- About 70% of people diagnosed with breast cancer will never have a recurrence.
- Your risk of breast cancer recurrence depends on many factors related to your original cancer.
- Your prognosis and treatment depend on whether your breast cancer recurrence is local, regional, or distant.
- Late relapse is uncommon, but breast cancer survivors should still get continuous follow-up care.
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.
What are the chances my breast cancer might come back?
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:
- Size of the original tumor or mass
- Cancer stage at the time of the initial diagnosis
- Your former breast cancer’s grade (characteristics of the cancer cells)
- Whether or not your lymph nodes were involved
- Types of treatment you underwent
Gene expression tests.
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.
- On any of the three tests, a score of 0-25 indicates a low risk of recurrence.
- A score of 26-100 indicates a higher risk of recurrence.
There are many tests that may be used, depending on your situation. Three that are commonly used are Oncotype DX, MammaPrint, and Prosigna.
- The MammaPrint test can help show how likely breast cancers are to recur in another part of your body after treatment.
- The Prosigna test may project relapse risk for post-menopausal women whose invasive breast cancers are hormone receptor-positive.
- The Oncotype DX test is done for stage I, II, or IIIa hormone receptor-positive tumors that haven’t metastasized beyond three lymph nodes and are HER2 negative. Sometimes, this test is conducted for DCIS (ductal carcinoma in situ or stage 0 breast cancer).
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.
After being cancer-free for years, am I still at risk of breast cancer recurrence?
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.
Can you have breast cancer recurrence after a mastectomy?
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 detect any abnormalities.
It’s important to note that a mastectomy does not reduce your risk of getting cancer somewhere else in your body.
What are the signs and symptoms of local recurrent breast cancer?
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:
- A new lump in the breast
- A new part of the breast that feels too firm
- Redness or swelling of the skin on your breast
- Abnormal changes to the nipple
- Pulling of the skin or swelling at the lumpectomy site
- Increased thickening on or near the mastectomy scar
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.
If I do get breast cancer again, what are my treatment options?
There are three areas where breast cancer might return. Your treatment options will vary depending on the type of recurrence you have.
Treatments for local recurrences
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.
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.
Treatments for regional recurrences.
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.
Treatments for distant recurrences.
Distant breast cancer recurrence is when 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:
- Hormone therapy
- Endocrine therapy
- Clinical trials
How can I prevent breast cancer recurrence?
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:
- Follow the breast cancer screening plan your oncologist advised.
- Maintain a healthy weight.
- Get regular exercise.
- Eat a healthy diet and limit your alcohol consumption.
The medical professionals (or oncologists) you work with may also recommend one of the following options:
- Hormone therapy may reduce the risk of recurrence if you have hormone receptor-positive breast cancer
- Chemotherapy may decrease the chance that cancer will recur
- Radiation therapy lowers breast cancer relapse risk for those who previously had a large tumor or inflammatory breast cancer
- Targeted therapy, a drug regimen that targets HER2 protein, can help reduce the chances of recurrence for those with HER2-positive breast cancers.
Protect against potential breast cancer recurrences.
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.
You can assess your risk of cancer or cancer recurrence by taking Ezra’s five-minute quiz, which evaluates questions about your lifestyle and medical history. Your score will highlight areas where you can improve your own health care and lifestyle.
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.