How Likely Is Breast Cancer To Come Back

Keep Up With Your Health Screenings

After youâve finished your cancer treatments, you still need to go to your doctor for your follow-up screenings. Your health care team may meet with you every few months after your treatment. They do this so that they can keep a close eye on any changes that may show signs that your cancer has come back. After you reach 5 years since your last treatment, you may need to see your doctor only once a year.

If youâve had some of your breast removed as part of cancer treatment, you may need to get a mammogram, a scan that checks for breast cancer, every 6 to 12 months after treatment. You may need to continue the scans once a year after that. If you had both breasts removed, you may not need a mammogram.

Depending on the stage and type of cancer you had, the number of follow-ups may differ. Itâs important not to skip or miss your follow-ups as cancer is more likely to come back within 2 years after treatment.

During these visits, itâs a good time to ask your doctor any questions or concerns you may have about what to watch out for, treatment side-effects, or your overall health.

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.

Why Do Recurrences Happen And What Can Trigger Them

Sometimes cancer cells can survive treatment. These cells may eventually reproduce enough to form a new tumor. If they manage to reach the blood stream or lymph system, they can spread to distant organs and tissues.

There are so many factors involved that its not possible to pinpoint exactly why an individual has a recurrence. We do know that the majority of recurrences happen within the first 5 years. The risk never completely goes away, but it does steadily decline over time.

The main factors that can influence your chance of recurrence are:

• tumor size

Its likely that youll need a combination of therapies to treat a breast cancer recurrence. Treatment depends on many factors such as:

• breast cancer type
• how far and to where it has spread
• your earlier treatments

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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.

What Is The Risk For Breast Cancer Recurrence

Key factors are the type and location of the recurrence. The highest risk of recurrence for breast cancer patients is during the first two years following treatment. At the Johns Hopkins Breast Center, our team of breast cancer specialists monitors patients very closely for those first two years. Some patients may be monitored longer, depending on the stage of their disease and other prognostic factors about their breast cancer. Your risk of recurrence is never zero; however, as more time passes, your risk goes down.;Read about the 10 lifestyle changes you can make to reduce your risk for breast cancer recurrence

MYTH: If Ive had a mastectomy, I cannot have a breast cancer recurrence. Get the facts.

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Locally Advanced Breast Cancer Prognosis

If breast cancer has come back and spread to the tissues and lymph nodes around the chest, neck and under the breastbone, there may be an increased risk of cancer cells spreading to other areas of the body.;

This means the overall prognosis can be harder to predict.

Treatments such as chemotherapy, hormone and targeted therapies are given for locally advanced breast cancer because they work throughout the whole body.

After Cancer Drug Treatment Or Radiotherapy

Cancer may sometimes come back after cancer drug treatment or radiotherapy. This can happen because the treatment didn’t;destroy all the cancer cells.;

Chemotherapy drugs;kill cancer cells by attacking cells that are in the process of doubling to form 2 new cells.;But not all the cells in a cancer;divide at the same time. Normal cells go into a long rest period between divisions. Cancer cells do too, although the rest period may be much shorter.;

Giving chemotherapy in a series of treatments helps to catch as many cells dividing as possible. Cells that were resting when you had your first treatment, may;be dividing when you have your next and so will be more likely to die.

But it is unlikely that any chemotherapy treatment kills;every single cancer cell in the body. Doctors try to reduce the number;of cancer cells as much as possible. The immune system kills off the remaining cells or they may;die off.;

You might find it helpful to read more about how chemotherapy works.;

Radiotherapy;makes small breaks in the DNA inside the cells. These breaks stop cancer cells from growing and dividing and often make them die. Normal cells close to the cancer;can also become damaged by radiation, but most;recover and go back to working normally. If radiotherapy doesn’t kill all of the cancer cells, they will regrow at some point in the future.

We have more information about radiotherapy treatment.;

You can read more about immunotherapy and targeted cancer drugs.

