Elizabeth Edwards' announcement that her breast cancer has recurred is a reminder that sometimes this disease cannot be tied in a ubiquitous pink ribbon and sent yonder.
Fueled in part by publicized medical advances and a well-oiled awareness campaign spearheaded by celebrities like a vibrant Sheryl Crow, who underwent treatment for breast cancer in 2006, there has been a growing sense that caught early, breast cancer can be treated and managed with precision and efficiency.
A visit to a breast oncologist may not be the same as a lunchtime botox injection appointment with one's dermatologist, but it's not fraught with the same heightened tension as it used to be.
But of the 2.3 million American women living with invasive breast cancer, 150,000 are thought to be living with advanced(metastatic) breast cancer (Stage 4), the form of the disease responsible for 40,970 deaths last year, according to Living Beyond Breast Cancer (LBBC), a non-profit organization dedicated to empowering women affected by breast cancer.
"Metastatic breast cancer is the one no one wants to talk about," says Linda T. Vahdat, Director of the Breast Cancer Research Program at Weill-Cornell Medical College in New York City.
Even with adjuvant treatment, the likelihood of recurrence generally depends upon the stage at initial diagnosis. For Stage 1, it's between 10-20 percent, Stage 2, 20-40 percent and Stage 3, 40-60 percent.
Dr. Vahdat agrees with the assertion John Edwards made at Thursday's press conference that while no longer curable, Stage 4 breast cancer is highly treatable.
But treatable for how long? Is metastatic breast cancer akin, as Edwards implied, to a chronic disease like diabetes?
The median survival rate for metastatic breast cancer is between three to five years, but up to 10% of patients live ten years or longer. "I have patients with Stage 4 breast cancer who've had it for fifteen years," says Dr. Joseph Sparano, Director of Breast Evaluation at Montefiore-Einstein Cancer Center, and a clinical oncology researcher.
Elizabeth Edwards' oncologist, Dr. Lisa Carey, said Thursday that she had to wait until all the results for medical tests taken earlier this week came in before she could develop Mrs. Edwards' treatment protocol. Both Drs. Vahdat and Sparano agree that there is no standard treatment for Stage 4 breast cancer.
The type and duration of treatment depends heavily on the biology of the disease. For example, if the tumor is HER 2 neu positive, then Herceptin, which has shown excellent results in extending advanced breast cancer survival rates, can be used. If the tumor is not HER 2 neu positive, then chemotherapies and other drugs are considered. A patient's age and other underlying medical conditions are factors too.
Elizabeth Edwards showed a zest to continue a life, which may be interrupted by the campaign trail her husband has decided to continue, but not by the disease. "I expect to do next week what I did last week," she said.
And indeed, Dr. Vahdat says that most of her patients with advanced breast cancer continue to work and live with relative normalcy.
A perhaps unintended consequence to Mrs. Edwards' public announcement is that she could shine a spotlight on others like her. In December, the LBBC released a study on the preferences and needs of women with advanced metastatic breast cancer. Based upon the responses of over 600 patients, the study showed that 47percent of the women worked full- or part- time and more than two-thirds found it helpful to read about or listen to the experiences of others with advanced breast cancer.
"When there is a recurrence, patients say that they sometimes feel isolated from others," adds Vahdat.
Perhaps Elizabeth Edwards' example to support her husband's presidential campaign and her determination to live her life as normally as possible (for a political wife anyway) will be a welcome salvo to these silent voices.
Managing editor of health news at FOXNews.com Dr. Manny Alvarez reviewed this article. He is a regular medical contributor on the FOX News Channel and chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.