Diagnosis may mean lifetime of treatments for Elizabeth Edwards
Elizabeth Edwards this week got the news that all breast cancer survivors dread: Her cancer is back.
Less than two years after she finished treatment for invasive ductal cancer in her right breast, doctors told the wife of presidential candidate John Edwards that she has a small tumor in a rib on her right side. The diagnosis means Elizabeth Edwards probably will never be cancer-free, and she may require chemotherapy or other treatment for the rest of her life.
Oncologists, however, said Edwards, 57, could live with cancer for many years.
"Many patients with exactly the circumstances that she has do very well for a number of years," Dr. Lisa Carey , Edwards's oncologist and director of the breast center at the University of North Carolina at Chapel Hill, said in a televised news conference yesterday. "And the fact that she is a healthy person and that there isn't a lot of the cancer and that she doesn't have symptoms all work in her favor."
Up to one-quarter of breast cancer survivors eventually face cancer again, depending on the type . Oncologists say that Edwards may have been at above-average risk of recurrence, in part because the original tumor had grown so large. Edwards acknowledged that she had not undergone a routine mammogram for years before she discovered a lump that "felt nearly as big as a plum" while showering during the last days of John Edwards's vice presidential campaign in 2004.
"When the tumor has gotten up to that size, already the tumor has had more chances to break off and spread to other places," explained Dr. Thomas Caughey , an oncologist at Mt. Auburn Hospital in Cambridge. "Some cancer cells that started in her breast escaped before they took the tumor out." Doctors cannot detect escaped cancer cells until there are millions of them, clumped in a tumor.
Carey said Edwards's cancer was "metastatic Stage 4," meaning that it is the return of her original cancer and that the disease has traveled through her blood or lymph system to other parts of her body. Statistically, people with metastatic cancers have a lower survival rate than those with localized tumors, but there are no precise survival statistics for someone with Edwards's characteristics.
Far from discouraged, Edwards said yesterday that she felt thankful that the bone cancer was detected while it was still small and readily treatable. Radiologists found the tumor on Monday when she underwent an X-ray for a suspected broken left rib. John Edwards said a subsequent scan showed no evidence that the cancer had reached other organs, which would have sharply reduced her prospects for survival.
"We're going to always look for the silver lining," said Elizabeth Edwards, the mother of one adult and two young children. "That's who we are as people."
Dr. Beverly Moy , an oncologist at Massachusetts General Hospital, where Edwards was first diagnosed, said her treatment probably will be less draining this time. During her first battle with cancer, she shaved off her hair rather than lose it to chemotherapy. Because doctors won't attempt to eradicate all the cancer cells this time, Moy said, Edwards may receive less intensive chemotherapy, localized radiation, or hormone treatments that have few side effects.
And Dr. Eric Winer , director of breast oncology at the Dana-Farber Cancer Institute, said Edwards has good reason to be optim i stic. He said nearly half the patients he saw yesterday were facing a recurrence of their cancer, adding: "Many women we take care of are living with metastatic breast cancer for many years."
Scott Allen can be reached at allen@globe.com. 