Who Is At Risk Of Breast Cancer Recurrence
Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.
What Else Can I Do
When someone has a local or locoregional recurrence, their fear of the disease getting worse is often even greater than the first time they were diagnosed. But just as the disease and its treatment constantly pose new challenges, the way you deal with cancer may also keep changing. There is no one-size-fits-all solution. Everyone copes differently with a disease like this and needs to find their own way to deal with it.
Many women say they felt very down at first, but then gradually started to take stock of what was going on and began to see things differently often feeling more mature and more aware than before. They try to live in the moment, enjoying and making the most of every single day. Some women make big changes in their lives and pursue new interests. Others take comfort in continuing to live their lives as normally as possible and trying to make the best of each day.
Preparing For A Mastectomy
Before having a mastectomy, you will have the opportunity to discuss the operation with a specialist breast care nurse or surgeon. You can discuss how the procedure might affect you physically and emotionally.
You’ll get practical advice about bras and bra inserts, if you need them.
Your surgeon will discuss the type of mastectomy you’ll have, the possible complications and the option of breast reconstruction. You may need to have chemotherapy or hormone therapy before the operation to reduce the size of any tumours.
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What Are The Types Of Breast Cancer Recurrence
If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
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Symptoms Elsewhere In The Body
Sometimes breast cancer cells can spread from the breast to other parts of the body. This is known as secondary breast cancer.
Some symptoms to be aware of include:
- unexpected weight loss and a loss of appetite
- severe or ongoing headaches
Find out more about the symptoms of secondary breast cancer.
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How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
Changes To The Breast Or Chest Area
After breast-conserving surgery or a mastectomy, with or without reconstruction, be aware of any changes to either side, such as:
- swelling on your chest, in your armpit or around your collarbone
- a change in shape or size
- a change in skin texture, such as puckering or dimpling
- redness or a rash on or around the nipple or on the skin
- liquid that comes from the nipple without squeezing it
- the nipple has become inverted or looks different, for example changed its position or shape
- swelling in the arm or hand
- a lump or thickening that feels different
COVID-19 booster vaccinations
Some people report swelling in the armpit or to the lymph nodes under the arm after a COVID-19 booster vaccination. This seems to be more common with the Moderna booster vaccination. If you notice any swelling following your booster vaccination, it should disappear within about 10 days, if not, or you have any concerns, contact your GP or treatment team.
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How Do Surgeons Reconstruct The Nipple And Areola
After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction .
Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.
A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts .
Locally Advanced Breast Cancer
If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer. Sometimes breast cancer is locally advanced when it is first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
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Mammograms After Breast Cancer Surgery
Nearly all women with breast cancer will have surgery at some point as part of their treatment. There are many different kinds of breast cancer surgery. The type of surgery you have had will affect if you need to get mammograms in the future:
- If you have had breast-conserving surgery , you will still need to get mammograms of the treated breast.
- If you have had a mastectomy, you most likely won’t need a mammogram of that breast.
However, if you had surgery on only one breast, you will still need to get mammograms of the other breast. This is very important, because women who have had breast cancer have a higher risk of developing a new cancer in the other breast.
While the American Cancer Society does not have specific guidelines for mammograms or other breast imaging in women who have been treated for breast cancer, there is information available about what these women will probably need to do.
How Do Surgeons Use Implants To Reconstruct A Woman’s Breast
Implants are inserted underneath the skin or chest muscle following the mastectomy.
Implants are usually placed as part of a two-stage procedure.
- In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle . The expander is slowly filled with saline during periodic visits to the doctor after surgery.
- In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomythat is, a tissue expander is not used to prepare for the implant .
Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or sling to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.
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Factors That Affect The Risk Of Breast Cancer Recurrence Following A Mastectomy
Your individual risk for breast cancer recurrence after receiving a mastectomy will depend on several factors, including the type of breast cancer you have and whether it is affected by hormones, the size and location of your tumor, how quickly the cancer cells grew and the stage of cancer at the time of treatment. In particular, if breast cancer has spread to nearby lymph nodes, such as those in the underarm area, the likelihood of recurrence may be higher.
Possible Side Effects Of Mastectomy
Bleeding and infection at the surgery site are possible with all operations. The side effects of mastectomy can depend on the type of mastectomy you have . Side effects can include:
- Pain or tenderness at the surgery site
- Swelling at the surgery site
- Buildup of blood in the wound
- Buildup of clear fluid in the wound
- Limited arm or shoulder movement
- Numbness in the chest or upper arm
- Neuropathic pain in the chest wall, armpit, and/or arm that doesnt go away over time. It is also called post-mastectomy pain syndrome or PMPS.
- If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
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What Is The Risk For Breast Cancer Recurrence
The risk of recurrence depends on the type of breast cancer and its stage. Timing matters, too: The highest risk of recurrence for breast cancer patients is during the first few years after treatment.
