June 1, 2024

1400H - 1500H
Via Zoom

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

Empowerment MUTE yourself but always

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

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:
Empowerment
objective - for laypeople
FEEDBACK TO THIS
to have an essential
PEP TALK!
Monitoring understanding on
Recurrence of MONITORING
Pls. type in your
Breast Cancer RECURRENCE OF
feedback in the chat
After Curative BREAST CANCER AFTER
box during the open
Treatment A CURATIVE
forum and before we
TREATMENT as part of
adjourn!
their health
management.
Thank you!
 LET’S NOW HAVE A
Empowerment GROUP PICTURE
objective - for laypeople TAKING BEFORE WE
to have an essential START PEP TALK
Monitoring understanding on PROPER IN 2
Recurrence of MONITORING MINUTES!
Breast Cancer RECURRENCE OF
After Curative BREAST CANCER AFTER Pls. turn on your
Treatment A CURATIVE video!
TREATMENT as part of Show your face!
their health
management.
 Empowerment ROJoson PEP Talk
objective - for laypeople
to have an essential I have a Patient
Monitoring understanding on Empowerment
Recurrence of MONITORING Program in which I
Breast Cancer RECURRENCE OF like to empower the
After Curative BREAST CANCER AFTER lay people or
Treatment A CURATIVE patients to take
TREATMENT as part of control in the
their health management of
management. their health.
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.
 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.
 Empowerment My PEP TALK today is
objective - for laypeople entitled:
to have an essential MONITORING
Monitoring understanding on RECURRENCE OF
Recurrence of MONITORING BREAST CANCER
Breast Cancer RECURRENCE OF AFTER Curative
After Curative BREAST CANCER AFTER TREATMENT
Treatment A CURATIVE
TREATMENT as part of
their health
management.
 Monitoring Contents Disclaimer:
Recurrence of • What does “after curative treatment for breast
Breast Cancer cancer” mean? ROJoson PEP Talk
After Curative • Why monitor breast cancer recurrence after contains ROJoson’s
Treatment curative treatment? Thoughts,
• Where are the sites of breast cancer Perceptions,
recurrences after curative treatment? Opinions and
• How to monitor breast cancer recurrence after Recommendations
curative treatment? (TPORs) culled from
• What are ROJoson’s advice on how to monitor experiences of
breast cancer recurrence after curative ROJoson and
treatment? writings of other
health professionals.
 Monitoring What does “after curative treatment for breast cancer” mean?
Recurrence of
Breast Cancer At the time of the initial consult with a breast specialist, the
After Curative breast specialist will determine the stage of the diagnosed breast
Treatment 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 What does “after curative treatment for breast cancer”
Recurrence of mean?
Breast Cancer
After Curative A “curative treatment for breast cancer” means the
Treatment 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 What does “after curative treatment for breast cancer”
Recurrence of mean?
Breast Cancer
After Curative What is the difference between CURE AND REMISSION
Treatment 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 What does “after curative treatment for breast
Recurrence of cancer” mean?
Breast Cancer
After Curative When oncologists say this or that cancer is still
Treatment “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 What does “after curative treatment for breast cancer” mean?
Recurrence of
Breast Cancer To repeat -
After Curative A “curative treatment for breast cancer” means the treatment plan
Treatment 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 Why monitor breast cancer recurrence after
Recurrence of curative treatment?
Breast Cancer
After Curative After a curative treatment for breast cancer,
Treatment 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 Why monitor breast cancer recurrence after
Recurrence of curative treatment?
Breast Cancer
After Curative The goal of breast cancer surveillance is to detect
Treatment 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 Why monitor breast cancer recurrence after Note: in breast
Recurrence of curative treatment? cancer, a strategy
Breast Cancer that can detect
After Curative Whatever breast cancer surveillance strategies recurrence early
Treatment are recommended, the following should be may NOT necessary
considered: be equated to
- Effectiveness in detecting recurrence prolonging survival
- Risk of the detecting strategies with a quality of life.
- Outcomes (whether they really prolong
survival with a good quality of life) Thus, usually a
- Costs of the detecting strategies battery of test is
- Availability of the detecting strategies NOT recommended.
 Where are the sites of breast cancer recurrences after curative
Monitoring
treatment?
Recurrence of
The more common sites of recurrences:
Breast Cancer
• Local recurrences - operative areas, breast, chest
After Curative
• Regional recurrences - lymph nodes in armpits and neck (above collar
Treatment
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 How to monitor breast cancer recurrence after
Recurrence of curative treatment?
Breast Cancer By:
After Curative • Self
Treatment • 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 How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Usually, 3 commonly practiced strategies in breast cancer
Treatment 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 How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Symptom - based surveillance (patient self-monitoring
Intractable –
Treatment system):
prolonged or
longed
Look and feel for common alert symptoms of recurrences:
duration - 2
• Mass on the operated areas, opposite breast, armpits,
to 4 weeks -
neck and other parts of the body
and evidently
• Intractable headache – possible brain
not due to
• Intractable bone pain – possible bones
causes other
• Intractable cough – possible lungs
than a
• Intractable abdominal pain – possible liver
recurrence
 Monitoring How to monitor breast cancer recurrence after The minimum areas
Recurrence of curative treatment? to be examined by
Breast Cancer the breast specialists
After Curative Sign - based surveillance (breast specialist clinical are the following: 2
Treatment examination - monitoring system): breasts / areas; 2
armpits; 2 areas of
PHYSICAL EXAMINATION searching for signs of the neck above the
recurrence collar bones; and
- looking and palpating for mass that would right upper quadrant
indicate a breast cancer recurrence of abdomen.
- evaluating a patient for recurrence with inputs
from history or interview for symptoms of
recurrence
 Monitoring How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Usually, 3 commonly practiced strategies in breast cancer
Treatment surveillance:
• Symptom- and sign-based surveillance with selective ROJoson Personal
Practice
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 How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Usually, 3 commonly practiced strategies in breast cancer
Treatment 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 Recommended by
with other lab tests as needed (depending on the risk NCCN and ASCO
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound,
bone scan, CT scan, PET scan, tumor markers, etc.)
 Monitoring How to monitor breast cancer recurrence after
Recurrence of curative treatment?
Breast Cancer
After Curative Annual mammography and physical exams are
Treatment 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.
https://
www.cancer.net/
The American Society of Clinical Oncology cancer-types/breast-
(ASCO) does not recommend routine screening cancer/follow-care-and-
for cancer at distant sites. monitoring
 Monitoring How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Usually, 3 commonly practiced strategies in breast cancer
Treatment 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, NOT being
recommended
bone scan, CT scan, PET scan, tumor markers, etc.)
internationally
 Monitoring How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative There are clinical studies that compare the use of battery
Treatment 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 How to monitor breast cancer recurrence after curative treatment?
Recurrence of
Breast Cancer There are clinical studies that compare the use of battery of tests vs
After Curative selective test approaches in breast cancer surveillance.
Treatment
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 How to monitor breast cancer recurrence after curative treatment?
Recurrence of
Breast Cancer
After Curative
Treatment
 Monitoring How to monitor breast cancer recurrence after curative treatment?
Recurrence of
Breast Cancer
After Curative
Treatment
LESS EXPENSE

