Breast cancer recurrence is when cancer comes back after treatment and after a period of time when it could not be detected. Anyone who has had breast cancer can be at risk of recurrence. It’s most likely to happen within the first few years but can also happen many years later.
Most people who have a breast cancer diagnosis will never experience a recurrence. But the risk is well worth making follow-up screenings an essential part of your healthcare going forward.
In this article, we’ll look at some signs of recurrence, how treatment differs from your initial treatment, and answers to other questions you might have about breast cancer recurrence.
The signs and symptoms of recurrence depend on where breast cancer returns. Early on, you might not have any obvious symptoms. Sometimes, recurrence is discovered through routine follow-up scans or bloodwork.
Locoregional recurrence
A local recurrence is when the cancer returns in the same general area as the original diagnosis. That could be breast tissue or sentinel lymph nodes (those closest to the breast). Regional recurrence is when cancer returns on the same side as the original diagnosis, involving lymph nodes in the:
- armpit
- collarbone
- neck
- under the breastbone
Doctors may use the term “locoregional” to describe local or regional recurrence. Signs and symptoms of local or regional recurrence may include:
- new nodule, lump, or thickening
- inverted nipple
- change in breast size, shape, or skin texture
- swelling of the chest, armpit, or around the collarbone
- redness or rash on the skin or around the nipple
- blood or other unusual discharge from the nipple
- swelling in the arm or hand
Distant recurrence
Distant recurrence is when breast cancer recurs in a distant site, such as the lungs, bones, brain, or liver. This is also called metastatic or stage 4 breast cancer.
While breast cancer can recur in the opposite breast, it is likely to be a new cancer. However, if the cancer has the same histology, pathology, and cell type as the original cancer, it is considered a recurrence.
Signs and symptoms of distant recurrence can include:
- unexplained fatigue
- severe headaches
- bone pain
- dry cough
- numbness, weakness
- breathlessness
- vision problems
- lack of appetite
- nausea
- unexplained weight loss
- balance issues
- confusion
- seizures
Sometimes cancer cells can survive treatment. These cells may eventually reproduce enough to form a new tumor. If they manage to reach the blood stream or lymph system, they can spread to distant organs and tissues.
There are so many factors involved that it’s not possible to pinpoint exactly why an individual has a recurrence. We do know that the majority of recurrences happen within the first
The main factors that can influence your chance of recurrence are:
- tumor size
- tumor grade, which indicates how aggressive the cancer is
- hormone receptor status
- HER2 status
- stage at initial diagnosis
- lymph vessel or blood vessel involvement
The following table shows how your risk of recurrence is broken down according to the factors listed above.
| Low recurrence risk | Moderate recurrence risk | High recurrence risk | |
|---|---|---|---|
| Primary tumor size | smaller than 1 cm | up to 5 cm | larger than 5 cm |
| Tumor grade | 1 | 1 or 2 | 3 |
| Hormone receptor status | hormone receptor-positive | hormone receptor-positive | hormone-receptor-negative and HER2-negative, also known as triple-negative breast cancer |
| Lymph node involvement | none | cancer in 1 to 3 lymph nodes | cancer in 4 or more lymph nodes |
| Lymph vessel or blood vessel involvement | none | none | cancer in lymph vessels or blood vessels |
| HER2 enriched | negative | negative | positive |
| Other factors | — | — | cancer in chest muscles or breast skin or inflammatory breast cancer |
It’s likely that you’ll need a combination of therapies to treat a breast cancer recurrence. Treatment depends on many factors such as:
- breast cancer type
- how far and to where it has spread
- your earlier treatments
Surgery
If you previously had breast-conserving surgery, otherwise known as lumpectomy, the next step might be a mastectomy. If you already had a mastectomy, it may be possible to remove the newly affected area, including lymph nodes.
If breast cancer recurred in a distant site, treatment options will depend on the location, size, and number of tumors.
Radiation therapy
Radiation therapy to the affected area usually follows surgery. This helps destroy any remaining cancer cells. Radiation therapy can also help shrink tumors that can’t be surgically removed.
