Breast cancer can come back as a local recurrence (meaning in the treated breast or near the mastectomy scar) or somewhere else in the body. Some of the most common sites of recurrence outside the breast are the lymph nodes, bones, liver, lungs, and brain.
How Do You Know?
You should keep doing breast self-exams, checking the treated area and your other breast each month. You should tell your doctor about any changes right away.
Also, keep getting regular mammograms. In some screening centers, three-dimensional mammograms are available in addition to traditional digital mammograms. If genetic tests show you have the BRCA mutations, you may also need an MRI of your breast. Talk to your doctor about the best screening tests for you.
Breast changes that might be a recurrence include:
- A lump or thickening in or near the breast or in the underarm that doesn’t go away after your period
- A change in the size, shape, or contour of the breast
- 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, red, warm, or swollen
- Blood or clear fluid coming out of a nipple
Along with monthly breast self-exams, you should go to follow-up appointments with your doctor. During these appointments, your doctor should examine your breasts, ask about any symptoms, and order lab or imaging tests if they are needed. Go over any new symptoms with your doctor right away, like pain, headaches, weight loss, lack of appetite, or anything else.
At first, your follow-up appointments may be every 3 to 4 months. The longer you are cancer-free, the less often you will need to see your doctor.
What Makes It More Likely
Tumor size. The larger the tumor was, the greater the chance of recurrence.
Cancer spread. If your breast cancer had spread to your lymph nodes, the more lymph nodes that had cancer cells, the more likely your risk of recurrence. Your risk is also higher if cancer cells were found in the lymph vessels or blood vessels of your breast.
HER2. This gene triggers the growth of cancer cells.
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 higher the odds 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 are usually more aggressive (faster growing).
The type of treatment you get for local breast cancer recurrences depends on the type of treatment you got at first. If you had a lumpectomy, local recurrence is usually treated with a mastectomy. If you had a mastectomy, recurrence near the mastectomy site is treated by removing the tumor if possible, usually followed by radiation.
If breast cancer is found in the other breast, it may be a new tumor unrelated to the first breast cancer. This would be treated like a new case of breast cancer. You would get either a lumpectomy or mastectomy, followed by more treatments if necessary.
If the cancer comes back in another part of the body, such as the bones, lungs, liver, or brain, you may get surgery, chemotherapy, radiation, hormone therapy, targeted therapy, or a combination. It depends on your specific situation.
Doctors may recommend that women whose cancer cells have high levels of the HER2 protein undergo targeted therapy, alone or with chemotherapy, with one of these drugs:
- Ado-trastuzumab emtansine (Kadcyla)
- Lapatinib (Tykerb)
- Neratinib (Nerlynx)
- Pertuzumab (Perjeta)
- Trastuzumab (Herceptin)
Immunotherapy stimulates you own immune system to find and destroy cancer cells. Atezolizumab (Tecentriq) is an immunotherapy drug that is used in combination with the chemotherapy drug paclitaxel (Abraxane) to block a protein called PD-L1. This treatment can be given to women with a certain type of advanced breast cancer.