Breast Cancer Recurrence
When The Dreaded Big C Returns: Risk Factors And Prognosis

When Breast Cancer Recurs


Breast Cancer Recurrence


What Does A Recurrence Mean?
What Are The Symptoms?
How Are Recurrences Monitored?
Are Some Women More Likely To Suffer A Recurrence?
Local Recurrence
Distant Metastasis
What Is the Treatment?
Can I Prevent A Recurrence?

Statistic Update
1 in 5 women with breast cancer who have completed 5 years of supplemental therapy suffer a return of cancer. (2008 study published in the Journal of the National Cancer Institute).

Topic Overview
Breast Cancer Guide

What Does A Recurrence Mean?

Some women unfortunately have to face breast cancer more than once. It may be a completely new primary cancer in a different part of the breast or in the opposite one. This will require going through the whole breast cancer diagnosis and treatment process again. Where cancer returns after treatment, this is known as recurrence. Breast cancer can return as a local recurrence - that is in tissue of the treated breast, usually near the mastectomy scar. Or it can be a distant recurrence – that is, it has spread to another part of the body (distant metastasis) such as the lungs, bones, lymph nodes or lungs. Statistically 60 percent of women remain free from breast cancer 5 years after surgery if no additional adjuvant therapies are applied. This is why surgery is usually combined with chemotherapy (an adjuvant therapy). Unlike other types of cancers, a woman is not considered 'cured' if she does not have a recurrence in the first 5 years. Although breast cancer is most likely to recur between years 2 and 5 after initial treatment, it can come back 10 or 20 years later. However the risk does decline over time. See, also: what does cancer remission mean?

What Are The Symptoms?

Many of the signs of a recurrence are the same as first time breast cancer symptoms:

1. A breast lump which feels like a small pea.
2. Nipple discharge.
3. Redness or scaly skin on the nipple or breast.
4. An area under the skin which looks like marble.
5. A thickening or lump in the breast or underarm that persists through a menstrual cycle.
6. A change in appearance of the breast or nipple - inflammation, dimpled look.

You should also be alert to other signs:

7. Sudden unexplained weight loss.
8. Chills and fevers unrelated to another illness.
9. Bone or abdominal pain.
10. Shortness of breath and coughs.
11. Headaches and vision problems.
12. Yellow skin or eyes.

How Are Recurrences Monitored?

Even if a woman has been given the all-clear for cancer she will still be seen by a doctor every 3 months for about 2 years. Gradually this stretches to 6 months for a few years and settles into once a year. During her visit the doctor will pay special attention to:

1. The incision scar, all remaining breast tissue and the underarm area and chest wall.
2. The remaining breast if both were not taken by mastectomy.
3. The other organs in the body such as bones, lungs, brain and liver which are particularly susceptible to metastasis.

The doctor will request a mammogram screening of any remaining breast tissue every 6 months for the first two years. Beyond this, there is little consensus on how to proceed with follow up care for women. Some doctors go considerably further and order regular blood tests, X-rays, CT scans, bone scans and blood chemistry panels. This certainly has the benefit of making a woman feel safer. However, the 1994 Consensus Conference on Follow-up of Breast Cancer concluded that except for regular mammograms and routine physical examinations (taking into account personal history), more tests accomplished very little. One exception is women diagnosed before the age of 35 with aggressive cancers. What was particularly emphasized is the importance of breast self-examination. It is even more important for women to carry out a BSE once a month if they have already had cancer.

Are Some Women More Likely To Suffer A Recurrence?

Yes, there are prognostic indicators or certain characteristics which increase the chance of recurrence. These are:

Tumor Size: The larger the lump, the greater the chance of cancer coming back.
Lymph Nodes: If they were involved in the original diagnosis, a recurrence is more likely.
Hormone Receptors: Nearly 75 percent of breast cancers contain high levels of estrogen receptors. This means the tumor is estrogen receptor positive. These types of tumors tend to be less aggressive and respond better to breast cancer hormonal therapy.
Nuclear Grade: This is the rate at which cancer cells divide. Cells with a high nuclear grade, also called proliferative capacity, tend to grow faster and can recur.
Histologic Grade: This is how 'normal' the cancer cells look under the microscope. Graded 1 to 4, grade 4 tumors have very abnormal cells. The higher the grade, the more likely the recurrence.
Oncogene Expression: Oncogene genes promote cancerous changes within cells. Their presence increases the chance of woman's recurrence.

Local Recurrence

A local recurrence occurs where cancer surgery, radiation therapy or chemo (see Chemotherapy Guide) did not kill all remaining cancer cells. These cells remain behind and continue dividing until they become large enough to be detected and diagnosed by breast biopsy. This is more likely to occur after lumpectomy, where breast tissue is conserved rather than mastectomy. After a lumpectomy a recurrence typically shows itself at the incision scar and is usually detected 2-6 years after surgery. The recurrence, once detected, is then staged by an oncologist (as in the original breast cancer staging). As long as the cancer has not spread to skin, the chest wall or distant organs, it remains a Stage 1 or 2. Regional recurrence is more serious again and indicates that cancer has spread to the chest, lymph nodes under the breastbone or above the collarbone. This occurs in about 2 to 5 percent of breast cancer cases.

Distant Metastasis

This is stage 4 cancer which has spread to other parts of the body. Most often it spreads to bones, the liver, lungs or brains. This diagnosis is not good news for patients but the situation is not hopeless. In fact many women with metastasis breast cancer go on to live decades after the original diagnosis. No matter where it has spread in the body, the disease is still known as breast cancer. If it spreads to the lungs the prognosis will still be better than those with lung cancer.

How Are Recurrences Treated?

The type of treatment offered will depend on the original breast cancer therapy the woman received. As radiation cannot be given to the same area twice, this will limit her options. If she was originally given a lumpectomy with radiation, then mastectomy is the usual treatment. If the initial treatment was mastectomy then the tumor is removed surgically and followed by radiation. In both cases hormone therapy and/or chemotherapy may also be recommended as a systemic therapy (acting throughout the body, not just locally). If distant metastasis has occurred treatment can range from doing nothing (except making the woman comfortable), to high dosages of chemotherapy or stem cell transplants. However, chemo and hormone therapy are the most common treatments.

Can I Prevent A Recurrence?

The best way to do so is to follow the breast cancer prevention guidelines. Introduce healthy lifestyle adjustments into your life (see cancer diet foods), ensure you take regular exercise and handle any weight management issues. Adjuvant therapies such as tamoxifen and aromatase inhibitors (letrozole, anastrozole and exemestane) can also help reduce the risks of recurrence. Also, see breast cancer books for published information on recurrences and prevention.

Important Note: Studies show, that despite popular myths, breast reconstruction surgery does not increase the chance of cancer coming back. Nor does it prevent detection.

Related Articles on Breast Cancer

For more about monitoring see the following:

Main causes of death in women: Top 10 diseases that kill women.
• The female body and human body explained with diagrams.
Thermography screening

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