Breast Cancer Recurrent

Breast cancer recurrence is when cancer returns after treatment, sometimes months or even years later. While most people treated for breast cancer will not experience a recurrence, understanding the types, symptoms, and treatment options can help you stay informed and prepared.

Table of contents

• What is recurrent breast cancer?
• Types of breast cancer recurrence
• How common is recurrent breast cancer?
• When does breast cancer recurrence occur?
• Which breast cancer types have the highest recurrence rate?
• Symptoms of recurrent breast cancer
• What causes breast cancer recurrence?
• How is recurrent breast cancer diagnosed?
• Treatment options
• Outlook and prognosis
• Can recurrence be prevented?

What is recurrent breast cancer?

Breast cancer recurrence is when breast cancer comes back after initial treatment^[1]. Although the initial treatment aims to eliminate all cancer cells, a few may survive treatment and remain undetected in the body. These cancer cells can multiply over time, becoming recurrent breast cancer^[2].

The cancer may come back months or years after you’ve finished treatment. Healthcare providers can treat recurrent breast cancer, though it can come back again^[1]. Even a single cancer cell that remained after treatment may be able to multiply and grow into a tumor^[5].

It’s important to understand that if cancer in one breast goes away after treatment but you develop it in your other untreated breast, the tumor is considered new cancer and not recurrent breast cancer. Healthcare providers may refer to this as second primary breast cancer^[1].

Types of breast cancer recurrence

The type of recurrence depends on where the cancer comes back in your body. There are three main types^[1]:

Local recurrence

Local recurrence means the cancer came back in the same breast or chest area as the original tumor^[5]. If you’ve had a lumpectomy (surgery to remove the tumor while preserving the breast), the cancer could recur in the remaining breast tissue. If you’ve had a mastectomy (surgery to remove the entire breast), the cancer could come back in the tissue that lines the chest wall or in the skin^[2].

Having local recurrence doesn’t mean the cancer has spread to other parts of the body^[6].

Regional recurrence

Regional recurrence, also called locally advanced breast cancer, occurs when cancer comes back near the original tumor^[1]. This includes cancer in the lymph nodes (small bean-shaped organs that are part of your immune system) in your armpit, around your collarbone area, or around the chest, neck, and under the breastbone^[6].

Regional recurrence may also affect the chest wall or skin of the breast. It may be referred to as stage 3 breast cancer^[6].

Distant recurrence

Distant recurrence occurs when breast cancer spreads away from the original tumor to other parts of your body^[1]. This is metastatic breast cancer, often referred to as Stage 4 breast cancer^[1].

Secondary breast cancer commonly affects the bones, lungs, liver, and brain. Other parts of the body may also be affected^[6].

How common is recurrent breast cancer?

Recurrent breast cancer is relatively uncommon. Most people diagnosed with breast cancer will never have a recurrence^[4]. The specific rate of recurrence depends on factors like your breast cancer stage and treatment^[1].

Breast cancer, especially when caught in its early stages, is highly treatable. Today, there are more breast cancer survivors in the United States than any other group of cancer survivors—four million, to be exact^[17].

When does breast cancer recurrence occur?

Most local recurrences of breast cancer occur within five years of a lumpectomy^[1]. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment^[1].

Recurrence rates for people who have mastectomies vary. There’s a 6% chance that cancer will recur within five years if healthcare providers didn’t find cancer in your lymph nodes during your original surgery. There’s a 25% chance of cancer recurrence if your lymph nodes are cancerous. This risk drops to 6% if you receive radiation therapy after a mastectomy^[1].

Which breast cancer types have the highest recurrence rate?

According to the American Cancer Society, inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC) are more likely to come back than other breast cancer types and subtypes^[1].

Symptoms of recurrent breast cancer

Symptoms vary depending on where the cancer returns. Cancer that comes back in the same area as the original cancer causes different symptoms than cancer that has spread to other parts of the body^[1].

Local breast cancer recurrence symptoms

Local recurrence may cause^[1][5]:

• Breast lumps or bumps on or under your chest
• A new lump in the breast or the chest wall
• An area of the breast that feels unnaturally firm
• Swelling of all or part of the breast
• Skin irritation or redness in the breast area
• Nipple changes, such as flattening or nipple discharge
• Swollen skin or skin that pulls near the lumpectomy site
• Thickening on or near the surgical scar
• Unusually firm breast tissue

After breast cancer surgery and radiation therapy, the breast area may be swollen and red for a few months after those treatments are completed. This is normal and not usually a sign of breast cancer recurrence^[5]. Still, if you have any concerns about any changes you notice in your breasts, talk to your doctor.

