When are you “cancer-free”?

Dr. Weeks’ Comment:  This is important to discuss with your oncologist. 

The meaning of ‘cancer-free’

As researchers learn more about recurrence, the goal posts for long-term survival keep moving further out

Is there such a thing as being cancer free for life? (Marser photo via Getty Images)

Sixteen years ago, right before her 42nd birthday, Jane Baker Segelken was diagnosed with breast cancer. The tumor was small, and she was told that if the cancer didn’t return within five years after treatment, her chances for long-term survival were good.

When Segelken made it to five years, she was advised to look to the seven-year mark, but before that seven years was reached, the target became 10 years, reflecting newer findings of longer-term studies.

“From the beginning,” says Segelken, “I knew I’d never be considered cured, and as I began to meet women who had recurrences at 15 or 20 years after diagnosis, I gave up the idea that if I had no recurrences in the first 10 years, I’d be cancer-free for the rest of my life.”

The good news is Segelken hasn’t had a recurrence, and research shows that “the longer you go, the less likely it is to come back,” says Mehra Golshan, director of Breast Cancer Surgical Services at Dana-Farber/Brigham and Women’s Cancer Center in Boston.

For the majority of breast cancers, Golshan says, chances of recurrence are greatest in the first five years.

Joseph Sparano, associate chairman of the Department of Medicine at Montefiore Medical Center in New York, concurs, adding that “some types of breast cancers, such as triple-negative breast cancer, usually recur within five years, while other types, particularly estrogen-positive cancers, can recur after 10 years or longer.”

And that’s why longer-term follow-up is important. “Adjuvant chemotherapy and hormonal therapy are after-surgery standard treatments, because they significantly reduce the risk of recurrence,” says Sparano. He commonly uses the 10-year framework when advising patients about the potential risks of undergoing adjuvant therapy.

For studies run by Cancer Cooperative Groups, which include researchers, cancer centers, and physicians working together to run clinical trials sponsored by the National Cancer Institute, patients are usually followed for 15 years after diagnosis. “Updated reports on how patients did over time are often published at 10 or more years,” says Dr. Jennifer Ligibel, an oncologist at Dana-Farber Cancer Institute. However, by that time, life moves along, and some survivors no longer follow up with researchers.

Dr. Catherine Alfano, deputy director of the Office of Cancer Survivorship at the National Cancer Institute, says that of the women diagnosed with breast cancer today, 90 percent will be alive in five years compared with 63 percent in the 1960s. “I think the main point about survival rates being much better now is that more people than ever are living with the effects of cancer for many years after their diagnosis and treatment,” she says, “which means that doctors and researchers are turning attention to helping survivors understand what the long-term effects of cancer might be, and how to prevent or minimize those.”

Experts agree that there is no magic number of years for a survivor’s risk of recurrence to disappear completely. “What we do know,” says Ligibel, “is that the amount of physical activity one is doing and how much one weighs at five years (after treatment) is related to the risk of recurrence in 10 years.” Overweight and obese survivors face worse odds.

Ligibel also stresses that more than 80 percent of women who develop breast cancer will not experience a recurrence or die of the disease. “A woman diagnosed with breast cancer,” she says, “has much better odds that she will never hear from her disease again than women with most other common cancers.”

Insurance eligibility

Eligibility for private health insurance coverage is now largely determined by which state you live in and its policies on pre-existing conditions. State-by-state information can be found at healthcare.gov.

Beginning in January 2014, all breast cancer survivors, as well as everyone in the U.S., will have access to coverage regardless of pre-existing conditions.

When it comes to life insurance, agents we spoke with at Prudential, John Hancock and Lincoln were more willing to write policies for breast cancer survivors than agents for other major insurers we interviewed. These three companies were willing to consider “borderline cases” and lower premiums to meet production goals, especially toward the end of the year, according to the agents.

MetLife says that for in situ breast cancer, women can be offered insurance at standard rates as soon as they have completed surgery and/or radiation treatments. The same is often true of Stage 1 cancer when surgery, radiation treatments and all cycles of chemotherapy have been completed.

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