However, radiation can’t be repeated in the same area. So, whether it’s an option for you or not depends on the area of recurrence and whether you had radiation therapy there before.
Chemotherapy
Chemotherapy is used to kill cancer cells no matter where they are in the body. It can shrink tumors, prevent new tumors from forming, and slow disease progression.
There are many chemotherapy drugs that can be used to treat breast cancer. If you previously had chemotherapy, you would likely need a different drug or combination of drugs to treat a recurrence.
Hormone and targeted therapies
Hormone therapy is used when the cancer is positive for hormone receptors. If you were already taking hormone therapy, you may need to switch to a different drug. There are also several targeted therapies for HER2-positive breast cancers.
Clinical trials
Recurrent and metastatic breast cancer can become resistant to treatment. Clinical trials are studies that test the safety and efficacy of new treatments that aren’t available anywhere else. If you’re interested, your oncologist can help find clinical trials that might be a good fit for you.
Supportive care
When breast cancer has spread to distant parts of the body, the goal of treatment is to slow disease progression and help relieve symptoms. Palliative care may include:
- radiation therapy
- chemotherapy
- pain management
- psychological and spiritual support
You can also take advantage of complementary therapies, such as:
- massage
- acupuncture
- meditation
- yoga
- tai chi
Everyone who has had breast cancer has some risk of recurrence. While many factors are beyond your control, there are a few steps you can take to help lower the chances of recurrence, including:
- Weight management. Some
research suggests that obesity is associated with increased risk of breast cancer recurrence. - Healthy diet. Maintain a diet rich in vegetables and fruits, whole grains, and lean protein. Limit red and processed meats, sugar, and alcohol. Discuss dietary supplements with a doctor.
- Adequate exercise. Get some form exercise for at least 30 minutes 5 days per week to maintain your overall health.
- Medication adherence. If you’re experiencing side effects, speak with your doctor so adjustments can be made.
- Symptom awareness. Be aware of changes in your body, such as new lumps or other signs of cancer.
- Proper follow up. Keep up with recommended screening tests. Communicate with your doctor regularly and report any new symptoms, even if they don’t seem serious.
Overall survival rates for breast cancer are generally based on the stage of the cancer at initial diagnosis.
Treatment for local and regional recurrence is often successful. However, there’s still a risk of developing distant metastases. Because there are so many variables, it’s difficult to provide an overall prognosis. Your oncologist can provide a clearer understanding of what to expect for your exact situation.
Metastatic breast cancer can be treated and go into remission, but it’s not considered curable.
Tips for coping with breast cancer recurrence
Fear of recurrence after cancer is totally normal. Rest assured that you’re not alone and that the feeling may fade over time. In the meantime:
- Be vigilant about regular checkups and follow-up testing. It may help to know that you’re doing everything within your control.
- Be mindful about your overall health. Follow your doctor’s recommendations for diet, exercise, and medications.
- Have fun. Dive into things that bring you joy or contentment.
It’s also important to know that recurrence is not your fault — guilt should never be part of the picture. Here are some constructive ways to deal with recurrence:
- Don’t go it alone. Lean on your family, friends, and social network for support.
- Join an in-person or online support group. There’s nothing quite like sharing with others who totally get it. You might also find it beneficial to speak with a therapist.
- Speak openly with your oncologist. Ask questions, discuss your concerns, and seek another opinion.
If someone you care about has a breast cancer recurrence, your support can make all the difference. You can lend a ton of support, even if you’re unsure what to say or do:
- Be there. Just showing up can be a major boost.
- Listen. Let them talk about fears and frustrations without fear of judgement.
- Ask how you can help. Their needs may not be obvious, so ask for specifics.
Breast cancer recurrence is when breast cancer returns after you finish treatment and after a period of time when the cancer isn’t detected. The risk of recurrence is highest in the first few years. It declines over time, but recurrence can still happen many years later.
Breast cancer recurrences can be successfully treated. Metastatic breast cancer is not considered curable, but it can be controlled and managed.