Breast Cancer Recurrence

What is recurrent breast cancer?

Breast cancer recurrence is when you have breast cancer that comes back (recurs) after treatment. Breast cancer can come back months or years after you’ve finished treatment. Healthcare providers can treat recurrent breast cancer, but it can come back again.

What are the types of breast cancer recurrence?

The type depends on where the cancer comes back:

• Local: Cancer returns in the same breast (chest) area as the original tumor.
• Regional: Cancer comes back near the original tumor, in lymph nodes in your armpit (axillary lymph nodes) or in or around your collarbone area.
• Distant: Breast cancer spreads away from the original tumor to your lungs, bones, brain or other parts of your body. This is metastatic breast cancer, often referred to as Stage 4 breast cancer.

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 cancer.

What 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.

How common is recurrent breast cancer?

It’s relatively uncommon, but the specific rate of recurrence depends on factors, like your breast cancer stage and treatment.

What is the average time for 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’s a 6% chance that cancer will recur within five years if healthcare providers didn’t find cancer in your axillary lymph nodes during your original surgery.
• There’s a 25% chance of cancer recurrence if your axillary lymph nodes are cancerous. This risk drops to 6% if you receive radiation therapy after a mastectomy.

What are the symptoms of recurrent breast cancer?

Symptoms vary depending on where cancer started. For example, cancer that comes back in the same area as the original cancer (local cancer) causes different symptoms than regional cancer, which is breast cancer that’s spread to nearby lymph nodes.

Local breast cancer recurrence may cause:

• Breast lumps or bumps on or under your 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 in your armpit or in or around your collarbone area.

Distant (metastatic 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:

• 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?

Breast cancer recurrence happens when treatment doesn’t kill all the cancer cells in your breast. Breast cancer treatments are effective, but breast cancer cells can be tricky:

• Treatment can shrink breast cancer tumors to the point that tests don’t detect weakened cancer cells. But the cells are still there, and over time, they can return stronger, start to grow and create tumors.
• Surgery to remove a tumor isn’t always 100% effective. Before surgery, cancer cells may move from your breast to nearby lymph nodes, tissue or into your bloodstream.

What are the risk factors for recurrent breast cancer?

Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:

• Age: Women and people assigned female at birth (AFAB) who develop breast cancer before age 35 are more likely to get breast cancer again.
• Cancer stage: Healthcare providers use cancer staging systems to develop treatment plans and set prognoses when people are first diagnosed with breast cancer. There’s a connection between the cancer stage at first diagnosis and the risk breast cancer will recur. For example, people with Stage III breast cancer are more likely to develop recurrent breast cancer than people with Stage I or Stage II breast cancer.
• 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.

What are complications of recurrent breast cancer?

Breast cancer that comes back or spreads is more difficult to treat:

• Treatment that worked before may not be as effective this time around, so your healthcare provider will try other treatments. They may recommend you take part in clinical trials.
• Metastatic breast cancer is more difficult to treat simply because you have breast cancer in more than one area of your body. (Regardless of where breast cancer spreads, it’s still considered breast cancer. That’s because breast cells are different from lung cells, bone cells or other cells in areas of your body where breast cancer may spread.)

How is breast cancer recurrence diagnosed?

Your healthcare provider will do some of the same tests you had when you first received your breast cancer diagnosis:

• Mammogram.
• Ultrasound.
• MRI, CT scan or positron emission tomography (PET) scan.
• Blood tests for tumor markers.
• Biopsy.

What are treatments for recurrent breast cancer?

Treatment varies depending on the recurrent cancer’s location and earlier treatments. For example:

• If you had a lumpectomy for a local or regional tumor, your provider may recommend a mastectomy to remove one or both of your breasts and nearby lymph nodes.
• If you had a lumpectomy, you may be a candidate for another lumpectomy with radiation. Talk to your doctor about this.
• If you have recurrent breast cancer in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
• If you had a mastectomy, treatment may include surgery to remove the additional tumor, followed by radiation therapy.

Other treatments may include:

• Hormone therapy.
• Chemotherapy.
• Immunotherapy.
• Targeted therapy.

What are treatments for metastatic breast cancer?

The main treatment for metastatic breast cancer is systemic therapy that covers your entire body, including chemotherapy, hormonal therapy, immunotherapy and targeted therapy.

Can breast cancer recurrence be prevented?

