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
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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.
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Cancer Beyond The Breast Area
A locally advanced recurrence means that the breast cancer has spread beyond the breast and the lymph nodes under the arm . This includes areas near to or around the breast but has not spread to other parts of the body.
A locally advanced cancer might come back in one or more of the following:
- the chest wall
- lymph nodes under the breastbone or between the ribs
- the nodes above the collarbone
- lymph nodes around the neck
Symptoms can include, changes in the breast, and swelling in the lymph nodes above and below the collarbone, the neck, and around the breast bone.
The tests you might have are usually the same as for checking for a local recurrence.
Do speak to your nurse or doctor if you notice any of these changes.
Fiber And Your Microbiome
A plethora of studies have recently looked at the role of gut bacteria in health. There is evidence that both the type of bacteria present in our guts, and the diversity of those bacteria, play a role in our everything from our ability to lose weight, our mood, and even how we do with cancer. This has given rise to a multitude of products to attempt to restore the microbiome called probiotics.
Unfortunately, at least for those who have not been on antibiotics, probiotics may not be the way to go and eating a healthy diet may be key. While we don’t have many studies looking specifically at breast cancer, the composition of the gut microbiome has been found to correlate closely with the response to immunotherapy drugs for cancer. What correlated the most with a response was the variety of bacteria rather than any particular strain, and it’s thought that probiotics may even reduce the diversity of gut bacteria via dilution. So where does this leave us?
The science on eating to improve the types of gut bacteria you have, as well as their diversity is relatively new. The one thing that seems to consistently help, however, is fiber. Fiber may be considered a “prebiotic” or the food that feeds the bacteria in our guts. Good choices include foods such as leeks, onions, properly prepared garlic, bananas, avocados, and other delicious foods.
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How Does Breast Cancer Spread
Breast cancer can spread through the lymphatic system, the bloodstream, or uncommonly, by local invasionwhich is when cancer cells actually invade nearby tissues, such as the chest wall or ribs.
When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage. The spread of breast cancer to lymph nodes does not necessarily mean that its metastatic, even though pathology reports often somewhat confusingly state breast cancer metastatic to lymph nodes.
A growing cancer may shed a cell or a clump of cells, and It can use your blood or lymph system as a network of highways for traveling. So, if a loose cancer cell makes it via the lymphatic system to your lymph nodes, its also possible that it may spread via the bloodstream to other parts of your body.
When cancer recurs in a lymph node near the breast, it is considered a regional recurrence and not a distant recurrence.
When breast cancer spreads to lymph nodes it has essentially declared its intent to metastasize. Breast cancer reaching the lymph nodes is in effect a declaration that its working to spread further.
In women with negative nodes, its trickier. What we want is a way to identify the 20 to 30 percent who have microscopic cells elsewhere and not over-treat the other 70 percent. At present we dont have a perfect way to do this.
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.
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Secondary Breast Cancer Prognosis
If cancer has spread from the breast to another part of the body , it can be treated but it cant be cured.
No two cancers progress in the same way, and as treatments have improved more and more people are living longer after a diagnosis of secondary breast cancer.
Your specialist will have an understanding of the likely progression of your secondary breast cancer and can talk to you about what you might expect.
Find out more about secondary breast cancer.
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.
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How Does This Breast Cancer Recurrence Risk Calculator Work
This health tool evaluates recurrence risk in the case of patients with a recurrence of breast cancer or metastatic disease.
The risk factors accounted for in this breast cancer recurrence calculator are:
Grade of tumor the higher the grade, the more likely a recurrence is. For instance, grade 4 contains increasingly abnormal and rapid growth cancer cells that are more likely to recur
Lymph nodes inflammation of lymph nodes is indicative of higher risk
Lymphatic or vascular invasion presence or absence of breast cancer cells in the lymphatic or vascular system.
Breast cancer recurrence can take place at the original site or spread to other parts of the body, indicating metastasis or distant recurrence .
