Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment. Breast cancer can come back as a local recurrence (in the treated breast or near the mastectomy scar) or somewhere else in the body. The most common sites of recurrence outside the breast include the lymph nodes, the bones, liver, lungs, or brain.
How Do I Know if There Is a Recurrence of Breast Cancer?
If you've been treated for breast cancer, you should continue to practice breast self-exams, checking both the treated area and your other breast each month. You should report any changes to your doctor right away. Breast changes that might indicate a recurrence include:
An area that is distinctly different from any other area on either breast
Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
A change in the size, shape, or contour of the breast
A mass or lump, which may feel as small as a pea
A marble-like area under the skin
A change in the feel or appearance of the skin on the breast or nipple, including skin that is dimpled, puckered, scaly, or inflamed (red, warm, or swollen)
Bloody or clear fluid discharge from the nipples
Redness of the skin on the breast or nipple
Along with performing monthly breast self-exams, scheduled follow-up appointments with your health care provider need to be kept. During these appointments, the health care provider should perform a breast exam, order lab or imaging tests as needed, and ask about any symptoms that are present. Initially, these follow-up appointments may be scheduled every three to four months. The longer you are cancer-free, the less often you will need to see the provider. Continue to follow recommendations on screening mammograms (recommended once a year).
What Are the Risk Factors for a Breast Cancer Recurrence?
The patient and the characteristics of the tumor that has been removed may help a doctor predict a possible recurrence of breast cancer. These are some common indicators:
Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence. The more involvement of lymph nodes, the higher the recurrence risk.
Involvement of the microscopic lymphatic system or blood vessels within the breast increases the risk of recurrence.
Tumor size. The larger the tumor, the greater the chance of recurrence.
Hormone receptors. About two-thirds of all breast cancers contain significant hormone receptors. This means a tumor has receptors for estrogen (called ER+) or progesterone (PR+) or both types. Progesterone receptor status tends to be a better predictor of recurrence than estrogen receptors.
HER2. This gene triggers the growth of cancer cells, and in general, HER2 cancers have a worse prognosis than other types. However, certain drugs are especially effective against HER2 cancers.
Histologic grade. This term refers to how much the tumor cells resemble normal cells when viewed under the microscope. The higher the histologic grade, the greater chance of recurrence.
Nuclear grade. This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade (also called proliferative capacity) are usually more aggressive (faster growing).