Recurrence Rate Of Breast Cancer

Tumor Size And Lymph Node Status

The risk of recurrence is linked to the size of the original tumor as well as the number of positive lymph nodes, although these factors alone can’t explain all recurrences. In the 2017 study noted earlier, for women who were cancer-free after five years of hormonal therapy, the risk of recurrence was highest for those who had large tumors that had spread to four or more lymph nodes , and lowest with small, node-negative tumors.

The risk of recurrence of these small, node-negative tumors, however, remains significant at roughly 1% per year until at least 20 years post-diagnosis. Due to the life expectancy of metastatic breast cancer , the risk of death lags somewhat behind recurrence.

Within these ranges, the risk of recurrence was greater in women who had larger tumors than smaller tumors . Tumor grade and Ki-67 had only moderate predictive value, and progesterone receptor status and HER2 status had no predictive value in this study.

It’s noteworthy that women who had one to three positive lymph nodes were twice as likely to have their cancer recur at distant locations between five years and 20 years post-diagnosis than in the first five years, and those who have node-negative tumors were roughly four times more likely to have a late than an early recurrence.

Risk Of Breast Cancer Recurrence

Risk of breast cancer recurrence varies greatly from person to person and depends on:

• The biology of the tumor, including biomarkers
• The stage at the time of the original diagnosis
• Treatments for the original cancer

If you are diagnosed with a breast cancer recurrence, its not your fault. You did nothing to cause it.

Learn about treatment for distant breast cancer recurrence .

Local Breast Cancer Recurrence

Breast cancer can return to the same area where it first appeared, Lange says. In this case, your doctor will base a treatment approach on how the first cancer was addressed.

If the original tumor was treated with lumpectomy and radiation, many patients may then need a bigger surgery, such as mastectomy, for the purpose of local control, she explains. If the original tumor was treated with mastectomy, then local resection of the recurrence should be considered. This is often followed by radiation therapy to the resection site.

Lange says an oncologist will evaluate a patient with recurrent breast cancer. Based on characteristics of the cancer cells and how they are behaving, the oncologist might recommend chemotherapy, hormonal therapy or a combination of treatments. For some patients, clinical trials of new therapies may be available.

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Recurrence Ebook: Volume 2

The most frequently asked question for women who have had breast cancer is: What are the chances it will recur?

With the aim of answering a wide range of questions while providing support, empowerment, and education, a free Q& A follow-up to our first Recurrence eBook delves deeper into breast cancer recurrence and related issues.

Intrinsic Subtypes And Late Recurrence

A number of different methods have been evaluated for the ability to predict late recurrence. Some of these include:

Higher expression of estrogen-responsive genes: A 2018 study found that people with ER+/HER2 negative breast cancers who had higher expression of estrogen-responsive genes and were not treated with extended hormonal therapy had a high risk of recurrence after five years.

Multigene assays: Several multigene assays may help predict late recurrence, but using this information to figure out when to extend hormonal therapy requires more research. A 2018 evaluation of an 18-gene, 10-year signature found that the information regarding prognosis was similar to other tests including Oncotype DX Recurrence Score, Prosigna PAM50 risk of recurrence score, Breast Cancer Index and IHC4.

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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.

Tips For Coping With Breast Cancer Recurrence

Fear of recurrence after cancer is totally normal. Rest assured that youre not alone and that the feeling may fade over time. In the meantime:

• Be vigilant about regular checkups and follow-up testing. It may help to know that youre doing everything within your control.
• Be mindful about your overall health. Follow your doctors recommendations for diet, exercise, and medications.
• Have fun. Dive into things that bring you joy or contentment.

Its also important to know that recurrence is not your fault guilt should never be part of the picture. Here are some constructive ways to deal with recurrence:

• Dont go it alone. Lean on your family, friends, and social network for support.
• Join an in-person or online support group. Theres nothing quite like sharing with others who totally get it. You might also find it beneficial to speak with a therapist.
• Speak openly with your oncologist. Ask questions, discuss your concerns, and seek another opinion.

