Check On Whether You Need Medications
After you complete your cancer treatment, if you have a high chance of your cancer returning, your doctor may prescribe you certain drugs to reduce your risk.
Tamoxifen and raloxifene are two such drugs. These drugs are approved for use in the U.S. and doctors usually prescribe them to lower the chances of estrogen-related breast cancer. Both drugs block estrogen hormone in breast cells. Studies show that they reduce your chances of getting breast cancer again by about 40%.
Tamoxifen. You take this once a day by mouth as a pill or liquid. It may make it less likely for you to get cancer in parts of your breast that werenât affected earlier. You may have side effects like hot flashes, vaginal discharge, irregular periods, loss of sexual interest, memory loss, fatigue, and joint pain.
Raloxifene. Itâs a pill you take once a day. Itâs usually given to women who are post-menopausal — those who stopped having their periods. It may also help you avoid or treat osteoporosis, when your bone density thins, putting you at risk of fractures.
While rare, these drugs can also cause blood clots in your leg veins or lungs. This can be a serious side effect that may need immediate medical attention. Contact your doctor as soon as possible if you think you have a blood clot.
Side effects can include vaginal discharge, muscle and joint pain, hot flashes, and night sweats. These drugs may also speed up osteoporosis and may raise your cholesterol.
What Are The Symptoms Of Breast Cancer Recurrence
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- Nipple changes, such as flattening or nipple discharge.
- Swollen skin or skin that pulls near the lumpectomy site.
- Thickening on or near the surgical scar.
- Unusually firm breast tissue.
- Biopsy of the site of suspected recurrence.
What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
References
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How Is Recurrent Breast Cancer Diagnosed
Many women who have had breast cancer in the past pay close attention to their bodies and are very aware of even the smallest changes. But many physical changes or health problems have nothing to do with the cancer they had before. Signs of breast cancer recurrence may include a lump in the breast, scar tissue or the chest area, as well as inflamed skin. Some women will notice these changes themselves, or a doctor might find them during an examination, for example during a check-up.
If you suspect that your breast cancer has come back, your doctor is the first person to go to. You might be referred to a hospital, tumor center or certified breast center for additional tests. If you are no longer at the same practice or center where you were treated for breast cancer the first time, it is important to bring along as much information as possible about your previous treatment. You can also consent to doctors sharing the relevant information about you with each other.
After a detailed talk about your medical history, you will have a physical examination, mostly to inspect the breast or the surgical scar. If breast cancer has come back, your doctor will also check whether the tumor has spread to the other breast or any other parts of your body. Any abnormalities in the body will be examined more closely. The breast cancer will then be classified using certain criteria, in the same way that it was when you first had this disease.
Can I Lower My Risk Of Getting A Second Cancer
There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen after breast cancer.
To help maintain good health, breast cancer survivors should also:
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Distant Breast Cancer Recurrence
Distant breast cancer recurrence is when the cancer has spread to another organ within the body. Breast cancer that has spreadalso called metastatic breast canceris no longer curable and needs to be managed as a chronic disease. There are various treatment options to control the cancer and stop its progression, prolonging a patients life and improving quality of life. These treatments may include:
- Chemotherapy
- Small molecule inhibitors
- Clinical trials
Life With Recurrent Cancer
Many people worry that their cancer will return. A study from the American Cancer Society found that a year after being diagnosed, around 2/3 of people were concerned about their disease coming back.
Some cancers come back only once, while others reappear two or three times. But some recurrent cancers might never go away or be cured.
This sounds scary, but many people can live months or years with the right treatment. For them, the cancer becomes more like a chronic illness, such as diabetes or heart disease.
While it may be hard not to fret, try to stay positive and remember that your situation is unique. And as treatments improve, so does the outlook for recurrent cancer.
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Getting Help And Support
You may find it helpful to talk to other people in the same situation if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry.
You can get in touch with a counsellor by contacting one of the counselling organisations.
You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
You can also look at our section about coping emotionally with cancer.
Or you can share your experiences with other people and find out how they coped by using our online forum, Cancer Chat.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic — the cancer has come back not in the breast , but elsewhere in the body as well. That’s a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a “new” cancer, and is treated as such.
