ROJoson PEP Talk: Monitor Recurrence of Breast Cancer After Curative Treatment

1. June 1, 2024
1400H - 1500H
Via Zoom
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.

2. June 1, 2024
1400H - 1500H
Via Zoom
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
There will be group pictures
at start and end of PEP TALK –
show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

5. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.

9. From October 23, 2021
onwards, I have been
tackling Health Disorder
and Health Issue Courses.
May 18, 2024 marks the
start of YEAR 4 of
ROJoson PEP Talk.
How long the PEP Talk
will last will depend on
our enthusiasm,
discipline and
perseverance.

10. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
My PEP TALK today is
entitled:
MONITORING
RECURRENCE OF
BREAST CANCER
AFTER Curative
TREATMENT

11. Contents
• What does “after curative treatment for breast
cancer” mean?
• Why monitor breast cancer recurrence after
curative treatment?
• Where are the sites of breast cancer
recurrences after curative treatment?
• How to monitor breast cancer recurrence after
curative treatment?
• What are ROJoson’s advice on how to monitor
breast cancer recurrence after curative
treatment?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and
writings of other
health professionals.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

12. What does “after curative treatment for breast cancer” mean?
At the time of the initial consult with a breast specialist, the
breast specialist will determine the stage of the diagnosed breast
cancer.
He/she can use the categorization of Stage 1 to 4 (with 1 being
earliest and 4 being most advanced) or use simple layman’s
categorization: localized / locoregional / advanced stage.
Based on the stage, the breast specialist determines the goal of
treatment (whether curative vs palliative). He/she maps out the
specific treatment plan based on the goal.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

13. What does “after curative treatment for breast cancer”
mean?
A “curative treatment for breast cancer” means the
treatment plan aims for complete remission with the
hope of NO recurrence whatsoever.
Strictly speaking, in the medical world, physicians do not
talk / promise / assure a CURE outcome after treatment
even in the earliest stage of cancer. They would use the
word REMISSION instead of CURE. Because no matter
what stage and treatment done, there is always a
possibility of recurrence.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

14. What does “after curative treatment for breast cancer”
mean?
What is the difference between CURE AND REMISSION
from cancer?
CURE means the cancer is completely gone and is not
expected to come back.
REMISSION means there is no evidence of residual cancer
after treatment at the moment but cancer may still come
back.
Again, with the recurrence being possible, physicians do
not talk of cure, but REMISSION.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

15. What does “after curative treatment for breast
cancer” mean?
When oncologists say this or that cancer is still
“curable” -
They mean that they can get rid of the cancer if
proper treatment is administered early enough.
The cancer has a good chance of being controlled
completely and attaining complete remission.
However, they still don’t guarantee cure. They
guarantee “good chance for complete remission.”
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

16. What does “after curative treatment for breast cancer” mean?
To repeat -
A “curative treatment for breast cancer” means the treatment plan
aims for complete remission with the hope of NO recurrence
whatsoever.
A curative intent or goal is usually aimed for Stages 1 and 2 breast
cancers and local and locoregional stages.
A non-curative intent or palliative goal is usually realistically aimed
for the advanced stages especially those with distant metastasis or
Stage 4.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

17. Why monitor breast cancer recurrence after
curative treatment?
After a curative treatment for breast cancer,
there is still a possibility of recurrence no matter
what. The lower the stage, the lesser the risk of
recurrence.
Regardless of the stages, after an execution of a
curative treatment plan, there must be a plan to
monitor for recurrences.
The commonly used medical term for monitoring
is surveillance.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

18. Why monitor breast cancer recurrence after
curative treatment?
The goal of breast cancer surveillance is to detect
breast cancer as early as possible, prior to the
onset of signs or symptoms of disease, to allow
for earlier, less aggressive treatments, thus
reducing the mortality and morbidity associated
with a recurrence.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

19. Why monitor breast cancer recurrence after
curative treatment?
Whatever breast cancer surveillance strategies
are recommended, the following should be
considered:
- Effectiveness in detecting recurrence
- Risk of the detecting strategies
- Outcomes (whether they really prolong
survival with a good quality of life)
- Costs of the detecting strategies
- Availability of the detecting strategies
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Note: in breast
cancer, a strategy
that can detect
recurrence early
may NOT necessary
be equated to
prolonging survival
with a quality of life.
Thus, usually a
battery of test is
NOT recommended.

20. Where are the sites of breast cancer recurrences after curative
treatment?
The more common sites of recurrences:
• Local recurrences - operative areas, breast, chest
• Regional recurrences - lymph nodes in armpits and neck (above collar
bones)
• Distant recurrences
• Bones
• Lungs
• Brain / Liver / Skin and soft tissues
• Opposite breast (Note: a new cancer arising on the opposite breast
is not a recurrence.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

21. How to monitor breast cancer recurrence after
curative treatment?
By:
• Self
• Breast specialist with or without lab
diagnostic tests
Self – through symptoms monitoring and
through breast self-exam
Breast specialist – through clinical breast exam
and lab tests as needed
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

22. How to monitor breast cancer recurrence after curative
treatment?
Usually, 3 commonly practiced strategies in breast cancer
surveillance:
• Symptom- and sign-based surveillance with selective
lab tests as needed (depending on the risk of
recurrence)
• Clinical examination and mammogram surveillance
with other lab tests as needed (depending on the risk
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

