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.
Treatment For Breast Cancer Recurrence
If your care team thinks you might have a cancer recurrence, theyll 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 youve had before:
- Local recurrence is likely to be treated surgically first with a mastectomy if you didnt 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, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
- Distant recurrence is mainly treated with drug therapychemotherapy, 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.
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Metastasis Is A Highly Inefficient Yet Lethal Process
In the next few sections, we introduce the concept of tumour dormancy and discuss its ties with DTC dissemination in order to highlight how its reversible nature might alter the equilibrium between unsuccessful and successful metastases, thus possibly dictating the timing of metastatic relapse, or whether relapse occurs at all. We then focus on two key determinants of relapse in HR+ breast cancer: the extrinsic effect of targeted therapy, and the consequences of intrinsic HR function modulation.
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Stage 3 Breast Cancer
What is Stage 3 breast cancer?
Stage 3 breast cancer is when tumors are larger than earlier stages or are growing into nearby tissues, and the cancer has spread to nearby lymph nodes. There are three categories of Stage 3 breast cancer:
- Stage 3A In some cases, Stage 3A breast cancer indicates that the cancer spread to four to nine area lymph nodes, and there may or may not be a tumor in the breast. In other cases, it can describe a cancer that has spread less but the tumor is larger than 5 centimeters.
- Stage 3B Stage 3B breast cancer can mean that the cancer has spread to the chest wall or to the breasts skin, causing swelling or an ulcer. It may also mean that cancer has spread to up to nine axillary lymph nodes or lymph nodes near the breast bone.
- Stage 3C Stage 3C breast cancer means the cancer may have spread to the chest wall or breasts skin, or it has spread to 10 or more nearby lymph nodes. It can also mean the cancer has also spread to lymph nodes above or below the collarbone.
What are the treatment options for Stage 3 breast cancer?
Stage 3 breast cancer treatment timeline
The treatment timeline for Stage 3 breast cancer depends greatly on the severity, extent of spreading, the type of treatment youre undergoing and how youre responding to those treatments. For most Stage 3 cases, treatment can last anywhere from six to 12 months with hormone therapy lasting many years after.
What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
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Where Does Breast Cancer Recur
Breast cancer recurrence can be categorized by where in the body it occurs when it returns. These categories include:
- Local recurrence This type of recurrence describes breast cancer that develops in or near the same area where it originally developed, such as scar tissue, the chest wall or other nearby tissue.
- Regional recurrence Breast cancer that returns in a nearby region, such as the lymph nodes in the armpit or collar bone, is known as a regional recurrence.
- Distant recurrence Also called metastatic recurrence, this type of recurrence describes breast cancer that returns in a distant area of the body, such as the bones, lungs or liver.
How Is Breast Cancer Stage Determined
The breast cancer staging process helps doctors determine how much cancer there is and where its located. The higher the breast cancer stage number, the more advanced the disease.
Breast cancer staging is so important because it provides cancer care teams which include breast surgeons, oncologists, pathologists, radiologists and many others an agreed upon way to talk about the disease. This makes it easier for them to understand diagnoses and collaborate on treatment plans.
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Types Of Stage 1 And 2 Breast Cancer
The most common types of invasive breast cancers are named after the area of the breast where they begin. Types of early breast cancers include:
- Invasive ductal carcinoma IDC means that the cancer originated in the milk ducts of the breast, and has spread into the surrounding breast tissue. IDC is the most common type of breast cancer, accounting for 80% of all breast cancers.
- Invasive lobular carcinoma ILC means that the cancer originated in the milk-producing lobules of the breast, and has spread into the surrounding breast tissue. ILC is the second most common type of breast cancer, and accounts for 10% of breast cancers.
- There are also other less common forms of invasive breast cancer, such as inflammatory breast cancer and Pagets disease of the nipple. For more information on the various types of invasive breast cancer, including the less common forms, please visit Types of Breast Cancer page.
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.
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Survival Rates Much Better If Second Cancer Detected Early
- Tags:Ductal Carcinoma In Situ, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, Breast Self-Exam, Early-stage: Stage 0 — DCIS , Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Early-stage: Stage IIIA, Personal History of Breast Cancer, Breast Physical Exam, and Mammography
Women successfully treated for early-stage breast cancer have a higher-than-average risk of a new breast cancer developing in the same or opposite breast. These women also are at risk of the original cancer coming back . A study found that survival rates are much better when any second breast cancer is detected early.
Researchers looked at the medical records of 1,044 women in Florence, Italy who were diagnosed and successfully treated for early-stage breast cancer. All the women were diagnosed with another breast cancer, at least 6 months after the first diagnosis, between 1980 and 2005. The timing is important because many of the women received breast cancer treatment more than 20 years ago, when diagnosis, treatment, and prevention techniques for new and recurrent breast cancer weren’t as good as they are today.
The women were followed for an average of 14 years after their first breast cancer diagnosis. During this time, about half the women had a recurrence of the original breast cancer and the other half had a new, second breast cancer in the opposite breast diagnosed.
Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
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Why Werent These Escaping Cells Identified The First Time The Cancer Was Treated
Although scans of the body can detect if there is obvious spread to these other organs, for women with early stage breast cancer there rarely is anything that shows up on a scan. There is a limit to what scans can tell us: they wont show extremely tiny spots of cancer, and they definitely cant show us if there are individual cells circulating in the body. Neither will any blood test, or any other test for that matter. So the first time around we perform our surgery and give our treatmentschemotherapy, hormonal therapy, radiationwith the hope that if microscopic spread has already taken place, the treatments will scavenge those cells and kill them before they take up residence someplace in the body.
Unfortunately, these treatments dont work 100 percent of the time. So if cells have spread, and if the treatments we give dont affect them, the cancer cells can persist and take hold someplace, developing into metastases, or spread. This is why and how recurrence happens.
Second Cancers After Breast Cancer
Breast cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. Cancer that comes back after treatment is called a recurrence. But some cancer survivors develop a new, unrelated cancer later. This is called a second cancer.
Women whove had breast cancer can still get other cancers. Although most breast cancer survivors dont get cancer again, they are at higher risk for getting some types of cancer, including:
- A second breast cancer
- Salivary gland cancer
- Melanoma of the skin
- Acute myeloid leukemia
The most common second cancer in breast cancer survivors is another breast cancer. The new cancer can occur in the opposite breast, or in the same breast for women who were treated with breast-conserving surgery .
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Types Of Recurrent 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.
Why Cancer Comes Back
The simplest explanation is that the treatment you had before didn’t destroy all the cancer cells in your body. Even very small cells that were left behind can grow into tumors over time.
That doesn’t mean you got the wrong treatment. Cancer cells are tricky, and some can survive aggressive therapies. It only takes a few cells.
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Stage 2 Breast Cancer
What is Stage 2 breast cancer?
Stage 2 breast cancer cells or tumors are larger than Stage 1 cancers, and may have spread to nearby lymph nodes. There are two types of Stage 2 breast cancer:
- Stage 2A Generally speaking, Stage 2A breast cancer can indicate one of the following:
- No tumor can be found in your breast, but cancer larger than 2 millimeters can be found in one to three underarm lymph nodes or near the breastbone.
- The tumor measures 2 centimeters or smaller, and has spread the nearby axillary lymph nodes.
- The cancer has not spread to area lymph nodes, however, the tumor measures between 2 and 5 centimeters.
What are the treatment options for Stage 2 breast cancer?
Stage 2 breast cancer treatment timeline
Again, it depends on what treatments or follow-up therapies are needed. Generally, the treatment timeline for Stage 2 breast cancer can last three to six months. Again, certain treatments like hormone therapies designed to stop the cancer from coming back can last for one to 10 years.
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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Take Care Of Your Emotional Needs
A breast cancer diagnosis can take quite a toll on your body, both physically and mentally. The treatments can affect each person differently. And the uncertainty that comes along with breast cancer may also affect your self-worth, identity, and your confidence.
After treatment, managing your new normal and coming to terms with all that has happened may feel challenging. Itâs important to take the time to heal and prioritize your overall emotional and mental health, in addition to your physical health.
- Make some time for self-care and put your needs first.
- Talk to a professional counselor or therapist if fears of breast cancer coming back start to interfere with your daily life.
- Connect with other people whoâve had breast cancer to gain a sense of community.
- Follow news on new treatments or findings.
- Practice mindfulness to reduce stress. Yoga, meditation, and other relaxation techniques can help you center yourself.
- Pick up a hobby that youâve enjoyed before, or explore new ones.
- Journal your feelings.
Keep in mind that if breast cancer does come back, it is not your fault and it can often be treated.
Johns Hopkins Medicine: âReducing Risk of Recurrence,â âEndocrine Therapy for Premenopausal Women,â âEndocrine Therapy for Postmenopausal Women,â âBreast Cancer Recurrence.â
Cleveland Clinic: â3 Reasons to Quit Smoking After a Cancer Diagnosis.â
American Lung Association: âTop Tips for Quitting Smoking.â
Type Of Breast Cancer
The type of breast cancer can affect the recurrence rate.
In a 2017 study, researchers found that people with estrogen-receptor positive breast cancer had a persistent risk of recurrence for at least 20 years after their original diagnosis.
According to Susan G. Komen, factors that influence recurrence can include:
- biology of the tumor
- treatment of the original tumor
- stage of the cancer at diagnosis
- firmness in new areas of the breast
- redness or swelling of the breast after the area has healed from surgery and radiation
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Survival Rates Of Stage 1 And Stage 2 Breast Cancer
According to data from the Australian Institute of Health and Welfare, the earlier breast cancer is first diagnosed, the better the outcome. The survival rates of people diagnosed with breast cancer have also improved over time due to earlier detection and improvements in treatment. Most people with early stage breast cancer can be treated successfully.
You may wish to discuss your prognosis and treatment options with your doctors. However, it is not possible to predict the exact course of your cancer and how long you will live. The length of survival can vary from person to person. Factors that influence this include:
- Response to treatment
- The type of breast cancer that you have
- The rate of tumour growth
- Other factors such as your age, medical history and overall health.