When breast cancer comes back after treatment and a period of time when it was thought to be gone, it's called recurrence. Only a few cancer cells need to survive treatment for this to happen. Over time, they can multiply enough to cause problems and be found.
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 places of recurrence outside the breast are the lymph nodes, bones, liver, lungs, and brain.
How Do You Know?
Keep doing breast self-exams, checking the treated area and your other breast each month. 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 gene tests show that you have changes to the BRCA genes, 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 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 look 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
- A new lump or swelling anywhere in your body
- Bone pain or a broken bone
- New pain that doesn’t go away
- Breathing problems or a new cough
- Headaches that don’t go away
- Yellow eyes or skin
- Changes in your energy level
Along with monthly self-exams, you should have follow-up appointments with your doctor. They should examine your breasts, ask about any symptoms, and order lab or imaging tests if needed. Tell them right away about any new symptoms.
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
There’s no sure way to know whether breast cancer will come back, and there’s no sure way to keep it from coming back. Things that raise the odds include:
- Tumor size. The larger the tumor was, the higher 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.
- Hormone receptors . About two-thirds of all breast cancers have receptors for estrogen (called ER+) or progesterone (PR+) or both types.
- 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).
Tests can tell your doctor what’s going on. They may be the same ones you had the first time you were diagnosed, such as mammograms, CT scans, MRIs, PET scans, and bone scans. The type of test used depends on where the cancer might be. Imaging tests will show exactly where it is and how far it has spread.
Many times, a biopsy is needed to know what kind of cancer it is. It may be breast cancer that’s come back, or it may be a new kind of cancer. (It’s rare, but you can have two different kinds of cancer.) This is key information when making treatment plans and talking about outcomes.
The type of treatment you get for local breast cancer recurrence depends on what 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 your 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 situation.
Doctors may recommend that women whose cancer cells have high levels of the HER2 protein get targeted therapy, alone or with chemotherapy, with one of these drugs:
- Ado-trastuzumab emtansine (Kadcyla)
- Lapatinib (Tykerb)
- Neratinib (Nerlynx)
- Pertuzumab (Perjeta)
- Trastuzumab (Herceptin)
Immunotherapy triggers your immune system to find and destroy cancer cells. Atezolizumab (Tecentriq) is an immunotherapy drug 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.
How Do I Deal With a Recurrence?
This diagnosis may be harder to deal with than the first one. You did your part, and the cancer was gone. It’s not fair to have to go through it all again. You may think you got the wrong treatment last time or did something wrong. You may be angry with your doctor. You may think you can’t do this again. These feelings are normal.
Talk to your doctor about your concerns. Get the information and help you need to move forward. Remember: You know a lot more than you did the first time. You’re better prepared and know what to expect. You also know which questions to ask. Also, keep in mind that cancer treatments are getting better all the time. There may be new ones that work better than the kind you had before.