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    When Breast Cancer Comes Back

    Recurrence is always possible. But when the cancer comes back, where it is and how it behaves all affect the outcome.

    Recurrence Can Mean Different Things continued...

    "Whether it's a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume we're dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation," says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.

    If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer ("new primaries" are not common, but they do happen) would be treated largely as an entirely new problem.

    "That woman will not only undergo surgery, but may well receive additional therapy that doesn't ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent," says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.

    If, on the other hand, you finished treatment for your original breast cancer only six months or a year ago, and the cancer has already recurred, that may be a sign that the tumor may be very aggressive.

    "This indicates to us that a woman may be at a higher risk to have a systemic recurrence," says Winer. If you didn't have chemotherapy before, doctors may recommend an aggressive chemotherapy regimen now. But if you've completed rigorous chemotherapy fairly recently, oncologists may not be in a rush to put you through that again.

    Of course, there are some complicating factors to treatment no matter when a recurrence occurs. For example, a woman who has previously had Adriamycin (doxorubicin) or another chemotherapy drug that is known to damage the heart cannot be prescribed that drug again -- whether it's a year later or ten years later.

    And a breast that has been treated with radiation cannot be radiated again. For that reason, if you had a lumpectomy the first time around, which was probably followed by radiation, your doctors will likely advise a mastectomy if the cancer recurs.

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