Breast Cancer: Breast Self-Exam

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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 (in the treated breast or near the mastectomy scar) 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.

How Do I Know There Is A Recurrence?

If you've been treated for breast cancer, you should continue to practice breast self-examination, checking both the treated area and your other breast each month. You should report any changes to your doctor right away. Breast changes that might indicate a recurrence include:

• An area that is distinctly different from any other area on either breast
• Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
• A change in the size, shape, or contour of the breast
• A mass or lump, which may feel as small as a pea
• A marble-like area under the skin
• A change in the feel or appearance of the skin on the breast or nipple, including skin that is dimpled, puckered, scaly, or inflamed (red, warm or swollen)
• Bloody or clear fluid discharge from the nipples
• Redness of the skin on the breast or nipple

In addition to performing monthly breast self-exams, keep your scheduled follow-up appointments with your healthcare provider. During these appointments, your healthcare provider will perform a breast exam, order lab or imaging tests as needed, and ask you about any symptoms you might have. Initially, these follow-up appointments may be scheduled every three to four months. The longer you are cancer-free, the less often you will need to see your healthcare provider. Continue to follow your healthcare provider's recommendations on screening mammograms (usually recommended once a year).

What Factors Determine The Likelihood Of A Recurrence?

Prognostic indicators are characteristics of a patient and her tumor that may help a physician predict a cancer recurrence. These are some common indicators:

• Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence.
• Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
• Hormone receptors. About two-thirds of all breast cancers contain significant levels of estrogen receptors, which means the tumors are estrogen receptor positive (ER+). ER-positive tumors tend to grow less aggressively and may respond favorably to treatment with hormones.
• Histologic grade. This term refers to how much the tumor cells resemble normal cells when viewed under the microscope; the grading scale is 1 to 4. Grade 4 tumors contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater chance of recurrence.
• Nuclear grade. This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade (also called proliferative capacity) are usually more aggressive (faster growing).
• Oncogene expression. An oncogene is a gene that causes or promotes cancerous changes within the cell. Tumors that contain certain oncogenes may increase a patient's chance of recurrence.

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