When Breast Cancer Comes Back

Medically Reviewed by Melinda Ratini, MS, DO on March 17, 2022
4 min read

It’s when your cancer comes back after treatment. It can happen a year after you finish treatment for breast cancer, or 5, 10, even 20 years later. You find another lump, or a shadow appears on your mammogram. Is the cancer back?

Every person who's had breast cancer knows that recurrence is possible. Sometimes -- such as at follow-up visits with the oncologist -- it might particularly be on your mind. It helps to know exactly what a recurrence might involve. And if your thoughts about recurrence start to become a worry, it's a good idea to talk it over with your doctor, therapist, or support group.

In simple terms, it means the return of the same cancer.

It could also mean the cancer has spread to other parts of the body. Doctors call this “metastatic” recurrence.  This is generally more serious than a simple return of cancer cells to the breast itself, which is also a recurrence.

Though some people use “recurrence” and “metastasis” to mean the same thing, they are different. Recurrence is more general. It simply means that cancer has returned – either as a metastasis or to the original breast. Metastasis is a specific type of recurrence. It means your original cancer has spread to other parts of your body. 

Sometimes new cancer shows up in the opposite breast and nowhere else. Doctors consider this a “new” cancer diagnosis, not a recurrence.

It’s usually better if a recurrence remains in the breast (non-metastatic breast cancer). But the seriousness depends in part on how long it has been since the original cancer. If it’s been 7 years, your medical team may approach the new growth just as they would a new presentation of breast cancer. The new cancer cells may be the same as before or they could be a new type. Either way, if it’s been a while since the first cancer, your medical team will often treat it largely the same as it treated the first one. This often starts with surgical removal of the tumor.

If you have surgery, your doctor will likely want to follow up with some type of other therapy. Though radiation therapy often follows surgery, you may not be able to get it if the breast got radiation treatment after a prior surgery for breast cancer.

But there are other options that your doctor will likely consider:

  • Hormone therapy
  • Targeted therapy
  • Immunotherapy
  • Chemotherapy

If the time since your last cancer is much shorter, say 6 months, your team may assume the tumor could soon spread (metastisize). This may change their approach to include more chemotherapy or other pharmaceutical approaches.

But you may not be ready for aggressive chemo if you’ve recently been through a round. So your medical team will have to work around that.

And the type of chemo matters, too. For example, if, in a previous round of chemo, you had doxorubicin or another cancer drug known to weaken the heart, it may not be possible to get it again.

The more your cancer spreads from the original tumor, the more serious it is likely to be. Your cancer may be local, regional, or distant:

Local: The cancer comes back in the same breast as the original tumor.

Regional: Here, the cancer returns to the same area as the original tumor, but in a more expanded sense that includes the armpit or collarbone lymph nodes. 

Distant: This is what doctors call metastatic cancer or stage IV breast cancer. Here, the cancer shows up far away from the original tumor in places like the bones, lungs, brain, or other areas. 

Breast cancer can recur in anyone who has had breast cancer. It’s highly unlikely to be a result of anything you did or failed to do.

There are, however, some things that seem to raise your risk of recurrence. These include:

Stage: Scientists use several things to come up with your breast cancer stage (stages I to IV). They look at the grade of tumor. This is a measure of how abnormal the cells look compared to similar noncancerous cells. After that, they look at the size of the tumor and how far cancerous cells have spread from the original site to other parts of the body. The higher the stage of your original tumor, the more likely it is to recur. 

Age: If you’re a woman and you get breast cancer before age 35, you’re more likely than older women to get it again. 

Tumor type: Some types of breast cancer are more aggressive and therefore more likely to return and spread to other parts of your body. These include inflammatory breast cancer and triple-negative breast cancer. This also includes hormone-receptive types. Not only are these more likely to come back, they’re also harder to treat.

Certain cancer cell behavior: Hormone-receptive cancer cells that don’t respond to hormone therapy or cancer cells that don’t respond to targeted treatments for the HER2 gene could be a sign of more likely recurrence.

High BMI: Lots of body fat (obesity) as measured by the body mass index, or BMI, can raise your risk of breast cancer recurrence.

Recurrence is a risk for up to 32 years after a first diagnosis of breast cancer, according to a recent study. Your risk of recurrence after 10 years of remission depends on a number of things like:

  • The size of the tumor
  • The number of lymph nodes with cancer
  • Whether cancer is estrogen receptor-positive

In general, once you have a breast cancer diagnosis, even if you are years in remission, it’s a good idea to be watchful and consult your doctor for regular breast exams and other screenings they think are appropriate. Early detection is the best way to get the best outcome from treatment. Talk to your doctor about the best schedule of checkups for you.