Research shows certain treatments may reduce the risk that certain breast cancer subtypes will come back. For example, hormone therapy, like tamoxifen or aromatase inhibitors, may reduce the risk of recurrence for people with early-stage estrogen-receptive breast cancer (ER-positive or ER+). Likewise, having chemotherapy after surgery (adjuvant therapy) may reduce your risk.

But in general, experts don’t fully understand why breast cancer comes back in some people and not others. If you have recurrent breast cancer, it’s important to remember there’s nothing you did or didn’t do.

While you may not be able to prevent recurrent breast cancer, doing breast self-examinations and having regular follow-up screenings may help your provider identify recurrent breast cancer before it spreads or while metastatic breast cancer tumors are relatively small and easier to treat.

Is breast cancer worse if it comes back?

Recurrent breast cancer can be more challenging to treat, but that doesn’t mean it’s always worse than the original breast cancer. If you have recurrent breast cancer, you may have different treatment than before, or more aggressive treatment such as surgery or more powerful anticancer drugs. A lot depends on your situation, and your healthcare provider is the best person to ask what you can expect.

Can recurrent breast cancer be cured?

That depends on your situation. Ask your healthcare provider what you can expect, including whether treatment is intended to cure recurrent breast cancer or keep it from growing and spreading.

What are the survival rates for recurrent breast cancer?

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.

It’s important to remember most cancer survival rates are estimates based on the experiences of large groups of people with the same condition.

More than that, these are estimates based on what was going on during a specific time that may be years in the past. (Think of the differences you see when you look at a selfie taken five years ago, and one taken just the other day. Just like your appearance, survival rates change over time.)

You probably had questions about cancer survival rates when you first learned you had breast cancer. Your provider was your best resource for information then, and they’re your best source now.

How do I take care of myself?

If you have recurrent breast cancer, you may be living with a lot of different emotions:

• You may feel angry that you must deal with more breast cancer treatment.
• You may feel frustrated because once again, you’re dealing with a condition that can make you feel as if you’ve lost control of your health.
• You may be worried or fearful about the future.
• You may feel hopeless because there aren’t any guarantees that breast cancer won’t come back again.

It’s normal and natural if you have these feelings. But if you feel trapped in a cycle of negative feelings, consider talking to your healthcare provider. They’ll do their best to answer your questions so you have facts that may help you push back against your fears. They may refer you to a mental health professional to help you understand and manage your feelings.

Here are some other things you can do to ease the emotional stress of living with recurrent breast cancer:

• Keep on eating a healthy diet: Focus on filling your plate with a variety of vegetables, fruit, lean protein and whole grains. Eating well helps you keep up your strength during treatment.
• Get some exercise: Regular exercise reduces stress and may help you to cope with some of the emotional challenges that come with having breast cancer in recurrence.
• Consider palliative care: Palliative care providers can help you manage symptoms and treatment side effects.
• Participate in cancer survivorship programs: You’re a survivor from the day you receive a breast cancer diagnosis. Ask your providers about programs and services tailored for people with recurrent breast cancer.

When should I see my healthcare provider?

You should call your provider if you have changes in your breasts or other symptoms, like coughs, headaches or swollen lymph nodes that don’t go away.

What questions should I ask my doctor?

If tests show breast cancer has come back, you may want to ask your provider:

• What type of breast cancer recurrence do I have?
• If it’s spread, where has it spread?
• What is the cancer stage?
• What are treatments?
• What are the treatment risks and side effects?
• Should I look out for signs of complications?

Can I ever be sure breast cancer won’t come back?

Unfortunately, no one can make that guarantee. Even when tests don’t detect any signs of breast cancer, there’s still a chance that some cancer cells that are too small to be detected can survive treatment for recurrent breast cancer. Likewise, cancer cells may travel from your breast to another part of your body. Once there, they may start growing and become tumors.

A note from Cleveland Clinic

It may be hard to hear you have breast cancer that’s come back. It’s understandable if you feel frustrated, angry and afraid. After all, you went through treatment and likely were elated when tests didn’t find signs of breast cancer. Now, it’s back, and you may feel like you’re facing a grim sort of Groundhog Day. It may help to know that recurrent breast cancer treatment often eliminates the recurring cancer. And you may be able to take part in clinical trials evaluating new treatments. If you have recurrent breast cancer, your healthcare provider will recommend the best treatment options for your situation, including clinical trials.