Breast Cancer Recurrence

Breast cancer recurrence occurs when breast cancer comes back after initial treatment and a period of remission

Breast cancer recurrence occurs when breast cancer comes back after initial treatment and a period of remission. Although breast cancer may recur practically anywhere in the body, the liver, bones, lungs, brain, and skin are the most common sites. 

Breast cancer recurrence requires systemic treatment, which includes chemotherapy, hormone therapy, or targeted therapy, to reach cancer anywhere in the body.

Some types of breast cancer are more likely than others to recur. Inflammatory breast cancer and triple-negative breast cancer are both aggressive and difficult to treat. As a result, they are more likely to recur.

Treatment of recurrent breast cancer is determined by previous therapies you have undergone and the location of the cancer recurrence. Local-regional recurrences of breast cancer, which are restricted to the breast or area immediately around the breast, are commonly treated with surgery, with or without radiation therapy.

Local recurrence

In a local recurrence, cancer reappears in the same location as the original cancer. If you have had a lumpectomy, cancer may return to the residual breast tissue; if a mastectomy was done, cancer may return to the tissue lining of the chest wall or skin. Symptoms of local recurrence of breast cancer inside the same breast include:

• A new breast bulge or an uneven patch of firmness
• Nipple discharge
• Changes in the breast skin
• Skin inflammation or a skin flare

Symptoms of local recurrence on the chest wall following a mastectomy include:

• Painless nodules on or under the skin of the chest wall 
• A new thickening region at or near the mastectomy scar

Regional recurrence

A regional breast cancer recurrence occurs when cancer reappears near the lymph nodes of the breast. It manifests as a bulge or swelling in the lymph nodes in the following areas:

• Beneath the arm
• Around the neck
• Close to the collarbone
• In the groove above the collarbone

Distant recurrence

A distant or metastatic recurrence of breast cancer indicates that the disease has spread to other regions of the body, most often the bones, liver, and lungs. Signs and symptoms include:

• Persistent pain in the chest or bone, which gradually worsens
• Trouble breathing
• Severe cough
• Intense headaches
• Reduced appetite
• Unexplained weight loss
• Seizures

Recurrent breast cancer occurs when cells from the original tumor break out and hide in the breast or another area of the body. Later, the cells begin to multiply.

Chemotherapy, radiation therapy, hormone therapy, and other treatment modalities that follow the initial diagnosis of breast cancer are intended to destroy any cancer cells that remain after surgery. Unfortunately, these treatments may not destroy all cancer cells as they can lie dormant for years without causing damage. Any stimulus that tends to trigger these latent cells may cause them to develop and spread to other places of the body for unknown reasons.

Everyone who has had breast cancer is at risk of recurrence; however, the risk varies greatly depending on several factors. 

Some breast tumors have an excellent prognosis and are unlikely to recur if detected early, are small, and do not involve lymph nodes. However, large tumors with lymph node involvement or more aggressive behavior are more likely to recur. The risk of breast cancer recurrence is higher in the following cases:

• Involvement of lymph nodes
• The tumor is larger than 5 cm (2 inches)
• Breast cancer is inflammatory
• Histological findings indicate that the main tumor was excised with little or no borders of healthy tissue
• Radiation was not given following the lumpectomy
• Initial diagnosis at a young age, as women younger than 35 years have the highest risk of breast cancer

Usually, a 5-year survival rate is used to estimate the prognosis and life expectancy. Cancer usually recurs within 5 years following treatment. If it does not reoccur within 5 years, the risks of recurrence within 10 years are low. If you remain cancer-free for 10 years, then you are said to have a normal life expectancy.

However, some studies report otherwise. A meta-analysis of 88 clinical studies involving 62,923 women with estrogen receptor-positive breast cancer reported that women who received endocrine treatment for 5 years and were cancer-free by the end of the treatment had developed cancer by up to 20 years after initial diagnosis. Although these women were cancer-free for the first 5 years, the risk of cancer recurring elsewhere (in the bone, liver, or lung) remained consistent from years 5 to 20 years.

If your doctor believes you have recurrent breast cancer based on the findings of mammography or physical exam or on signs and symptoms, you may be subjected to further tests to confirm the diagnosis:

• Imaging tests: Imaging tests, such as MRI, CT, X-ray, bone scan, or positron emission tomography, may be done to look for abnormal cells. Your doctor will decide which tests will be most beneficial in your case.
• Biopsy: A biopsy involves tissue extraction for detailed evaluation in a lab. Your doctor may advise you to get a biopsy done to collect suspicious cells for testing as this is the only method to determine whether your cancer has returned. A pathologist analyzes cells in a laboratory to identify the types of cells involved.

A pathologist can identify whether the cancer is a recurrence or a new form. Tests can reveal if the tumor is susceptible to hormone therapy or targeted therapy, which may have changed since your first cancer diagnosis.

Treatment will be determined by previous treatments you underwent for breast cancer. Your doctor will consult with you to choose the most effective treatment.

• If you received breast-conserving therapy and cancer has returned to the breast, you will likely need a mastectomy.
• Chemotherapy, hormonal treatment, or targeted therapy may be used at the location where cancer has returned.

Recurrent breast cancer is not always as life-threatening as initial breast cancer. If diagnosed early, it can be treated and with better results. It is best to have yourself screened on a regular basis after completing your initial breast cancer treatment. In addition, to avoid a recurrence, take all precautions and follow your doctor's instructions.

Early-stage breast cancer is normally removed surgically, but it may also require radiation, chemotherapy, and hormone treatment. If cancer recurs in the breast, lymph nodes, or elsewhere in the body, it suggests that some of the original breast cancer cells survived the therapy. Recurrent cancer cells are considered more resistant and aggressive cells as they necessitate more invasive surgery and, in most cases, chemotherapy.

Strategies that can reduce the risk of breast cancer recurrence include the following:

• Hormone therapy: If your breast cancer is hormone receptor-positive, hormone therapy may help minimize your risks of recurrence.
• Chemotherapy: Chemotherapy reduces cancer recurrence and increases your life expectancy.
• Radiation therapy: If you have undergone a breast-saving operation for breast cancer, or have had a big tumor or inflammatory breast cancer, you have a low risk of recurrence if radiation therapy is used.
• Targeted therapy: If your cancer produces more HER2 protein, medications that target this protein may help lower the risks of recurrence.
• Maintaining a healthy weight: Maintaining a healthy weight may reduce the risk of recurrent breast cancer.
• Exercise: Regular exercise can reduce the risk of breast cancer recurrence.
• Nutritious diet: Eat plenty of vegetables, fruits, and grains. Limit alcohol intake to one drink a day.