Key takeaways:
Many breast cancer survivors worry about breast cancer recurrence. It’s a legitimate concern, considering the 30% overall recurrence rate. And, while it’s important that you be vigilant, you don’t need to jeopardize your emotional health by being overly fearful.
Many factors determine the level of risk for recurrence, and many breast cancers—especially those that were low-grade, diagnosed early, and didn’t affect the lymph nodes—have a very low risk of recurrence.
Breast cancer has the highest risk of returning during the first two years after your original cancer is treated. While your risk of recurrence is never zero, it goes down over time.
Following your initial breast cancer treatment, you’ll follow a regular schedule of follow-up exams your oncologist likely recommended. During your regular checkups, screenings, and mammograms, they will look for signs or symptoms of cancer recurrence.
Finding out that you have recurrent breast cancer can almost feel more terrifying than an initial diagnosis. If you do receive such news, don’t panic. While it may feel alarming and disheartening, the right treatment can eliminate breast cancer just as it did the first time.
Your risk of breast cancer recurrence depends on many factors directly related to the first occurrence and treatment.
With your first occurrence of breast cancer, your oncologist will consider the following when assessing your chances of recurrence:
After early-stage breast cancer treatment, your oncology team may perform a gene expression test to help anticipate your risk of relapse.
Your oncologist can use the information to determine whether you would benefit from chemotherapy, hormone therapy, or both after breast surgery.
The test examines the genes in your cancer cells to obtain a recurrence score. The scores range from zero to 100 and show your risk of relapse.
There are many tests that may be used, depending on your situation. The most commonly used tests are Oncotype DX, MammaPrint, and Prosigna.
Talk to your medical team to learn more about which tests might be right for your situation and your own risk of recurrence. Every person faces a unique situation.
Despite being breast cancer-free for many years, you may live with a daily nagging concern or underlying fear about the cancer coming back.
For peace of mind and to stay ahead of your breast health, it’s essential that you get regular, annual screenings and checkups.
Breast cancer that comes back within five years of diagnosis and initial treatment is called “early recurrence.” Breast cancer that returns more than five years after diagnosis and initial treatment is called “late recurrence.”
While late relapse is not common, cancer survivors are not guaranteed a clean-bill of health. Life-long follow-up care is recommended to help you stay healthy.
A bilateral mastectomy, or surgical removal of both breasts, significantly reduces your chances of breast cancer relapse. However, there is still a minimal chance that residual breast tissue or cancer cells could recur on the chest wall.
If you’ve had a lateral mastectomy, in which only one breast is removed, you can still develop breast cancer in the opposite breast. An annual screening mammogram of the remaining breast is essential to screen for any abnormalities.
It’s important to note that a mastectomy does not reduce your risk of getting cancer somewhere else in your body.
You’ll likely recognize the symptoms if you have a breast cancer relapse. They will be much the same as what you experienced with your original breast cancer diagnosis, with a few additional possible signs at the treatment areas:
Note that after a mastectomy and radiation, the entire area may be swollen and red for weeks or even months, so this may not be a recurrence sign. However, redness can also indicate infection, so it’s a good idea to get it checked out.
If you had a mastectomy and breast reconstruction, you might notice some lumps near the scar. These are caused by scar tissue or dead fat cells, and they’re harmless.
If symptoms arise, your clinician can monitor you by performing a clinical breast exam. They may also order an additional screening, such as an MRI. An MRI has higher accuracy in screening for breast cancer.
There are three areas where breast cancer might return. Your treatment options will vary depending on the type of recurrence you have.
Local breast cancer recurrence is when cancer comes back in the same area that the first tumor was found.
Suppose you had a lumpectomy, surgery to remove the cancer and abnormal tissue, and radiation during your first experience with breast cancer. In that case, you cannot be treated with radiation again. The standard treatment, in this case, would be a mastectomy.
Suppose you didn’t have radiation along with the original lumpectomy. In that case, your medical practitioner may recommend another lumpectomy followed by radiation treatment.
Depending on your oncologist’s evaluation, they may also recommend chemotherapy, hormonal therapy (Tamoxifen or an aromatase inhibitor), or both.
Research has shown that the characteristics of breast cancer may be different if it comes back. For example, the hormone-receptor status may change, or your HER2 status might be different. Your oncologist may want to biopsy the area to check for changes in these two important indicators.
Regional recurrence is when cancer reappears in the lymph nodes in the armpit or collarbone area near where the tumor was initially diagnosed.
Treatment options are much the same here as with local recurrence. It might help to note that, because local and regional breast cancer recurrences share many of the same characteristics, some medical practitioners use the term “locoregional” recurrence.
Distant breast cancer recurrence is when breast cancer has spread (metastasis) to another organ or part of your body, such as your lungs, bones, or brain. Though rare, distance recurrence can also occur in the opposite breast.
Also called metastatic breast cancer, this recurrence level is no longer curable. It needs to be managed as a chronic disease. Still, even if a cure isn’t possible for your recurrent cancer, treatment may control your cancer for a long time.
Treatment options may include:
Several preventative measures can lower your risk of getting breast cancer again.
To help reduce the risk of breast cancer recurrence, consider the following strategies:
The medical professionals (or oncologists) you work with may also recommend one of the following options:
If you’ve had breast cancer before, there is a small chance you can get it again. However, you can put some preventative measures in place.
Practice holistic health care by eating well, exercising, getting plenty of sleep, and caring for your emotional well-being, including practices to help manage your fear and pervasive worry about relapse.
Most importantly, see your oncologist for regular checkups, self-examine your breasts carefully and consistently, schedule an annual MRI screening, and have a yearly mammogram.
To learn more about mammograms, please check out:
