Breast Cancer Recurrence: What You Should Know

Elyse Caplan remembers it well, that first conversation with her oncologist. She had just been diagnosed with stage IIB breast cancer, and they were discussing the game plan for treatment. If her oncologist mentioned "recurrence" -- the possibility that her cancer could return -- it was lost on her, she says.

"You sit through an hour-long appointment and take notes, but when the doctor says one thing that's very upsetting, you just freeze," she tells WebMD. "You're thinking, 'I'm going to lose my hair. How am I going to tell my boss, my kids?' You don't hear much after that."

Yet the risk of breast cancer returning is a critical issue that must be emphasized early on, she says. "The whole goal of treatment is to eradicate the disease and hopefully reduce risk of recurrence," Caplan tells WebMD. "But I'm not so sure doctors are speaking as directly to that point as they could be."

It's true, many oncologists don't directly address the subject of recurrence, says Victor Vogel, MD, co-director of the Biochemoprevention Program at the University of Pittsburgh Cancer Institute.

"I don't think we've come up with a good way to talk about it," Vogel tells WebMD. "Recurrence is fearsome stuff, disturbing. No one likes the uncertainty of it -- which patient will have a recurrence, when it will happen, how long we can control it, when they will die from it. So we hide behind the business at hand, stay busy with the treatments."

"We've got that one shot to get it right, in that initial treatment, so we focus on that," Vogel says.

The problem is, some women quit taking breast cancer medications, not realizing it raises the risk of cancer returning. Some are having serious side effects from the medications. Others are feeling fine and don't see the harm of stopping, he explains.

By quitting the treatment, they may put their lives in jeopardy. "If a patient completes the treatment, there is significantly less chance of recurrence," Vogel tells WebMD. "Oncologists need to do a better job of explaining that." If side effects are the problem, there may be options to provide relief, he says.

There are also lifestyle changes that women can make to either prevent cancer from returning or catch it early, so treatment can begin quickly.

Importance of Sticking With the Plan

When a woman is first diagnosed with breast cancer, her oncologists analyze the tumor closely -- already calculating her recurrence risk -- to determine the best plan of attack, explains Mark Pegram, MD, a breast cancer specialist with the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine. 

More than ever before, today's breast cancer treatment is individualized -- tailored to the makeup of each patient's cancer cells, Pegram says. "If you have a large tumor that has spread to lymph nodes, the chance of recurrence is much higher than if it's smaller and has not spread. Even if you have a small tumor, it could be the tumor has characteristics that could make it aggressive."