If someone you care about has a breast cancer recurrence, your support can make all the difference. You can lend a ton of support, even if youre unsure what to say or do:

• Be there. Just showing up can be a major boost.
• Listen. Let them talk about fears and frustrations without fear of judgement.
• Ask how you can help. Their needs may not be obvious, so ask for specifics.

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Have You Noticed Changes In Your Breasts Recently

Many of the symptoms of breast cancer are invisible and not noticeable without a professional screening like a mammogram or ultrasound. But some symptoms can be caught early just by looking out for certain changes in your breasts and being proactive about your breast health.

Our new guide, Know the Symptoms, provides a checklist of symptoms that will help you know what to look for in your breasts during a self-exam and take note of the important information to provide your doctor to guide them in their professional evaluation of your health. Know what to look for when checking your breasts by getting this free guide.

Coping With A Breast Cancer Recurrence

Finding out that your cancer has come back can cause a mix of emotions. You might feel shocked, angry or frightened.

Its important that you have a chance to ask questions. Your cancer specialist can give you information thats tailored to your individual situation. Your breast care nurse can also be a helpful source of information and support.

Ongoing treatment and an uncertain prognosis can cause you to feel worried and anxious about your future. Theres no easy way to deal with this uncertainty but you might want to get in touch with other people who are going through something similar.

You can exchange tips on coping with uncertainty and side effects of treatment, ask questions, share experiences and talk through concerns on our online Forum.

You can also call our free Helpline on 0808 800 6000 for information and support, and to find out about Breast Cancer Nows services.

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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.

Mastectomy And Local Breast Cancer Recurrence

With mastectomy, the best predictor of local breast cancer recurrence is whether the lymph nodes in the underarm area contain cancer.

The risk of local recurrence is usually higher when there are more axillary lymph nodes with cancer than when there are few or no nodes with cancer .

Learn more about breast cancer recurrence.

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Early Recurrence Vs Late Recurrence

A recurrence of breast cancer at any time can be devastating. While 6% to 10% of breast tumors are diagnosed when the disease is already metastatic , 90% to 94% of metastatic breast cancers represent a distant recurrence of previous early-stage breast cancer .

Since distant metastases are responsible for around 90% of breast cancer deaths, finding ways to reduce the risk of recurrence is critical in improving the survival rate from the disease. Overall, it’s estimated that around 30% of breast cancers will recur at distant sites.

Introduction To Breast Cancer Recurrence

Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment. Breast cancer can come back as a local recurrence or as a distant recurrence somewhere else in the body. The most common sites of recurrence include the lymph nodes, the bones, liver, or lungs.

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Understanding Breast Cancer Recurrence

Australia has one of the best survival rates of breast cancer in the world, with 91% of women surviving at least five years past their diagnosis. New Zealand is not far behind with 88% of women surviving five years past their first diagnosis.

This information may come as a relief for those diagnosed with early stages of the disease, as many recurrences appear within five years after the initial treatment, the exception being ER positive breast cancer, as many recurrences will occur after the first five years as within the first five years. But the fear of recurrence , is a common issue faced by women who have had early stage breast cancer. The chance of recurrence is not the same for all breast cancer patients. Understanding the risk of recurrence for your type of breast cancer may help to ease some anxiety.

Additional Resources And References

For more books on breast cancer and recurrence, please visit the Imaginis.com breast health bookstore at

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Am I Still At Risk Of Breast Cancer Recurrence If I Have Had A Mastectomy

Yes. You are still at risk of breast cancer recurrence if you have had a bilateral mastectomy . Undergoing a bilateral mastectomy drastically reduces your chances of local or contralateral breast cancer recurrence as almost all of the breast tissue has been removed. However, there is still a chance that residual breast tissue or cancer cells could recur on the chest wall.