BIG EXPENSE
 Monitoring How to monitor breast cancer recurrence after curative
Recurrence of treatment?
Breast Cancer
After Curative Usually, 3 commonly practiced strategies in breast cancer
Treatment surveillance:
• Symptom- and sign-based surveillance with selective ROJoson Personal
Practice
lab tests as needed (depending on the risk of
recurrence or suspicious for recurrence)
• Clinical examination and mammogram surveillance Recommended by
with other lab tests as needed (depending on the risk NCCN and ASCO
of recurrence)
• Battery of lab test surveillance (mammo, ultrasound, NOT being
recommended
bone scan, CT scan, PET scan, tumor markers, etc.)
internationally
 Monitoring What is ROJoson’s advice on how to monitor
Recurrence of breast cancer recurrence after curative
Breast Cancer treatment?
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 Contents
Summary
Recurrence of • What does “after curative treatment for breast
cancer” mean? Take Away
Breast Cancer
After Curative • Why monitor breast cancer recurrence after
Treatment 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?
 Monitoring Be always in touch with reliable medical
Take Away in
Recurrence of information on “Monitoring Recurrence of Breast
Cancer After Curative Treatment.” relation to
Breast Cancer
After Curative
Patient
Treatment Knowledge is power; it gives power. Empowerment
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.
 Empowerment This ends my PEP
objective - for laypeople TALK today on:
to have an essential MONITORING
Monitoring understanding on RECURRENCE OF
Recurrence of MONITORING BREAST CANCER
Breast Cancer RECURRENCE OF AFTER Curative
After Curative BREAST CANCER AFTER TREATMENT
Treatment A CURATIVE
TREATMENT as part of
their health
management.
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.

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:
Empowerment
objective - for laypeople
FEEDBACK TO THIS
to have an essential
PEP TALK!
Monitoring understanding on
Recurrence of MONITORING
Pls. type in your
Breast Cancer RECURRENCE OF
feedback in the chat
After Curative BREAST CANCER AFTER
box during the open
Treatment A CURATIVE
forum and before we
TREATMENT as part of
adjourn!
their health
management.
Thank you!
 LET’S NOW HAVE A
Empowerment GROUP PICTURE
objective - for laypeople TAKING BEFORE WE
to have an essential START Q&A AND
Monitoring understanding on INTERACTIONS!
Recurrence of MONITORING
Breast Cancer RECURRENCE OF Pls. turn on your
After Curative BREAST CANCER AFTER video!
Treatment A CURATIVE Show your face!
TREATMENT as part of
their health
management.