At the Johns Hopkins Breast Center, our team of breast cancer specialists monitors patients who are at risk of recurrence, Lange explains. The follow-up schedule depends on the stage of cancer, what kind of treatment has been received and prognostic factors. The risk of recurrence decreases as time goes on, but never gets down to zero.
If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment
It has long been recognized that breast cancer is not always cured by locoregional treatment alone.
The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.
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How Does Recurrence Affect Treatment
Its usually better if a recurrence remains in the breast . But the seriousness depends in part on how long it has been since the original cancer. If its been 7 years, your medical team may approach the new growth just as they would a new presentation of breast cancer. The new cancer cells may be the same as before or they could be a new type. Either way, if its been a while since the first cancer, your medical team will often treat it largely the same as it treated the first one. This often starts with surgical removal of the tumor.
If you have surgery, your doctor will likely want to follow up with some type of other therapy. Though radiation therapy often follows surgery, you may not be able to get it if the breast got radiation treatment after a prior surgery for breast cancer.
If the time since your last cancer is much shorter, say 6 months, your team may assume the tumor could soon spread . This may change their approach to include more chemotherapy or other pharmaceutical approaches.
But you may not be ready for aggressive chemo if youve recently been through a round. So your medical team will have to work around that.
And the type of chemo matters, too. For example, if, in a previous round of chemo, you had doxorubicin or another cancer drug known to weaken the heart, it may not be possible to get it again.
What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
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Beyond The First 5 Years
The risk of breast cancer recurrence is highest during the first 2 years after the initial diagnosis. As time passes, the risk of recurrence steadily decreases. Many survivors celebrate their 5-year cancer-free date because it is well known that the vast majority of patients who have not had a recurrence by that time have a relatively low risk of recurrence at all.
A late recurrence of breast cancer is one that recurs after the 5-year milestone. Since the likelihood of recurrence is so low at this point, we must ask ourselves:
Who experiences a late recurrence?
What factors contribute to their risk?
Why do seemingly cured patients, like my mother, have to face their cancer again?
Doctors, scientists, and researchers have identified factors that are related to the potential risks for late recurrence of breast cancer. Generally, these factors relate to the patients age, the cancers stage at diagnosis, hormone receptor status, genetic information, and lymph node involvement. Overall, the risk of a recurrence after 5 years is low, but breast cancer survivors with a higher risk of late recurrence are:
Survivors with the following receptor statuses
Estrogen receptor-positive tumor
Tumor larger than 2 centimeters
High number of involved lymph nodes
Postmenopausal survivors who are younger than 60 and had
Tumor larger than 2 cm
High number of involved lymph nodes
Postmenopausal women who are older than 60 and had
High number of involved lymph nodes
Limit Or Avoid Alcohol
Studies show that there is a link between moderate and heavy alcohol use and breast cancer. Alcohol is known to raise estrogen levels in your blood. This makes it more likely for you to get cancer again. If youâre a cancer survivor, itâs best to avoid alcohol altogether.
If you do choose to drink, make sure to limit it to only one drink a day to lower your chances of your cancer coming back.
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For Women With Breast Cancer Considering Prophylactic Mastectomy
Prophylactic mastectomy is a surgery to remove one or both breasts prophylactic meaning a preventative measure, done in hopes of reducing your risk of breast cancer. Bilateral prophylactic mastectomies, or double mastectomies, are the removal of both breasts.
For breast cancer patients, the average lifetime risk of developing a new breast cancer in the opposite breast is low, ranging from 4 to 8%, and is even lower in patients who receive chemotherapy or hormone therapy as part of their treatment. It is also important to be aware that while removing the opposite breast reduces the risk of developing a new cancer, it does not change the outcome from the existing cancer. For the majority of women, removing the opposite breast is not necessary. However, there are some women who may be at higher risk, and your doctor can help you determine your level of risk and decide on the right course for you.
Understanding The Zone To Be Reconstructed
Up until the 1980 s, it was not considered safe to reconstruct a breast until 2 years after the original mastectomy . Nowadays however, there is a wealth of evidence supporting immediate reconstruction and the oncologic safety thereof. Reconstruction may be immediate, delayed-immediate , or delayed . As a departure from Halsteds radical mastectomy of the late 1800 s , the trend of nipple sparing mastectomy and skin sparing mastectomy has brought reconstruction from general to plastic surgery. Some retrospective studies suggest that NSM does not correlate with cancer recurrence , while some recommend extreme caution . As for SSM, skin sparing varies from patient to patient, making it difficult to apply a standard to retrospective literature . However, it was reported that 0 of 44 patients with ductal carcinoma in situ relapsed upon SSM, while 10 out of 177 with invasive ductal carcinoma presented relapse within 10 years . When it does occur, DCIS relapse with SSM has been correlated with the young age of the mastectomy patients .
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