When Breast Cancer Comes Back
Recurrence is always possible. But when the cancer comes back, where it is and how it behaves all affect the outcome.
By Gina Shaw
Reviewed By Charlotte Grayson
It can happen a year after you finish treatment for breast cancer, or five, 10, even 20 years later. You find another lump, or a shadow appears on one of the mammograms you're having much more often now. Is the cancer back?
Every woman who's had breast cancer knows that recurrence is possible. Some may do a better job than others at keeping that worry in a tightly closed box on the other side of the room. But sometimes -- such as at follow-up visits with the oncologist -- it's hard to avoid.
And sometimes, the worry proves true. After all you and your doctors did, after those scary and exhausting and painful months of treatment, the cancer is rearing its ugly head again.
How often does breast cancer recur? That depends on a number of factors, including:
For example, if your original tumor was less than 1 centimeter and had not spread to the lymph nodes, the chance of the cancer's returning may be only 5%. If you had a large tumor with multiple lymph nodes involved, the odds that it will in time recur can be significantly higher -- 50% or greater for some women.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic -- the cancer has come back not in the breast (or not only in the breast), but elsewhere in the body as well. That's a much more serious situation (see Metastatic Breast Cancer as a Chronic Condition). 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 ("new primaries" are not common, but they do happen) 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.
If, on the other hand, you finished treatment for your original breast cancer only six months or a year ago, and the cancer has already recurred, that may be a sign that the tumor may be very aggressive.
"This indicates to us that a woman may be at a higher risk to have a systemic recurrence," says Winer. If you didn't have chemotherapy before, doctors may recommend an aggressive chemotherapy regimen now. But if you've completed rigorous chemotherapy fairly recently, oncologists may not be in a rush to put you through that again.
Of course, there are some complicating factors to treatment no matter when a recurrence occurs. For example, a woman who has previously had Adriamycin (doxorubicin) or another chemotherapy drug that is known to damage the heart cannot be prescribed that drug again -- whether it's a year later or ten years later.
And a breast that has been treated with radiation cannot be radiated again. For that reason, if you had a lumpectomy the first time around, which was probably followed by radiation, your doctors will likely advise a mastectomy if the cancer recurs.
Decisions to Consider if Breast Cancer Recurs
Deciding on a course of treatment for breast cancer recurrence is complex. There's the question of what kind of treatment you had before and how well you responded to it. Also, doctors don't have a lot of information about comparing treatment approaches in women with recurrent breast cancer.