Be aware that many people talk about recurrence and metastasis in the same breath. But they are not the same thing. If you have had a local recurrence, when the cancer remains confined to your breast, the good news is that your prognosis is not necessarily any worse than it was the first time.
“Whether it’s a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume we’re dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation,” says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.
If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer would be treated largely as an entirely new problem.
“That woman will not only undergo surgery, but may well receive additional therapy that doesn’t ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent,” says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
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Can I Lower My Risk Of Breast Cancer Progressing Or Coming Back
If you have breast cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Fortunately, breast cancer is one of the best studied types of cancer in this regard, and research has shown there are some things you can do that might be helpful.
Staying as healthy as possible is more important than ever after breast cancer treatment. Controlling your weight, keeping physically active, and eating right may help you lower your risk of your breast cancer coming back, as well as help protect you from other health problems.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .
This might be chemotherapy, hormone therapy or targeted therapy.
Chemotherapy
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.
Radiotherapy and surgery
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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Breast Cancer May Return Even 20 Years Later Researchers Find
This means women with the most common type of breast cancer, called estrogen-positive or hormone-positive breast cancer, need to think carefully about whether they want to stop taking the pills, even if they cause side-effects, doctors said.
These breast cancers have a lingering smoldering quality and carry substantial risk of late recurrence after five years of therapy, said Dr. Harold Burstein of the Dana Farber Cancer Institute, who was not involved in the study.
Many patients think. OK, I made it to five years. I know Im safe, said Dr. Jennifer Litton, an oncologist at the MD Anderson Cancer Center. But for estrogen-receptor positive breast cancer, its a continued lifelong risk.
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Breast cancer is the second-biggest cancer killer of American women, after lung cancer. The American Cancer Society says every year, it’s diagnosed in 200,000 women and a few men, and kills around 40,000.
Most breast cancers are fueled by estrogen, and drugs called hormone blockers are known to cut the risk of recurrence in such cases.
Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors sold as Arimidex, Femara, Aromasin and in generic form do the job with less risk of causing uterine cancer and other problems. The longer women take them, the lower their risk of having the cancer come back.
However, they do cause side-effects.
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Diagnosis Of Invasive Lobular Carcinoma
The earlier youre diagnosed with ILC and start treatment, the better your outlook. As with other types of cancer, early stages of ILC are likely to be treated more easily with fewer complications. This typically but not always leads to a complete recovery and low recurrence rates.
However, early diagnosis of ILC can be a challenge, compared with the much more common IDC. Thats because the growth and spread patterns of ILC are more difficult to detect on routine mammograms and breast exams. ILC tumors are likely to have multiple origins, and they grow in single-file lines rather than a lump.
The first step in a diagnosis of ILC is a breast examination. Your doctor will feel your breast for a thickening or hardening of the tissue. They will also look for any swelling in the lymph nodes under your arms or around your collarbone.
Other diagnostic tests may include:
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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.
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.
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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
- Spine
- Pelvis
- The long bones of the arms and legs
Symptoms and Detection
Treatment
Liver Metastases
What Recurrence Means
Cancer recurrence means the cancer you originally had has come back. It can develop in the same place it started or in a new part of your body.
When the cancer returns or spreads to a different spot, it’s still named after the area where it started. For example, breast cancer that comes back in your liver is called a breast cancer recurrence.
Doctors typically classify recurrent cancers by how much they spread and where they crop up:
- Local recurrence: The cancer comes back in the same place, or very close to, where it first started.
- Regional recurrence: The tumor develops in the lymph nodes or tissues that are near the original cancer.
- Distant recurrence: The recurrent cancer has spread, or what doctors call “metastasized,” to faraway organs or tissues in your body.
Tests such as imaging scans, lab tests, and biopsies can help your doctor figure out if your cancer has recurred.
A recurrence isn’t the same thing as a second cancer. That’s a new cancer that develops in another type of cell. Special tests can show your doctor if your disease is recurrent or a new kind. Second cancers are much less common than cancer recurrences, but they do happen.
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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.
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
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