Breast Cancer Recurrence
What is breast cancer recurrence?
Breast cancer recurrence (or recurrent breast cancer) describes breast cancer that comes back after treatment. Breast cancer can recur months or years after treatment ends and you’re in remission. When you’re in remission, tests show no signs of disease and you have no symptoms.
What are the types of breast cancer recurrence?
If you develop cancer in the opposite, untreated breast (but not anywhere else in the body), you receive a new breast cancer diagnosis. This isn’t the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit (axillary lymph nodes) or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
What are risk factors for breast cancer recurrence?
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual (abnormal) cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. They’re more likely to come back and spread.
How common is breast cancer recurrence?
Most local recurrences of breast cancer occur within five years of a lumpectomy. 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. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didn’t find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Symptoms and Causes
What causes breast cancer recurrence?
The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests don’t detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.
Even surgery to remove a cancerous tumor isn’t always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.
What are the symptoms of breast cancer recurrence?
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- 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.
Regional breast cancer recurrence may cause:
- Chronic chest pain.
- Difficulty swallowing.
- Pain, swelling or numbness in one arm or shoulder.
- Swollen lymph nodes under the arm or near the collarbone or breastbone.
Distant (metastatic or stage 4) breast cancer can involve any organ including bones, lungs, brain or liver. Symptoms depend on where the cancer spreads. You may experience:
Bone pain or pain in the affected area (metastatic breast cancer pain).
Diagnosis and Tests
How is breast cancer recurrence diagnosed?
Your healthcare provider will conduct some of the same tests you had at the original diagnosis. You may need additional tests like bone scans or X-rays to check for cancer spread.
Tests for breast cancer recurrence include:
- Blood tests for cancer tumor markers (proteins).
- MRI, CT scan or positron emission tomography (PET) scan.
- Biopsy of the site of suspected recurrence.
Management and Treatment
What are the complications of breast cancer recurrence?
Breast cancer that comes back can be harder to treat. The same therapy isn’t always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs — not lung cancer. Metastatic (stage 4) breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
How is breast cancer recurrence managed or treated?
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast (or both breasts) and sometimes lymph nodes.
- Chemotherapy: Chemotherapy (chemo) circulates in blood, killing cancer cells.
- Hormone therapy: Tamoxifen and other hormone therapies treat cancers that thrive on estrogen (hormone positive).
- Immunotherapy: Immunotherapy (biological therapy) engages your body’s immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
How can I prevent breast cancer recurrence?
Healthcare providers don’t know why some people experience breast cancer recurrence. A recurrence isn’t your fault. You didn’t do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the body’s production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare provider’s recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
Outlook / Prognosis
What is the prognosis (outlook) for people who have breast cancer recurrence?
Many factors affect survivorship after breast cancer recurrence. Everyone’s situation is different.
In general, your chances of being alive five years after diagnosis are:
- 99% for localized breast cancer.
- 86% for regional breast cancer.
- 27% for distant (metastatic) breast cancer.
When should I call the healthcare provider?
You should call your provider if you have:
- Breast lump or breast changes.
- Persistent cough.
- Severe headaches or vision problems.
- Swollen lymph nodes.
- Unexplained pain or nausea.
What questions should I ask my healthcare provider?
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
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