When breast cancer comes back, it is known as recurrent breast cancer. Breast cancer can recur in the same breast or in the opposite breast. It can also spread to nearby regions of the body, or more distant areas or organs.
Doctors generally detect recurrent breast cancer after finding no active cancer cells on scans for a period of time.
A person’s risk of developing recurrent breast cancer can depend on different factors, including the stage of the original breast cancer, the type of tumor, and the type of cancer treatment the person has previously had.
This article discusses how likely it is that a person’s breast cancer will recur, the symptoms a person may experience, and a person’s outlook if they develop recurrent breast cancer.
According to the breast cancer charity Susan G. Komen, everyone who has had breast cancer has a risk of recurrence. Those risks include:
After a mastectomy
A mastectomy involves surgical removal of the whole breast. There are several different types of mastectomies including:
- Simple mastectomy: The surgeon removes the breast tissue but leaves the surrounding lymph nodes or muscles beneath the breasts.
- Modified radical mastectomy: The surgeon removes the breast tissue and the lymph nodes under the arm but leaves the muscles beneath the breasts.
- Radical mastectomy: The surgeon removes the breasts, surrounding lymph nodes, and the muscles under the breasts.
- Nipple-sparing mastectomy: The surgeon removes the breasts but leaves the nipples intact
- Partial mastectomy: This procedure is more extensive than a lumpectomy but less extensive than a simple mastectomy. The surgeon removes the part of the breast where the cancer is present as well as some surrounding tissues.
When a person undergoes a mastectomy as part of their cancer treatment, there is a higher chance of recurrence if a doctor finds cancer cells in the surrounding lymph nodes.
If there is no cancer in the surrounding lymph nodes, there is a 6% chance the cancer will recur locally within 5 years.
However, if cancer was present in the surrounding lymph nodes, and the person has a mastectomy but does not pair that with radiation therapy, their chance of recurrence could increase to 23%.
After a lumpectomy
A lumpectomy is a surgical procedure that removes cancerous breast tissue along with an area of healthy surrounding tissue. This procedure preserves breast tissue. After a lumpectomy, people may undergo radiation therapy.
If a person has a lumpectomy and develops local or regional recurrence of breast cancer, a doctor may suggest a mastectomy and radiation therapy.
According to older research that set the standard for treatment recommendations, the rate of recurrence for people who chose a lumpectomy is about the same as the rate of recurrence for people who undergo a mastectomy.
Type of breast cancer
The type of breast cancer can affect the recurrence rate.
In a 2017 study, researchers found that people with estrogen-receptor (ER)–positive breast cancer had a persistent risk of recurrence for at least 20 years after their original diagnosis.
According to Susan G. Komen, factors that influence recurrence can include:
- biology of the tumor
- treatment of the original tumor
- stage of the cancer at diagnosis
A local recurrence happens if new cancer cells grow in the same breast the cancer originally affected.
If a person has had the breast tissue removed, a local recurrence can develop in the scar tissue where the breast tissue was removed.
A 2021 study found a
Symptoms
Symptoms of a local breast cancer recurrence include:
- a new lump in the breast where the cancer first occurred
- changes on or near a person’s mastectomy scar, including new thickenings or lumps
- new swelling or pulling near the the lumpectomy site
- nipple changes
- firmness in new areas of the breast
- redness or swelling of the breast after the area has healed from surgery and radiation
Diagnosis
Diagnosing local recurrent breast cancer starts with a person discussing with their doctor any new changes to their breast or scar tissue that develop after they have healed from treatment.
A doctor may perform an exam and suggest that the person has a mammogram or other imaging tests, such as an ultrasound, MRI, or PET scan.
Treatment
According to the
If a person originally had a lumpectomy, a doctor may recommend a mastectomy.
If a person originally had a mastectomy, a doctor may try to remove the tumor and recommend radiation.
For either scenario, a doctor may also suggest hormone therapy, chemotherapy, or targeted therapy in addition to removing the tumor and using radiation therapy.
Outlook
The outlook for local breast cancer recurrence varies from person to person.
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However, a 2017 study shows that survival rates have increased and outcomes have generally improved over the last 35 years.