23. How to monitor breast cancer recurrence after curative
treatment?
Symptom - based surveillance (patient self-monitoring
system):
Look and feel for common alert symptoms of recurrences:
• Mass on the operated areas, opposite breast, armpits,
neck and other parts of the body
• Intractable headache – possible brain
• Intractable bone pain – possible bones
• Intractable cough – possible lungs
• Intractable abdominal pain – possible liver
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Intractable –
prolonged or
longed
duration - 2
to 4 weeks -
and evidently
not due to
causes other
than a
recurrence

24. How to monitor breast cancer recurrence after
curative treatment?
Sign - based surveillance (breast specialist clinical
examination - monitoring system):
PHYSICAL EXAMINATION searching for signs of
recurrence
- looking and palpating for mass that would
indicate a breast cancer recurrence
- evaluating a patient for recurrence with inputs
from history or interview for symptoms of
recurrence
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
The minimum areas
to be examined by
the breast specialists
are the following: 2
breasts / areas; 2
armpits; 2 areas of
the neck above the
collar bones; and
right upper quadrant
of abdomen.

25. How to monitor breast cancer recurrence after curative
treatment?
Usually, 3 commonly practiced strategies in breast cancer
surveillance:
• Symptom- and sign-based surveillance with selective
lab tests as needed (depending on the risk of
recurrence or suspicious for recurrence)
• Clinical examination and mammogram surveillance
with other lab tests as needed (depending on the risk
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment ROJoson Personal
Practice

26. How to monitor breast cancer recurrence after curative
treatment?
Usually, 3 commonly practiced strategies in breast cancer
surveillance:
• Symptom- and sign-based surveillance with selective
lab tests as needed (depending on the risk of
recurrence or suspicious for recurrence)
• Clinical examination and mammogram surveillance
with other lab tests as needed (depending on the risk
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Recommended by
NCCN and ASCO

27. How to monitor breast cancer recurrence after
curative treatment?
Annual mammography and physical exams are
recommended surveillance strategies for people
who have been treated for curable breast cancer.
More intensive follow-up in people with no
symptoms has not been proven to improve
outcomes.
The American Society of Clinical Oncology
(ASCO) does not recommend routine screening
for cancer at distant sites.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
https://www.cancer.net
/cancer-types/breast-
cancer/follow-care-and-
monitoring

28. How to monitor breast cancer recurrence after curative
treatment?
Usually, 3 commonly practiced strategies in breast cancer
surveillance:
• Symptom- and sign-based surveillance with selective
lab tests as needed (depending on the risk of
recurrence or suspicious for recurrence)
• Clinical examination and mammogram surveillance
with other lab tests as needed (depending on the risk
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
NOT being
recommended
internationally

29. How to monitor breast cancer recurrence after curative
treatment?
There are clinical studies that compare the use of battery
of tests vs selective test approaches in breast cancer
surveillance.
Results of this trial support the view that a protocol of
frequent laboratory tests and roentgenography after
primary treatment for breast cancer does not improve
survival or influence health-related quality of life. Routine
use of these tests should be discouraged.(JAMA.
1994;271:1587-1592)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

30. How to monitor breast cancer recurrence after curative treatment?
There are clinical studies that compare the use of battery of tests vs
selective test approaches in breast cancer surveillance.
Conclusions. —Periodic chest roentgenography and bone scan
allow earlier detection of distant metastases, but anticipated
diagnosis appears to be the only effect of intensive follow-up, and
no impact on prognosis is evident after 5 years. Periodic intensive
follow-up with chest roentgenography and bone scan should not be
recommended as a routine policy.(JAMA. 1994;271:1593-1597)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

31. How to monitor breast cancer recurrence after curative treatment?
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

32. How to monitor breast cancer recurrence after curative treatment?
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
LESS EXPENSE
BIG EXPENSE

33. How to monitor breast cancer recurrence after curative
treatment?
Usually, 3 commonly practiced strategies in breast cancer
surveillance:
• Symptom- and sign-based surveillance with selective
lab tests as needed (depending on the risk of
recurrence or suspicious for recurrence)
• Clinical examination and mammogram surveillance
with other lab tests as needed (depending on the risk
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment ROJoson Personal
Practice
Recommended by
NCCN and ASCO
NOT being
recommended
internationally

34. What is ROJoson’s advice on how to monitor
breast cancer recurrence after curative
treatment?
ROJoson TPORs
1. Symptoms of patients (what they felt and
observed) (regular, monthly at least, for life)
2. Signs from physical exams of physicians,
particularly cancer specialists (regular at
planned intervals for life)
3. Laboratory diagnostic tests or procedures (as
indicated – selective / not battery of tests)
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

35. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Contents
• What does “after curative treatment for breast
cancer” mean?
• Why monitor breast cancer recurrence after
curative treatment?
• Where are the sites of breast cancer
recurrences after curative treatment?
• How to monitor breast cancer recurrence after
curative treatment?
• What are ROJoson’s advice on how to monitor
breast cancer recurrence after curative
treatment?
Summary
Take Away

36. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on “Monitoring Recurrence of Breast
Cancer After Curative Treatment.”
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
“Monitoring Recurrence of Breast Cancer
After Curative Treatment” as part of your
health management.
Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment

37. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
This ends my PEP
TALK today on:
MONITORING
RECURRENCE OF
BREAST CANCER
AFTER Curative
TREATMENT

38. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

39. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

40. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

41. Monitoring
Recurrence of
Breast Cancer
After Curative
Treatment
Empowerment
objective - for laypeople
to have an essential
understanding on
MONITORING
RECURRENCE OF
BREAST CANCER AFTER
A CURATIVE
TREATMENT as part of
their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!