Breast cancer recurrence

This page was reviewed under our medical and editorial policy by

Daniel Liu, MD, Plastic and Reconstructive Surgeon

This page was reviewed on February 18, 2022.

Even after initial treatment is complete and tests show no sign of disease, there is a chance breast cancer may return. When that happens, it’s called recurrent breast cancer. In most cases, recurrent cancers appear within the first three years after treatment. But in some cases, breast cancer recurrence may develop many years later, either locally or in distant organs in the body.

Understanding the breast cancer recurrence rate

According to the Susan G. Komen® organization, women with early breast cancer most often develop local recurrence within the first five years after treatment. On average, 7 percent to 11 percent of women with early breast cancer experience a local recurrence during this time.

For breast cancer patients with a family history of cancer, or a BRCA1 or BRCA2 gene mutation, the cancer recurrence rate is higher. The risk of finding new cancers, such as ovarian cancer, may also be higher. Cancer recurrence risk is based on many factors, including the cancer type and how it was treated.

Learn more about risk factors for breast cancer

Types of recurrent breast cancer

There are three types of recurrent breast cancer:

Local recurrence: When cancer returns to the same part of the breast as the initial diagnosis, the disease is classified as a local recurrence.

Regional recurrence: This type is diagnosed when the breast cancer is found in nearby lymph nodes and/or the chest wall.

Distant recurrence: Also called metastatic breast cancer, this occurs when breast cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common areas for metastasis include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast.

Learn more about breast cancer stages

Breast cancer recurrence symptoms

The signs of cancer recurrence depend on where the cancer resurfaces. The patient might not see or feel any signs of a local recurrence, and, if she does, it'll probably be a slight change in or around the breast or underarm area. More often than not, the patient's provider finds evidence of a local recurrence during a physical exam or mammogram. 

A distant recurrence will typically produce some symptoms, but because many of those breast cancer symptoms are common to other health problems, it can be hard to tell if they’re due to a distant recurrence or something else. Have an open conversation with the cancer care team about any symptoms, especially if they last more than two weeks. 

Pay special attention to these symptoms, which could signal a breast cancer recurrence:

  • Weight loss without trying
  • Headaches, bone pain or any new or different pain that the patient can’t explain
  • Shortness of breath or wheezing
  • Seizures
  • Fatigue
  • Fever, chills or a cough that won’t get better
  • Yellow tinge to skin and eyes (jaundice)
  • Easy bruising or bleeding
  • Digestive issues, like nausea, vomiting, diarrhea, loss of appetite or trouble swallowing
  • Blood in the urine or stools 
  • Any new lumps or areas of swelling

What's the risk of recurrence?

Everyone who has had breast cancer has some risk of recurrence, but it’s typically low.  

In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, it’s considered to be a significant milestone to be celebrated. Recurrence after that five year mark—rare, but possible—is called late recurrence. 

There’s still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence: 

  • Having high blood sugar
  • Being very overweight (obese)
  • Not eating enough fruits and vegetables
  • Having had a surgical site infection after surgery

Certain types and characteristics of the original breast cancer also may also lead to a higher risk of recurrence:

  • A tumor of more than five centimeters across
  • Cancer cells that are HER2-positive 
  • Cancer cells that are triple-negative (HER2-negative and hormone receptor-negative for both estrogen and progesterone)
  • Cancer cells in four or more axillary lymph nodes at the time of surgery
  • Cancer cells in the chest muscles or breast skin

Women may be at higher risk for late recurrence if they had:

  • A tumor of more than two centimeters
  • A high number of affected lymph nodes
  • A hormone receptor-positive cancer
  • A HER2-negative cancer
  • Hormone therapy for only a short time after surgery 

Research is mixed on whether or not drinking alcohol increases the risk of breast cancer recurrence—some studies have found there is a link and others have not. Regardless, avoiding excessive drinking is a good idea for everyone's general health. 

Four steps to avoid a recurrence

There’s nothing women can do to guarantee that cancer won’t come back, but they can make some changes to help them feel their best after cancer treatment and help stay strong.

Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. It's probably not necessary to take vitamin or mineral supplements, unless the care team suggests them. In fact, taking more of certain vitamins or minerals than needed can have a negative effect on cancer recovery, so be sure to discuss any supplements with the care team before taking them. 

Exercise on most days of the week. Being active can improve the patient's mood, boost self-esteem and reduce fatigue. It’s even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.

Lean on a strong support system. Cancer might be all about the cellular changes in the body, but it certainly doesn’t stop there. Taking care of emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help patients manage the stressors that cancer treatment and recovery can bring.

Don’t skip follow-up care. Going to all follow-up appointments and getting any tests or screenings the providers recommend, even ones not connected to breast cancer, are important ways patients can take care of themselves.

Treatment for breast cancer recurrence

If the care team suspects a cancer recurrence, they’ll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide treatment.

Treatment of breast cancer depends on where the cancer has recurred and what breast cancer treatment the patient has had before:

  • Local recurrence is likely to be treated surgically first with a mastectomy if the patient didn’t have one already or a surgical removal of the tumor if she did. After surgery, breast cancer chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if the specific type of cancer will respond to one or both of them.
  • Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, the patient will likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
  • Distant recurrence is mainly treated with drug therapy—chemotherapy, hormone therapy, targeted therapy for breast cancer or a combination of these. Breast cancer surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.

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