When breast cancer comes back

Breast cancer survival rates have increased dramatically over the last few years.  However, sometimes breast cancer can recur, coming back in the same breast, or spreading elsewhere in the body. If you do develop a breast cancer recurrence, you still have plenty of treatment options.

Breast cancer cells from your original tumour can sometimes remain in the body after initial treatment is complete. Surgery to remove the primary tumour does not always take away all of the cancerous cells, or they may have broken away from the primary tumour and travelled to other parts of the body where treatment didn’t affect them. Residual cancer cells can sometimes lie dormant and undetected in the body for some time, only to begin growing and form a tumour weeks, months or even years later. When they do start causing symptoms, this is called breast cancer recurrence.

Types of breast cancer recurrence

Women generally develop one of three types of breast cancer recurrence:

  • Local breast cancer recurrence: this develops in the same place as the original tumour and is the most common type of breast cancer recurrence. It is usually considered to be a failure of treatment rather than a spread of the cancer cells. Local recurrence can occur after breast-conserving surgery or, less commonly, after a radical mastectomy.
  • Regional breast cancer recurrence: this occurs in the chest, either in the pectoral muscles or in the nearby lymph nodes. These lie under the breastbone, above the collarbone, and the neck. This is the rarest type of breast cancer recurrence, accounting for only around 2% of cases.
  • Distant breast cancer recurrence: this occurs when the original cancer cells have spread to other parts of the body. This is also known as metastasis and means that the cancer cells have gone beyond the breast and local lymph nodes. The most common place for distant recurrence of breast cancer is the bone, and this happens in 25% of cases. Other common sites include the liver, lungs and less commonly the brain.

The cells that make up the recurrent breast cancer are the same type as the original tumour. If a new, unrelated tumour forms in the same breast, or the other breast, this is not classed as breast cancer recurrence. It is classified and treated as a new primary tumour.

How is breast cancer recurrence detected?

Although you will receive check-ups after your first breast cancer treatment with follow-up mammograms, remaining breast aware after your initial therapy is crucial; many cases of breast cancer recurrence are first discovered by the woman herself.

  • Symptoms of local breast cancer recurrence are similar to those of the primary tumour. You may notice a lump or thickening in your breast or changes to the skin or nipple. If you had a mastectomy previously, you may notice a lump or thickening on the chest wall or along your mastectomy scar. If you have any of these symptoms, your GP will again use the triple assessment (examination, mammogram or ultrasound, and biopsy) that was done for your primary diagnosis.
  • Regional breast cancer recurrence can cause a lump or swelling in the lymph nodes in your underarm, in your neck, above your collarbone or around your breastbone. You may also experience other symptoms such as pain or difficulty breathing or swallowing if the breast cancer recurrence develops in your lungs or oesophagus. If you have these symptoms, a physical examination, CT or MRI scan and biopsy will be able to give you an accurate diagnosis.
  • Distant breast cancer recurrence can cause a variety of symptoms depending on the site of the secondary tumour. These range from bone pain, breathing difficulties and abdominal tenderness, to jaundice, headaches and seizures. The symptoms of distant recurrence are similar to those of advanced, secondary or metastatic breast cancer. Whole body scans such as MRI or PET scans may be used to locate distant recurrence of breast cancer.

Am I at risk of breast cancer recurrence?

A woman who has been treated successfully for breast cancer is more at risk of developing breast cancer recurrence if she previously had:

  • Lymph node involvement.
  • A large tumour, greater than 5 cm/2 inches.
  • Inflammatory breast cancer.
  • Histology reports that showed that small or no margins of healthy tissue were removed with the original tumour. This makes it more likely that some cancer cells were left behind.
  • No follow-up radiation after lumpectomy.
  • Her first diagnosis at a young age. The highest risk is seen in women who are younger than 35 when their first breast cancer develops.

A diagnosis of breast cancer recurrence can be more devastating or emotionally difficult to cope with than your initial diagnosis. It may be helpful to discuss your feelings with your loved ones, your breast cancer care team or a support group. Your breast care team, specialist nurses and counsellors will be able to offer advice on ways to help you cope emotionally.