When breast cancer returns after initial treatment has ended, it’s called recurrent breast cancer. This is caused by a small number of undetectable cancer cells that were left behind. Over time these cells can develop into a new tumor in the breast.
- Local recurrence means it has returned to the same breast/chest area as your original cancer, often near the surgery site. After a lumpectomy, cancer can recur in the remaining breast tissue. After a mastectomy, cancer can recur in the tissue lining the chest wall or in the skin.
- Regional recurrence happens in the lymph nodes near the original cancer, often in the armpit or near the collarbone.
- Distant recurrence means it has spread from the original cancer site to bones, brain, lung, or other organs. Metastatic cancer is a distant recurrence.
Although most recurring breast cancers happen within five years after diagnosis, recurrence can happen at any time. The risk of recurrence lessens over time but never decreases to zero.
One question often asked when making decisions about their initial breast cancer treatment is whether there is one type of surgery that makes breast cancer less likely to return. How do you know what’s right for you?
What’s the Difference Between a Mastectomy and a Lumpectomy?
A lumpectomy is surgery to remove the breast cancer tumor along with a margin of healthy surrounding tissue. Because only a portion of breast tissue is removed, the shape of the breast is preserved which is why this type of surgery is also referred to as breast-conserving surgery. Most patients receive radiation therapy after a lumpectomy to reduce the risk of cancer recurrence.
A mastectomy is surgery to remove the entire breast. A radical mastectomy removes the breast, lymph nodes, and some of the chest wall muscles. A modified radical mastectomy leaves the muscles under the breast intact. Radiation is not usually given after a mastectomy.
Mastectomy is usually recommended if the cancer is in several locations throughout the breast, or if the cancer has grown too large to be removed effectively with breast-conserving surgery. It’s also suggested if the patient has a BRCA1 or BRCA2 gene mutation that makes breast cancer recurrence much more likely. Even if the cancer is found at an early stage, patients with a BRCA mutation may choose to have a single or double mastectomy to lower the likelihood of recurrence.
Does the type of breast cancer surgery impact breast cancer recurrence?
Both lumpectomy followed by radiation therapy and mastectomy are highly effective in treating breast cancer. The five year survival rate of both is about the same. Recurrence is still possible for patients who had either type of surgery. There are studies that show lumpectomy patients have a slightly higher risk of breast cancer recurrence with a 15% chance for lumpectomy patients compared to 6% for mastectomy patients over the course of their lifetimes.
What Makes Breast Cancer More Likely to Return?
Breast cancer does not always return. But it’s normal to be concerned about it. Here are some factors that make breast cancer more likely to return:
- Age at the time of first diagnosis – having breast cancer before age 35 increases recurrence risk.
- The stage of your cancer when first diagnosed is determined by tumor size, grade, and if the cancer has spread. Recurrence is higher for patients with large tumors.
- Type of breast cancer – aggressive cancers (inflammatory or triple-negative breast cancers) are more likely to recur and spread. Hormone receptor-positive breast cancer has a lower risk of recurrence if treatment includes hormone therapy.
- Lymph node-positive – if breast cancer cells were found in the lymph nodes during your initial diagnosis the risk of recurrence increases.
- The type of treatment you had initially and when you had it. Studies show that giving a systemic treatment like chemotherapy after surgery and radiation can lower the risk of recurrence.
- Obesity increases your risk of recurrence. Trying to lower your weight and eat a healthy diet can help lower the likelihood of breast cancer returning.
Treatment Options When Breast Cancer Recurs
Treating recurrent breast cancer usually includes different treatments than the first time. This is because previous treatments may no longer be effective, or tumors develop tolerance to chemotherapy drugs. Metastatic cancer in distant areas of the body will be treated as breast cancer with breast cancer drugs.
Treatment options will depend on your type of cancer, where it recurs, previous treatments, and your treatment goals. Thanks to extensive breast cancer research over the years, new and different treatments for recurrent and metastatic breast cancer are now available that may not have been an option at the time of the initial diagnosis. In fact, you may be a candidate to participate in a clinical research trial locally, giving you access to the most advanced breast cancer treatment options available today.
How Are You Monitored for Recurrent Breast Cancer?
Follow-up care is especially important after breast surgery because your risk of recurrent breast cancer never goes away completely. Monitoring can include:
- Your oncologist will recommend a schedule of appointments after treatment is complete. Most commonly you’ll start with appointments every few months, with the time between appointments becoming longer as time goes by. After five years, you may see your oncologist once a year.
- A mammogram every six months to a year if you had a lumpectomy or partial mastectomy. A complete mastectomy of one breast still requires a mammogram for the remaining breast.
- Pelvic exams annually if you’re taking hormone drugs and still have your uterus.
- Bone density testing if you’re taking an aromatase inhibitor hormone drug for early-stage breast cancer.
- Blood tests to check for circulating tumor cells (CTCs) in your blood, blood tumor markers (CA-15-3, CA 27-29, or CEA) are monitored to see if they begin to rise.
If you develop symptoms or your oncologist thinks cancer may have recurred, you may have blood tests, biopsy, or imaging testing (X-rays, CT, or PET scans).
You should also watch for any new symptoms such as a new lump or other changes in your breast.
Survival Rates for Recurring Breast Cancer
Numerous factors determine survival rates, and every patient’s case is different. Survival statistics for five years after a recurrent breast cancer diagnosis are:
- Localized recurrent breast cancer - 99%
- Regional recurrence - 86%
- Distant or metastatic - 27%
Can You Reduce the Risk of Cancer Recurrence?
Yes! There are a number of lifestyle choices you can make that, along with medical treatments, can potentially eliminate or reduce your breast cancer recurrence risk. They include:
- Follow your oncologist’s instructions on all follow-up care; don’t skip any doctor appointments
- Live healthy by improving your diet, getting regular physical activity, maintaining a healthy weight, not smoking, and eliminating (or reducing) alcohol
- Ask your doctor about cancer-treatment support resources
These treatments have been linked to lower risks of breast cancer recurrence:
- Hormone therapy (for up to five years) after initial treatment can reduce the risk of hormone receptor-positive breast cancer recurrence.
- Chemotherapy can reduce recurrence risk and extend life.
- Radiation therapy after surgery lowers risk in patients who’ve had a lumpectomy, a large tumor, or inflammatory breast cancer.
- Targeted therapy reduces the risk for cancers that make extra HER2 protein.
- Bone-building medications reduce the risk of cancer spreading to your bones.
Choosing Between a Lumpectomy and Mastectomy When Considering Recurrence
Your breast cancer surgeon will discuss their recommendation for you with options, if possible, for you to consider. The right timing of the surgery will be discussed with the rest of the cancer treatment team to determine whether you’ll receive other treatments before surgery and to discuss what should be done after surgery to help keep the cancer from recurring.
If you have received a breast cancer diagnosis -- whether it’s an initial diagnosis or a recurrent breast cancer diagnosis, the Rocky Mountain Cancer Centers team is available for a consultation. Located in Colorado including the Denver metro area, Boulder, Colorado Springs, and throughout the front range, we can create a personalized treatment plan for every type and stage of breast cancer.