Recurrent breast cancer

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, the disease may return many years later, either locally or in distant organs in the body.

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 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

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 cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common metastatic areas 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

The signs of cancer recurrence depend on where the cancer resurfaces. You might not see or feel any signs of a local recurrence, and, if you do, it will probably be a slight change in or around your breast or underarm area. More often than not, your provider might find evidence of a local recurrence during a physical exam or mammogram. 

A distant recurrence will typically produce some symptoms, but because many of those 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 your cancer care team about any symptoms you’re having, especially if they last more than two weeks. 

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

• Weight loss without trying
• Headaches, bone pain or any new or different pain that you 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 your urine or stools 
• Any new lumps or areas of swelling

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 your surgery

Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:

• 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

You might be at higher risk for late recurrence if you 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 your 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 your general health. 

There’s nothing you can do to guarantee that your cancer won’t come back, but you can make some changes to help you feel your best after cancer treatment and keep your body 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. You probably don’t need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements you’re considering with your care team before taking them. 

Exercise on most days of the week. Being active can improve your 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 your body, but you know it certainly doesn’t stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.

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

If your care team thinks you might have 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 your treatment.

Treatment options depend on where the cancer has recurred and what treatment you’ve had before:

• Local recurrence is likely to be treated surgically first with a mastectomy if you didn’t have one already or a surgical removal of the tumor if you did. After surgery, chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind 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, you’ll 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 or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.