ment, however, has been observed in the area of sexual functioning.⁵ Recent evidence suggests that among women of reproductive age, concerns about reproduction lower ratings of quality of life (Schover, 2005; Wenzel et al., 2005).

There is limited information on racial or ethnic differences in quality of life among women diagnosed with breast cancer. One study that compared outcomes of African-American and white breast cancer survivors found that differences in reported quality of life were attributable to socioeconomic and life-burden factors and not to race/ethnicity (Ashing-Giwa et al., 1999). African-American women demonstrated better quality of life outcomes as compared to white women in a study of younger breast cancer survivors (aged 50 years or younger) who were also disease-free survivors for 2 to 10 years (Ganz et al., 2003a). African-American women found more meaning in life as a result of having had breast cancer, while Hispanic women reported more physical symptoms, according to a study of breast cancer survivors followed up within 5 years of their diagnosis (Giedzinska et al., 2004).

Table 3-3 summarizes specific late effects found among breast cancer survivors. These late effects are described more fully below.

Women with recurrent disease in the breast or regional lymph nodes can be treated and potentially cured. Disease that has metastasized to distant organs, however, is not curable, but some women live years or even decades after such metastases are discovered. Most recurrences in the breast are detected within 5 years of diagnosis with a peak rate of recurrence during the second year following diagnosis (Burstein and Winer, 2000; Emens and Davidson, 2003). There is not a defined time at which breast cancer survivors can be considered definitively cured of their disease because recurrences can occur more than 20 years after primary therapy. More than three-quarters of recurrences are identified through symptoms (e.g., shortness of breath, bone pain) or by physical examination (e.g., feeling a mass). Recommendations for follow-up include routine history, physical examination, and annual mammogram.