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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

Can Earlier Detection Of Recurrence Improve Breast Cancer Outcomes

The risk of metastatic relapse weighs heavily on the minds of patients, physicians and caregivers for years, sometimes decades, after treatment of the primary tumour is complete. Nearly 17 million cancer survivors are living in the United States, 3.9 million of whom are breast;cancer survivors, and repeated monitoring for cancer recurrence in these individuals presents a significant challenge to healthcare;delivery systems. For breast;cancer patients, current American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines limit follow-up care to mammography, medical history and physical exam, stating that in the absence of clinical signs and symptoms suggestive of recurrent disease, there is no indication for laboratory or imaging studies for metastases screening., Despite these guidelines, however, many patients receive high-cost imaging analysis and tumour marker blood tests during routine follow-up exams, exposing them to radiation and increasing healthcare costs.,,, So, what has led to the current precarious balance between the desire to detect recurrence early and clinical guidelines that limit the use of diagnostic tests?

Table 1 Exploiting tumour dormancy as a window of therapeutic opportunity to target MRD.

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What Are The Signs And Symptoms Of Local Recurrent Breast Cancer

Youll likely recognize the symptoms if you have a breast cancer relapse. They will be much the same as what you experienced with your original breast cancer diagnosis, with a few additional possible signs at the treatment areas:

• A new lump in the breast
• A new part of the breast that feels too firm
• Redness or swelling of the skin on your breast;
• Abnormal changes to the nipple
• Pulling of the skin or swelling at the lumpectomy site
• Increased thickening on or near the mastectomy scar

Note that after a mastectomy and radiation, the entire area may be swollen and red for weeks or even months, so this may not be a recurrence sign. However, redness can also indicate infection, so its a good idea to get it checked out.;

If you had a mastectomy and breast reconstruction, you might notice some lumps near the scar. These are caused by scar tissue or dead fat cells, and theyre harmless.;

If symptoms arise, your clinician can monitor you by performing a clinical breast exam. They may also order an additional screening, such as an MRI.

Can I Do Anything To Prevent Cancer Recurrence

While eating right, exercising, and seeing your cancer care team for follow-up visits are helpful, they cannot keep cancer from recurring. Many people blame themselves for missing a doctor visit, not eating right, or postponing a CT scan for a family vacation. But even if you do everything just right, the cancer still might come back. Still, there are certain actions you can take to be as healthy as possible.

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Breast Cancer May Come Back Even Many Years After Treatment

• Tags:Postmenopausal, Pre- or Perimenopausal, Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Early-stage: Stage IIIA, Progesterone-Receptor Positive, Estrogen-Receptor Positive, Planning/Considering Hormonal Therapy, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, Luminal A Breast Cancer, and Luminal B Breast Cancer

A;study;shows that there is a risk of breast cancer coming back even many years after surgery and other treatments to reduce that risk.

The researchers looked at the health histories of almost 3,000 women who didn’t have early-stage breast cancer come back during the 5 years after diagnosis and initial treatment. Breast cancer that comes back within 5 years of diagnosis and initial treatment is called “early recurrence.” Breast cancer that comes back more than 5 years after diagnosis and initial treatment is called “late recurrence.”

Ten years after initial diagnosis and treatment, 11% of the women in the study had a late recurrence. At 15 years after initial diagnosis and treatment, 20% of the women had a late recurrence.

The study showed that the risk of late recurrence was more likely when:

• the cancer was later stage at the time of diagnosis; the risk of late recurrence at 10 years after initial diagnosis and treatment was:
• 7% with stage I cancer
• 11% with stage II
• 13% with stage III

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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The Extrinsic Effect Of Targeted Therapy

Fig. 4: The effects of cell-extrinsic and cell-intrinsic determinants in dictating breast;cancer outcomes.