Most recurrences occur within the first five years after first treatment with average risk rates of about 11%. This percentage increases in the case of patients with cancer family history or BRCA gene mutations.
Diagnosis of localized recurrence takes place through physical exam and mammogram while diagnosis of metastasis depends on types of symptoms and available testing.
Recurrence cancer treatment depends on the initial treatment, for example in the case of a lumpectomy, local recurrence is treated with mastectomy while in case the initial treatment was mastectomy, an attempt to remove the second tumor surgically is made, followed by radiation therapy.
Using Your Family History
You should certainly share your family history with your medical team. Your doctors might advise genetic counseling or genetic testing if your family history suggests that you could be carrying a breast cancer gene.
Some red flags include:
- Cancer of any kind before the age of 50
- More than one relative with the same type of cancer
- One family member who has more than one type of cancer
- A family member who has cancer not typical for that gender, such as breast cancer in a male
- Certain combinations of cancer, such as the combination of breast cancer with ovarian cancer, uterine cancer, colon cancer, prostate cancer, pancreatic cancer, or melanoma
- Cancer in both of one organ, for example, bilateral breast or ovarian cancer
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Minimize The Risk Of Second Cancers
Keep Track of Your Health Care
- Keep a health journal.
- Write down everything you want to ask your health care team. Take notes and keep track of questions between visits.
- Make a list of your medications. Bring this information to the visit along with all of your medication bottles. This will help the health care team keep track of all the medications you are taking, including vitamins and over-the-counter medications.
- Take notes during health care appointments.
- Keep all of your health records together and bring this information with you to health care appointments.
- Bring extra copies of important documents to give to appropriate health care team members. You can also fax or mail these before your appointment. Having the health care team read your documents may be an easier way for you to communicate.
- Store pamphlets, information about medication side effects and important phone numbers in your notebook so that everything is in one place.
One of the most important things you can do is to follow-up with a health care team that is well-informed about survivorship care. Good medical care and screening can help detect second cancers early.
Also:
- Try to find balance with a healthy lifestyle.
- Know if your family has a history of cancer.
- Use a health journal to prepare for your next visit with a member of your health care team.
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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If Cancer Comes Back In The Same Breast
If the breast cancer comes back in the same breast it’s called local recurrence. The cancer might be picked up at one of your follow up scans or appointments. Or you might notice your breast or scar looks or feels different.
Symptoms of local recurrence can include:
- a small pink or red lump called a nodule on the breast or scar
- change in shape or size of the breast
- a swelling in your arm or hand on the side of your breast surgery
- changes in the shape or position of the nipple
- redness or a rash on the skin on or around the breast area
- a lump or thickening in the breast
Let your doctor know as soon as you can if you notice any changes. You usually have tests to check if the cancer has come back.
Breast Cancer Is A Heterogeneous Disease
Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.
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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.
Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
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Be Mindful Of Your Environment Including Household Chemicals
It’s long been suspected that environmental exposures, including the chemicals we are exposed to in everything from household cleaners to cosmetics, may play a role both in breast cancer risk and recurrence. While it’s difficult to study , we are learning that practicing caution is wise.
A 2017 review looked at the evidence to date connecting breast cancer and the environment. Some compounds, such as PCBs , may raise the risk of recurrence. Others may alter the regulation of genes involved in cell growth, apoptosis , and much more. Endocrine disrupting chemicals can mimic the function of hormones in our bodies, and it’s well known that the hormone estrogen should be avoided to reduce breast cancer recurrence, at least for people with hormone positive tumors.
There is a great amount of information out there of varying degrees of concern, but the important thing to note is that it’s relatively easy to avoid concerning chemicals . Most household cleaners can easily be replaced with baking soda, lemon juice, and vinegar .
The environmental working group has a website where you can search on thousands of personal care products . And adding a few houseplants to your home can help to absorb many indoor air carcinogens with indoor air thought to be more of a concern that outdoor air pollution.