Protect Against Potential Breast Cancer Recurrences
If youve had breast cancer before, there is a small chance you can get it again. However, you can put some preventative measures in place.
Practice holistic health care by eating well, exercising, getting plenty of sleep, and caring for your emotional well-being, including practices to help manage your fear and pervasive worry about relapse.
You can assess your risk of cancer or cancer recurrence by taking ezras know-your-risk quiz, which evaluates questions about your lifestyle and medical history.
Your score will highlight areas where you can improve your own health care and lifestyle.
Most importantly, see your oncologist for regular checkups, self-examine your breasts carefully and consistently, schedule an annual MRI screening, and have a yearly mammogram.
To learn more about mammograms, please check out:
What Are The Signs Of Breast Cancer Recurrence
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
If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:
- Unexpected weight loss or change in appetite
- Severe or ongoing headaches
However, symptoms will vary depending on where the secondary cancer presents, and some primary and secondary cancers may not present any obvious symptoms. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.
If you have any health concerns or symptoms that are new or persistent, speak with you GP or treating physician.
Surgery After Previous Lumpectomy
If breast-conserving surgery was performed the first time breast cancer was diagnosed and a tumor has grown back in the same breast, the complete removal of the breast is usually recommended. This involves removing the entire mammary gland tissue and surrounding skin, but not the chest muscles. The nipple can also be spared if it doesn’t contain any cancer cells and immediate reconstructive surgery is also planned. Abnormal or cancerous lymph nodes are typically removed as well.
If the tumors are small and limited, a second lumpectomy might be an option. That will depend on the location of the tumor and how long ago the first was made. More radiotherapy may be needed after a lumpectomy.
It is often possible to reconstruct the breast after a mastectomy. This procedure can already be started during the operation , or it can be done at a later stage. Doing the procedure later gives you more time to think over the pros and cons of the various options. Having reconstructive surgery later on will mean another operation and another stay at the hospital.
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How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
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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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.
What Are The Signs Of Distant Breast Cancer Recurrence
If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:
- Unexpected weight loss or change in appetite
- Severe or ongoing headaches
However, symptoms will vary depending on where the secondary cancer presents. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.
Studies have shown that doctors are sometimes reluctant to mention the symptoms of metastatic disease. In medical school it was suggested that we shouldnt tell people who had been treated for cancer what to look for if they were worried about recurrences because theyd start imagining that they had every symptom we told them about, but that doesnt reassure people at all it just means theyll be afraid of everything instead of a few specific things. When youve had cancer, youre acutely aware of your body, and any symptom thats newor that you never noticed beforecan take on terrifying significance as you worry that your cancer may be back. Inevitably this will mean a lot of fear over symptoms that turn out to be harmless.
As I explain to my patients, there are good reasons these days to remain optimistic, even after cancer comes back. Newer, better treatments are becoming available all the time. And for women who were treated a long time ago, the options for treatment may have changed and improved significantly since the first time they were treated
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Primary Metastatic Breast Cancer
The prognosis of primary metastatic breast cancer depends on the location of the metastases, but is generally regarded as poorer than that of secondary metastatic tumors . In primary metastatic breast cancer, resection with tumor-free margins improves 5-year overall survival by 40% to 50% . The role of axillary surgery is unclear.
What Is The Outlook For Someone With A Breast Cancer Recurrence
Overall survival rates for breast cancer are generally based on the stage of the cancer at initial diagnosis.
Treatment for local and regional recurrence is often successful. However, theres still a risk of developing distant metastases. Because there are so many variables, its difficult to provide an overall prognosis. Your oncologist can provide a clearer understanding of what to expect for your exact situation.
Metastatic breast cancer can be treated and go into remission, but its not considered curable.
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Treatments For Local Recurrences
Local breast cancer recurrence is when cancer comes back in the same area that the first tumor was found.
Suppose you had a lumpectomy, surgery to remove the cancer and abnormal tissue, and radiation during your first experience with breast cancer. In that case, you cannot be treated with radiation again. The standard treatment, in this case, would be a mastectomy.
Suppose you didnt have radiation along with the original lumpectomy. In that case, your medical practitioner may recommend another lumpectomy followed by radiation treatment.
Depending on your oncologists evaluation, they may also recommend chemotherapy, hormonal therapy , or both.
Research has shown that the characteristics of breast cancer may be different if it comes back. For example, the hormone-receptor status may change, or your HER2 status might be different. Your oncologist may want to biopsy the area to check for changes in these two important indicators.