If you have had a single mastectomy , you are still at risk of developing cancer in the breast that remains.

It must be noted that having a mastectomy or bi-lateral mastectomy does not reduce your risk of developing cancer in other parts of your body .

About Breast Cancer Recurrence

During surgery to remove early-stage breast cancer, surgeons remove all the cancer they can see. In some cases, there may be individual cells circulating in the bloodstream or hiding in the bones or other places in the body. These cells may be inactive and not growing, or what doctors call dormant. But at some point in the future, the cells may start growing and cause a recurrence.

Doctors prescribe treatments after surgery such as hormonal therapy, chemotherapy, and targeted therapies to destroy any cancer cells left behind and reduce the risk of recurrence.

The risk of recurrence is unique to each person diagnosed with early-stage breast cancer and depends on a number of factors, including:

• age at diagnosis

Doctors work very hard to estimate the risk of recurrence for each person. They use that estimate to tailor a treatment plan you can start after surgery to keep the risk of recurrence as low as it can be.

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Breast Cancer Recurrence Rates Low With Nipple

A recent study published in Plastic and Reconstructive Surgery confirms that nipple-sparing mastectomy is a very safe procedure when performed in appropriate patients. Preserving the nipple-areola complex at the time of a mastectomy is associated with a very low risk of recurrence, just over 3%.

Nipple-sparing mastectomy remains a viable option in the appropriately indicated patient with regards to long-term cancer recurrence, state the researchers.

What Are The Different Types Of Cancer Recurrence

The different types of recurrences cancer patients may develop include: Local recurrence: The cancer is back in the same place as the original tumor. Regional recurrence: The cancer is back in the lymph nodes nearby the original tumors location. Distant recurrence: The cancer has spread to a different location than the original tumor.

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Definitions Of Variables And Outcomes

Age was divided into the following subgroups: 5059 years, 6069 years, 7079 years, 8089 years, and 90 years . Race was classified as white, black, and others. Marital status was classified as married, never married, widowed, and others. Tumor size was classified as2 cm, 23 cm, 34 cm, and 45 cm. Tumor grade was classified as I, II, III, and IV based on histological findings. Positive lymph node was classified as 0, 1, 2, and 3. ER and PR status were classified as positive and negative.

Table 1 Comparison of demographic and clinical characteristics among female patients with early-stage IDC receiving different treatments.

The primary outcomes were short-term recurrence rate and long-term recurrence rate . Recurrence times were tracked beginning on the day breast cancer was first diagnosed. Recurrence was defined as local tumor recurrence in the breast , chest wall , ipsilateral/parasternal/infra- or supraclavicular lymph nodes, and skin of the chest wall . Because the time of surgical resection of tumors is not available in the database we used, we choose to use the time of diagnosis as the beginning of recurrence-free survival according to previous study using the same database.

Should I Have Scans Or Blood Tests To Check For Breast Cancer

After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated with scans regularly. The frequency is often annually but is best discussed with your specialist.

Current guidelines and evidence recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on. These tests have not been shown to improve outcomes and cause unnecessary scanxiety. If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.

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Circulating Tumor Cells At 5 Years Post

In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.

In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.

Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.

That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.

Integrative Subtypes And Late Recurrence

Researchers recently developed a model to identify 11 integrative subtypes of breast cancer with different risks and timing of recurrence, according to the findings of a 2019 study published online in Nature.

Four integrative subtypes were identified that were associated with a high risk of late recurrence . Altogether, these four subtypes accounted for roughly 26% of breast cancers that were estrogen receptor-positive and HER2 negative.

These subtypes included tumors that had an enriched copy number alterations in genes that are thought to drive the growth of cancer , including:

They were also able to identify a subgroup of triple-negative tumors that were unlikely to recur after five years as well as a subgroup in which people continue to be at risk of late recurrence. A Breast Cancer Recurrence Calculator including integrative subtypes has been developed but, at the current time, this is meant for research purposes alone.

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