From geisinger.org
Find out why breast cancer comes back — and take steps to lower your risk
Fortunately, most women treated for breast cancer won’t have a recurrence. After successfully treating the original cancer, many women are considered in remission.
Even so, breast cancer recurrence does happen — months or even years after treatment and a period with no signs of disease. Cancer may return in the breast after a lumpectomy, in the chest area after a mastectomy or in more distant parts of the body.
“Anyone who has been treated for breast cancer has some risk of recurrence, but newer and more advanced therapies are helping to reduce that risk,” says Mona Duncan, MD, a breast surgeon at Geisinger.
Still, understanding your individual risk (and how to reduce it) and knowing what changes to watch for can help you feel more confident about your health after treatment.
Why does breast cancer come back?
Surgical treatment for breast cancer can include a mastectomy to remove the majority of breast tissue or a lumpectomy, which removes only the cancerous lump. But surgery can’t remove the cancer cells that may have travelled beyond the breast.
“Currently, our technology can’t identify all cancerous cells in the body, and we assume that some are outside the breast even with early breast cancer,” says Dr. Duncan. “That’s why systemic treatments — medications that travel throughout the body — are typically recommended after both surgeries.”
Depending on the cancer, these can include chemotherapy, hormone therapy, targeted therapies or a combination of these. Studies have shown that a lumpectomy with radiation and mastectomy are equivalent in treating breast cancer.
But even after effective surgery, radiation and systemic therapies, microscopic cancer cells can survive treatment. These cells may be too small to detect with testing and can remain dormant for months or even years before they begin multiplying again.
While care continues to advance, no approach can guarantee that every cancer cell is eliminated. That’s why ongoing follow-up is vital to allow your care team to evaluate new symptoms and act early if concerns arise.
Risks of breast cancer recurrence
Thankfully, breast cancer recurrence is uncommon. But your individual risk depends on several factors, including:
- Age at diagnosis. Women diagnosed with breast cancer before age 35 have a higher risk of recurrence, partly because their cancers tend to more aggressive.
- Cancer stage. Larger tumours and cancers that have spread to the lymph nodes (later stages) carry higher risk.
- Cancer type. More aggressive cancers, like inflammatory and triple-negative breast cancers, are harder to treat — and more likely to be diagnosed at a later stage.
- Surgical margins. Cancer cells found at the edge of tissue removed during breast-conserving surgery (called positive margins) increase risk of recurrence.
- Treatment adherence. Completing recommended chemotherapy, radiation, targeted and endocrine therapies help reduce risk.
“Recurrent breast cancer develops from the original cancer and typically has the same features,” says Dr. Duncan. “Your doctor will consider these factors together to help you better understand your individual risk.”
Types of breast cancer recurrence
There are several types of breast cancer recurrence, all of which have a different prognosis and require different treatment.
Local recurrence
Local recurrence happens when breast cancer returns in the same area it originally developed. That could mean the same breast after a lumpectomy or chest wall after a mastectomy.
You might notice a new lump, skin changes such as redness, scaling, dimpling or a rash that doesn’t go away. You also may have an inverted nipple or nipple discharge.
Local recurrence is more common with younger women or more aggressive cancers. Making sure the edges are clear of cancer and receiving radiation after a lumpectomy are important to reduce risk.
“In the case of local recurrence, most doctors will recommend a full mastectomy if a patient has already had a lumpectomy and radiation therapy or a wide excision, along with radiation, if the patient already had a mastectomy,” says Dr. Duncan. “Additional systemic treatment also may be indicated.”
Regional recurrence
Regional recurrence happens when breast cancer returns in lymph nodes near the breast, such as the armpit, collarbone or along the breastbone. You might notice swollen lymph nodes, pain or numbness in the affected area.
“The lymph nodes are a filter within our immune system,” says Dr. Duncan. “They remove waste and toxins in our tissue, similarly to how the kidneys cleanse our blood. With cancers, some of the cells can be trapped, which leads to pain and swelling.”
Regional recurrence is usually treated with surgery to remove the involved nodes and may require additional radiation, plus systemic treatment.
Metastatic recurrence
Metastatic recurrence is marked by the spread of breast cancer outside the breast and nearby lymph nodes to other parts of the body. Cancer cells can travel through the bloodstream or lymphatic system and form tumours elsewhere.
The bones are the most common site of metastatic breast cancer, followed by the lungs, brain and liver. Symptoms vary based on the location and can include bone pain, shortness of breath, headaches or neurological changes.
Metastatic recurrence is considered stage IV breast cancer. While it’s not curable, it can often be controlled for many years thanks to advances in treatment — which can help slow cancer growth, relieve symptoms and extend life.
Systemic therapy is the main treatment for metastatic breast cancer. Depending on the cancer, this may include chemotherapy, hormone or targeted therapy or other anti-cancer medications.
Opposite breast cancer
Opposite breast cancer, or second primary breast cancer, is not considered recurrent cancer, but it’s still a concern.
The chance of developing a second, unrelated breast cancer depends on whether you carry an inherited genetic mutation associated with breast cancer and your age when you were first diagnosed.
“Women who carry a BRCA mutation have a significantly higher risk of developing a second opposite breast cancer,” says Dr. Duncan. “For most women, the risk is about .3% to .5% each year or roughly 3% to 5% in 10 years. Endocrine therapies can help reduce this risk.”
Can you prevent breast cancer recurrence?
There’s no way to prevent breast cancer from coming back, but treatments are designed to help lower your risk of recurrence.
That’s why one of the most important things you can do is complete your recommended treatment. That may include radiation after a lumpectomy and any systemic treatment like chemotherapy, hormone or targeted therapy.
Other ways to reduce your risk of breast cancer recurrence include:
- Keeping up with follow-up care and getting all recommended breast screenings. It’s also important to stay up to date on vaccines.
- Maintaining a healthy weight through a balanced diet of fruits, vegetables, whole grains and lean meats. A nutritionist can help you create a food plan tailored to your needs.
- Staying active with a goal of at least 150 minutes of moderate-intensity exercise each week, plus 2 or more days of strength training.
- Limiting alcohol and quitting smoking.
- Managing stress through techniques like breathing exercises, yoga or meditation.
- Getting at least 7 to 9 hours of sleep each night.
Work with your oncology team to develop a survivorship plan that outlines your follow-up visits, recommended imaging and symptoms to report. A new or persistent symptom doesn’t necessarily mean your cancer has returned, but it’s worth discussing with your care team.
“Partnering with your care team, recognizing changes early and taking steps that support your long-term health can all help reduce your risk of breast cancer recurrence,” says Dr. Duncan. “Thankfully, for most women, that risk is low.”
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