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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?
- 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.
How Will My Prognosis Affect My Treatment?
Following surgery or radiation, your treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with your surgeon, may advise the use of tamoxifen (tamoxifen citrate, Nolvadex) or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
How Would A Recurrence Be Treated?
The type of treatment for local breast cancer recurrences depends on your initial treatment. If you had a lumpectomy, local recurrence is usually treated with mastectomy, since radiation therapy cannot be delivered twice to the same area. If the initial treatment was mastectomy, recurrence near the mastectomy site is treated by removing the tumor whenever possible, usually followed by radiation therapy.
In either case, hormone therapy and/or chemotherapy may be used after surgery and/or radiation therapy. If breast cancer is found in the other breast, it may be a new tumor unrelated to the first breast cancer. Treatment would include a lumpectomy or mastectomy and possibly systemic therapy (chemotherapy and/or hormonal therapy).
Women with distant recurrence involving organs such as the bones, lungs, brain, or other organs are treated with systemic therapy. Radiation therapy or surgery may also be recommended to relieve certain symptoms.
Immunotherapy with trastuzumab (Herceptin) alone or with chemotherapy may be recommended for women whose cancer cells have high levels of the HER2/neu protein. Immunotherapy is generally started after hormonal or chemotherapy are no longer effective.
Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.
Edited by Charlotte E. Grayson, MD, February 2004.
Portions of this page © The Cleveland Clinic 2000-2004
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Breast AnatomyThe breast, or mammary gland is made up of lobules, milk producing glands, and a system of ducts to transport milk. Both males and females have breasts. Abnormal enlargement of breasts in men is referred to as gynecomastia. In women, during pregnancy the breasts grow larger and produce milk. Common medical conditions that affect the breasts include breast cancer, breast lumps, fibrocystic changes and cysts, mastitis, and benign tumors (fibroadenomas).
Breast cancer is an invasive tumor that develops in the mammary gland. Breast cancer is detected via mammograms, breast self-examination (BSE), biopsy, and specialized testing on breast cancer tissue. Treatment of breast cancer may involve surgery, radiation, hormone therapy, chemotherapy, and targeted therapy. Breast cancer risk may be lowered by managing controllable risk factors.
What you should know about breast cancer
- Breast cancer is the most common cancer among American women.
- One in every eight women in the United States develops breast cancer.
- There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
- The causes of breast cancer are unknown, although medical professionals have identified a number of risk factors.
- There are many different types of breast cancer.
- Breast cancer symptoms and signs include
- a lump in the breast or armpit,
- bloody nipple discharge,
- inverted nipple,
- orange-peel texture or dimpling of the breast's skin (peau d'orange),
- breast pain or sore nipple,
- swollen lymph nodes in the neck or armpit, and
- a change in the size or shape of the breast or nipple.
- Breast cancer can also be symptom free, which makes following national screening recommendations an important practice.
- Breast cancer is diagnosed during a physical exam, by a self-exam of the breasts, mammography, ultrasound testing, and biopsy.
- Treatment of breast cancer depends on the type of cancer and its stage (0-IV) and may involve surgery, radiation, or chemotherapy.
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