Regional breast cancer recurrence symptoms

Regional recurrence may cause^[1]:

• Chronic chest pain
• Difficulty swallowing
• Pain, swelling or numbness in one arm or shoulder
• Swollen lymph nodes in your armpit or in or around your collarbone area

Distant (metastatic) breast cancer symptoms

Distant or Stage 4 breast cancer can involve any organ, including your bones, lungs, brain or liver. Symptoms depend on where the cancer spreads. You may experience^[1]:

• Pain where breast cancer has spread, including bone pain
• Chronic dry cough
• Dizziness, balance problems or seizures
• Extreme fatigue
• Loss of appetite, nausea and weight loss
• Severe headaches
• Numbness or weakness

What causes breast cancer recurrence?

During surgery to remove the original breast cancer, the surgeon removes all the cancer that can be seen and felt. However, a small number of cancer cells may remain after surgery or may survive radiation and chemotherapy. Tests may not be sensitive enough to detect them^[5].

If some cancer cells remain in the body, over time they can start growing again and become recurrent breast cancer^[4]. These undetected cancer cells multiply, becoming recurrent breast cancer^[2].

The risk of recurrence is unique to each individual and depends on a number of factors. For example, if the original cancer was a larger size or a higher stage, there may be a greater risk of recurrence^[5].

How is recurrent breast cancer diagnosed?

The process of diagnosing a breast cancer recurrence is similar to diagnosing the original cancer and typically involves some or all of the same tests^[5].

Local or regional recurrence diagnosis

Diagnosing a local or regional recurrence usually involves similar tests to those used to diagnose primary breast cancer. You will usually have a breast or chest examination to assess any symptoms^[6].

Diagnosing a local recurrence involves a combination of tests and almost always includes^[5]:

• Breast physical exam
• Mammogram
• Biopsy

Other tests that may be used are^[5]:

• Ultrasound
• Breast MRI

Additional diagnostic tests

If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis^[7].

Tests and procedures may include imaging tests such as magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan or positron emission tomography (PET). Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation^[7].

Your doctor may recommend a biopsy procedure to collect suspicious cells for testing, as this is the only way to confirm whether your cancer has returned. Working in a laboratory, a specialist examines the cells and determines the types of cells involved^[7].

The characteristics of a local recurrence may be different from the original breast cancer. For example, the original cancer may have been hormone receptor-negative and the local recurrence may be hormone receptor-positive. This is why your doctor will do tests on the local recurrence^[5].

Treatment options

Healthcare providers may use new or different treatments for recurrent breast cancer. They may also recommend clinical trials^[1]. When working with you to decide on a treatment plan, your doctors will take into account the treatments you’ve received in the past^[5].

Your treatment options will depend on several factors, including the extent of the disease, its hormone receptor status, the type of treatment you received for your first breast cancer, and your overall health^[7].

Treatment for local recurrence

When a local recurrence is found, it’s treated in much the same way as the first breast cancer. The tumor is removed by a surgeon, examined by a pathologist and tested for biomarkers^[12].

Local recurrence after a lumpectomy can most often be treated successfully. Treatment generally includes surgery, most often a mastectomy. Radiation therapy may be given if it wasn’t part of the initial breast cancer treatment. Treatment may also include chemotherapy, hormone therapy, and other drug therapies^[12].

Treatment for regional and distant recurrence

Treatment for regional or distant recurrence may eliminate or control the disease^[2]. Even if a cure isn’t possible, treatment may control the disease for long periods of time^[2].

Outlook and prognosis

Learning you have recurrent breast cancer may be harder than dealing with the initial diagnosis. But having recurrent breast cancer is far from hopeless. Treatment may eliminate local, regional or distant recurrent breast cancer^[2].

The stage of a local recurrence is determined by the cancer’s characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor figure out your prognosis, which is the likely outcome of the disease, decide on the best treatment options for you, and determine if certain clinical trials may be an option for you^[5].

Can recurrence be prevented?

If you have a local breast cancer recurrence or metastasis, it’s not your fault. You did nothing to cause it^[12].

However, certain lifestyle factors may be linked to a lower risk of recurrence. The World Cancer Research Fund recommends that people who have had breast cancer follow advice to reduce their risk of cancer coming back. This includes^[16]:

• Eating a healthy diet that is high in fibre and low in saturated fats
• Being physically active
• Maintaining a healthy weight
• Limiting alcohol

Women who gain weight during or after treatment of breast cancer have been consistently shown to be at higher risk of breast cancer-related death. Also, women who are overweight or obese at the time of diagnosis have a poorer prognosis^[18].

Based on genetic testing, your provider may recommend additional treatments to further reduce your risk of recurrence^[1].