Although recently a group of Spanish scientists managed to reduce it to 22% by combining it with V940, a “fully personalized” vaccine that seeks to prevent the tumor from progressing again, once surgically removed, in patients with a high risk of reappearing.

Cancers with the lowest risk of recurrence include thyroid cancer (especially papillary thyroid carcinoma), breast cancer, and prostate cancer. The latter two have a lower recurrence rate. especially when detected at an early stage.

This may also vary depending on the subtype diagnosed. In the breast cancer patients With positive hormone receptors, for example, the recurrence rate is estimated at between 5% and 9% at the time of chemotherapy. On the other hand, as García-Foncillas explains, “the triple negative subtype of this cancer is more likely to recur than a hormone-dependent breast cancer with a proliferation rate and HER2 protein negativity.”

This difference also occurs in colon cancer. In case of BRAF gene mutation, the risk of recurrence will be higher. This is why studies must be carried out with great precision, which guide towards the possible evolution of risks in the future.

How to reduce risks

This risk of recurrence is estimated under equal conditions. And, even if a complete remission cannot be guaranteed, there is a series of measures that can be adopted reduce -not to avoid- the risk of relapse. “Careful monitoring must be carried out, because the important thing in terms of relapse is to detect it early,” says the president of the ECO Foundation.

“Regular exercise has proven to be a powerful tool to reduce the risk of recurrence, especially in cancers such as colon and breast,” adds Sánchez-Bayona. In this sense, a review of studies published in 2022 found that the risk of recurrence in breast cancer survivors was reduced by 16% when physical examinations and activity were practiced.

Diet also plays an important role in reducing the risk of cancer recurrence. Experts recommend a balanced diet rich in fruits, vegetables and fiber, as well as a reduction in the consumption of saturated fats. The goal is none other than “maintain adequate body weight“, since being overweight is associated with a higher risk of recurrence of several types of cancer. Another habit to eliminate is tobacco and alcohol consumption.

There are others non-modifiable risk factorssuch as the aggressiveness of the tumor or the stage at which it was detected. In cancers such as breast cancer, there are genetic factors, such as mutations in the BRCA1 and BRCA2 genes, that can increase the risk of recurrence.

Advances in targeted therapies

In recent years, however, advances in targeted therapies and immunotherapy have transformed the landscape of oncology treatment, achieve reduction in the risk of recurrence of certain types of cancer. “In HER2-positive breast cancer, targeted therapies such as trastuzumab have significantly improved both survival and the likelihood of relapse,” illustrates Sánchez-Bayona.

“In melanoma,” he continues, “immunotherapy with checkpoint inhibitors revolutionized the treatment“Early diagnosis, practiced in more and more cancers, has also had a significant impact on relapse-free survival.

Another new technique to reduce the risk of recurrence is liquid biopsy. “It is still in the investigation phase,” García-Foncillas emphasizes, “but it consists of taking blood samples and looking for the presence of tumor DNA.” In some tumors, such as those of the breast, lung or colon, it is more advanced. Although it must continue to be associated with imaging tests, since some tumors may not have expression at the blood level.

In reality, both in Spain and in the world, the number of recurrent cancers is unknownsince these cases are not compiled in the files prepared annually. There is better knowledge about long-term survivors (those who have beaten cancer and lived more than five years after their diagnosis). In our country, it is estimated that there are more than two million. And it is likely that, “although slowly, this figure will continue to increase in the coming years.”