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Breast Cancer Recurrence

Breast cancer recurrence describes the return of breast cancer, usually after a period of time during which the cancer could not be detected. Breast cancer recurrence is different from metastatic breast cancer. Breast cancer that comes back in or near the breast is locally recurrent breast cancer. Breast cancer that has spread (or metastasized) to distant parts of the body (bone or liver, for example) is generally referred to as metastatic or distant breast cancer.

If you experience any of the following symptoms, you should check with your doctor or nurse practitioner as soon as possible.

• 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

What factors determine the likelihood of a cancer recurrence?

• Characteristics of a patient's tumor may help predict cancer recurrence. Some common indicators are lymph node involvement, tumor size, hormone receptor status, grade, and the results of tests that profile the tumor (such as Oncotype-DX® and Mammaprint®).

How will my prognosis affect my treatment?

• Following your treatment, your doctor will discuss with you the likelihood that cancer will recur. Statistics can measure the degree of risk for large groups of people but cannot determine with certainty whether or not your individual cancer will recur. This uncertainty is difficult for most people coping with a cancer diagnosis. The medical oncologist, who works with your surgeon, may advise the use of hormonal therapy or chemotherapy to rduce that risk.

How would a recurrence be treated?

The type of treatment for local breast cancer recurrences depends on the nature of the recurrence and the initial treatment.

• If you had a lumpectomy, local recurrence is usually treated with mastectomy, since radiation therapy cannot be delivered twice to the same area.
• If the initial treatment was mastectomy, recurrence near the mastectomy site is treated by removing the tumor whenever possible, usually followed by radiation therapy. In either case, hormone therapy and/or chemotherapy may be used after surgery and/or radiation therapy.
• If breast cancer is found in the other breast, it may be a new tumor unrelated to the first breast cancer. Women with distant recurrence involving organs such as the bones, lungs, brain, or other organs are treated with systemic therapy. Radiation therapy or surgery may also be recommended to relieve certain symptoms.
• Immunotherapy with trastuzumab (Herceptin) alone or with chemotherapy may be recommended for women whose cancer cells have high levels of the HER2/neu protein. Immunotherapy is generally started after hormonal or chemotherapy are no longer effective.

The content on this page was reproduced, in whole or in part, from the National Cancer Institute (NCI) website at www.cancer.gov.