Part I The journey of a breast;cancer patient from the development of undetectable disease and its clinical discovery , through its surgical removal and adjuvant ET , to metastatic relapse and death . The presence of tumour lesions across the body is indicated by starsthe smaller referring to the clinically undetectable ones , the bigger ones to the clinically detectable ones . Part II The development of an HR+ breast;tumour lesion in the breast , comprising a mixture of ER+/PR+ and ER/PR cells . DTC escape from the primary site can occur early and/or late during tumorigenesis , although the HR phenotype of DTCs at these stages is often unclear. Bones, lungs and liver are represented as common secondary sites for breast cancer metastases, albeit the sequential patterns of DTC spread among these organs are still elusive . Targeted treatment for HR+ breast;cancer patients relies on adjuvant ET. Several mechanisms of ET resistance cytostasis, ESR1 mutations and HR function regulationcontribute to DTC outgrowth. DTC disseminated tumour cell, ER oestrogen receptor, ET endocrine therapy, HR hormone receptor, PR progesterone receptor. Figure created with BioRender.com.

Lumpectomy Plus Radiation Therapy And Local Recurrence

For women who have lumpectomy plus radiation therapy, the chance of local recurrence in 10 years is about 3-15 percent .

The risk of local recurrence depends on tumor characteristics, including biomarkers .

It also depends on whether or not the tumor margins and the lymph nodes in the underarm area contain cancer cells. The chance of local recurrence is lower when :

• Tumor margins do not contain cancer
• Lymph nodes do not contain cancer

Chemotherapy, hormone therapy and/or HER2-targeted therapy can lower the risk of breast cancer recurrence for people treated with lumpectomy plus radiation therapy .

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Most Women Diagnosed With Early

• Tags:Tumor Between 1 cm and 1.9 cm, Tumor Between 2 cm and 2.9 cm, Tumor Between 3 cm and 3.9 cm, Tumor Between 4 cm and 4.9 cm, Tumor Smaller than 1 cm, Early-stage: Stage 0 — DCIS , Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Lymph Nodes Removed, 1-9 Involved, Lymph Node Removal, Sentinel Lymph Node Removal/Dissection, After Surgery, Planning/Considering Surgery, and Preparing for/Undergoing Surgery

When early-stage breast cancer is removed, the lymph node closest to the cancer called the sentinel node often is removed and sent to a pathologist for evaluation. Removing just this one node is called sentinel node biopsy or sentinel node dissection.

If cancer cells are in the sentinel node, it means the cancer has spread beyond the breast. Until recently, doctors thought that more treatment was necessary to reduce the risk of the cancer coming back , including removing other underarm lymph nodes .

But a practice-changing study, called the ACOSOG Z-11 trial, found that women diagnosed with early-stage disease with one or two positive sentinel nodes who have lumpectomy and radiation do just as well as women who have axillary node surgery.

Among other directives, the new guidelines say:

The researchers found that women who had only sentinel lymph surgery more than doubled, from 23% in 2009 to 56% in 2011, the year after publication.

Is Tumour Dormancy The Sole Explanation For Recurrence

In pondering the mechanisms of metastatic relapse among breast;cancer patients, one obvious question is whether early recurrence is simply the consequence of direct metastatic outgrowth, whereas late relapses reflect a period of tumour dormancy. To address this query, it is imperative to consider how long it takes for a single cancer cell to grow into a clinically detectable metastasis. Pioneering measurements of breast;tumour volume doubling time carried out by radiographic analysis on more than 800 women concluded that it takes ~12 years on average for a single cell with a 10-µm diameter to reach a clinically detectable mass of 1cm,, and that metastases can have a TVDT up to twofold higher than their matched primary tumours. However, these initial analyses focused on a small number of samples, without taking into account the vast heterogeneity among breast tumours or the effect that adjuvant therapies might have on their growth rate, as the subjects in this study were untreated.

Fig. 3: The puzzling timing of metastatic relapse in breast;cancer patients.

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You Can Still Live A Long Life

Talk to your doctor about ways to reduce your risk of recurrent or opposite breast cancer.; The risks are probably less than you think but completing recommended treatment including radiation following a lumpectomy and any recommended systemic treatment is essential.;For more information or two find a breast health provider, click here.

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