There are many factors that influence a person’s overall prognosis after a local recurrence including:
- being younger than 45 when the cancer recurs
- how long after the initial cancer the recurrence occurs
- how early the recurrence is diagnosed
- the type of breast cancer
- the treatments used
Breast cancer that comes back near the site of the original occurrence is called a regional recurrence.
Regional recurrences often occur in the lymph nodes in the armpit or collarbone on the side of the body where the cancer originally developed.
Symptoms
Symptoms of a regional recurrence of breast cancer include:
- swelling on the collarbone, near the breastbone, or in or under the arm on the same side the cancer first developed
- persistent pain or loss of feeling in the arm, shoulder, or chest
- swallowing problems (dysphagia)
Diagnosis
Diagnosing regional recurrences of breast cancer depends on the type of treatment a person had initially.
For a person who had a lumpectomy, a doctor may recommend regular mammograms, which can sometimes detect cancer in the nearby lymph nodes.
A doctor may suggest other initial imaging tests for a person who has undergone a mastectomy, including ultrasound, PET, and MRI scans.
If a lymph node shows signs of being enlarged, a doctor may order a biopsy of the lymph nodes to check for cancer cells.
Treatment
According to the
Additionally, a doctor may recommend a person consider chemotherapy, hormone therapy, or other forms of systemic treatment.
Outlook
As with local recurrence, the prognosis for a person with regionally recurrent breast cancer varies based on a number of factors, including:
- age
- treatment type and plan
- how long after initial diagnosis the recurrent cancer develops
- how early a doctor finds the recurrent cancer
Distance recurrence occurs when breast cancer cells return in a location away from the breast or local tissue. The recurrence can occur anywhere in the body, but it commonly occurs in the lungs, bones, liver, or brain.
Symptoms
Symptoms of distance recurrence vary based on the location of the cancer cells.
Some potential symptoms include:
- seizures
- bone pain
- weight loss
- weakness anywhere in the body
- confusion
- persistent dry cough
- loss of appetite
- severe headaches
- numbness
- constant nausea
- loss of balance
- vision problems
Diagnosis
A doctor may use several tests to diagnose distant recurrence.
They can include:
- blood tests
- biopsies
- X-rays
- PET scans
- MRI scans
- bone scans
- CT scans
Treatment
According to the
The treatment
- systemic medications such as biologics, immunotherapy, or chemotherapy
- surgery
- radiation
People may also receive palliative care for cancer that has spread far away from the breast, just as some do for stage 4 cancer.
Learn more about palliative care here.
Outlook
According to a
Complementary therapies may help a person feel better, although they cannot cure breast cancer.
These treatments may not work for everyone, and a person should not stop traditional therapies when trying complementary therapies. A person may wish to discuss which complementary therapies are suitable for them with a doctor before they begin them.
Some potential complementary therapies a person can discuss with their doctor include:
- massage therapy
- acupuncture
- herbal medications
- tai chi
The exact cause of recurrence is not always clear.
In some cases, the original treatment may not have removed all the cancer cells.
In other recurrences, a doctor cannot determine the exact cause of the recurrence, though most cases occur within
A person may not be able to prevent breast cancer from recurring. However, a person may reduce their chances of recurrence by:
- exercising regularly
- stopping smoking
- maintaining a healthy weight
- avoiding alcohol
- using endocrine therapies as prescribed
- attending counseling or joining a support group
- eating a healthy diet
- getting vitamin D levels checked regularly
- reducing stress
- getting regular health screenings
If a person is struggling due to their breast cancer, they can consider talking to a doctor about support groups or other counseling services to help them cope.
Joining a support group allows a person to talk to people with similar experiences.
A person can look through Susan B. Komen’s support resources for more information and to find local support groups.
A person may wish to contact a doctor if they notice signs that their cancer has returned.
Since the cancer may have spread, a person should contact a doctor about any unusual symptoms throughout their body, not just their breasts.
When making an appointment, a person should be prepared to talk about any new symptoms they are experiencing. They may also want to be ready to discuss their history with cancer.
A doctor may want to ask questions, order tests, and perform a physical examination.
Breast cancer recurrence can develop in anyone who has had breast cancer before.
A person can take steps to help reduce the likelihood of breast cancer returning, but they may not be able to prevent it from recurring.
A person can contact a doctor to discuss their risk factors and any symptoms that could be a sign that their cancer has returned.