Symptoms Of Cancer In The Bones
The most common place that breast cancer travels is to the bones. Areas of breast cancer in the bones, called lesions, can cause pain and make your bones more likely to fracture or break. These problems are more likely in the bones you use often, such as
Breast cancer bone lesions can cause calcium to go into your bloodstream. Calcium in the bloodstream can result in more general symptoms, including fatigue, nausea, constipation, and irritability.
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How Is A Local Breast Cancer Recurrence Or Metastasis Found
Breast cancer that recurs at the original site is called a local recurrence. Breast cancer that returns and spreads to other parts of the body is called a distant recurrence . This is metastatic breast cancer and may also be called stage IV or advanced breast cancer.
A local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.
Metastasis is usually found when new and persistent symptoms are reported to a health care provider and follow-up tests are done.
If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.
Learn about follow-up care after breast cancer treatment.
How Long After Breast Cancer Treatment Do Recurrences Occur
The risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.
The late recurrence or relapse of breast cancer refers to cancers that come back after five years, but may not return for 10 years, 20 years, or even more. For people who have estrogen receptor-positive tumours, the cancer is actually more likely to recur after five years than in the first five years.
In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumours there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumours.
An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who dont understand this risk are often less likely to be supportive as you cope with the fear of recurrence.
Bone Metastases
- The long bones of the arms and legs
Symptoms and Detection
Treatment
Liver Metastases
Treatment
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How Long Before Recurrence Is Off The Table
Recurrence is a risk for up to 32 years after a first diagnosis of breast cancer, according to a recent study. Your risk of recurrence after 10 years of remission depends on a number of things like:
- The size of the tumor
- The number of lymph nodes with cancer
- Whether cancer is estrogen receptor-positive
In general, once you have a breast cancer diagnosis, even if you are years in remission, itâs a good idea to be watchful and consult your doctor for regular breast exams and other screenings they think are appropriate. Early detection is the best way to get the best outcome from treatment. Talk to your doctor about the best schedule of checkups for you.
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Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
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What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
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.
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Signs And Symptoms Of Recurrent Local Breast Cancer May Include:
- A change in the shape or size of a breast
- A lump in the breast or underarm area
- A marble-like hardened area of skin on or around the breast
- Change in shape or position of a nipple
- Discharge from the nipple that is bloody or clear
- Nipple retraction, meaning that its pushed in rather than sticking out
- Red or scaly breast skin or nipple
- Skin of the breast that is dimpled or puckered
- Swelling in the breast
When To Contact A Doctor
A person may wish to contact a doctor if they notice signs that their cancer has returned.
Since the cancer may have spread, a person should contact a doctor about any unusual symptoms throughout their body, not just their breasts.
When making an appointment, a person should be prepared to talk about any new symptoms they are experiencing. They may also want to be ready to discuss their history with cancer.
A doctor may want to ask questions, order tests, and perform a physical examination.
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Treatments Of Recurrent Breast Cancer
What type of cancer treatment you received in the past will help determine the type of treatment suitable for local breast cancer recurrences. You may have to go for mastectomy for local recurrence if you have had a lumpectomy in the past. It is mainly because radiation therapy is not effective in the same area.
In case you have undergone mastectomy already, it is important to first remove the tumor near the treated site. You will also receive radiation therapy in this case. It is possible to develop a new tumor in your other breast. In this case, your treatment would include a mastectomy or lumpectomy, along with systemic therapy.
You will be treated with systemic therapy using hormonal therapy, chemotherapy, or both in case of distant recurrence that involves organs such as the lungs, bones, liver, or brain. Surgery and radiation therapy is also considered an option in this situation.
Breast Cancer Signs And Symptoms
Knowing how your breasts normally look and feel is an important part of your breast health. Although having regular screening tests for breast cancer is important, mammograms do not find every breast cancer. This means it’s also important for you to know what your breasts normally look and feel like, so youll be aware of any changes in your breasts.
The most common symptom of breast cancer is a new lump or mass . A painless, hard mass that has irregular edges is more likely to be cancer, but breast cancers can be also soft, round, tender, or even painful.
Other possible symptoms of breast cancer include:
- Swelling of all or part of a breast
- Breast or nipple pain
- Nipple or breast skin that is red, dry, flaking, or thickened
- Nipple discharge
- Swollen lymph nodes under the arm or near the collar bone
Many of these symptoms can also be caused by benign breast conditions. Still, its important to have any new breast mass, lump, or other change checked by an experienced health care professional so the cause can be found and treated, if needed.
Remember that knowing what to look for does not take the place of having regular screening for breast cancer.Screening mammography can often help find breast cancer early, before any symptoms appear. Finding breast cancer early gives you a better chance of successful treatment.
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