What is breast cancer recurrence?

Sometimes breast cancer can recur, or come back, in the same breast or spread elsewhere in the body. 

Cancer cells from the primary tumour may remain in the body after treatment is complete. 

They can sometimes be undetected in the body for some time and begin growing weeks, months or even years later. 

When they start causing symptoms, this is called breast cancer recurrence.

Types of breast cancer recurrence 

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

Local breast cancer recurrence

This is when cancer develops in the same place as the primary tumour.Local recurrence can occur after breast-conserving surgery and, in rare cases, it can still come back following a radical mastectomy.

Regional breast cancer recurrence

This occurs in the chest, either in the pectoral muscles or in the nearby lymph nodes. The cancer cells are found under the breastbone, above the collarbone, and the neck. 

This is the rarest type of breast cancer recurrence making up 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 - it 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, which 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 primary 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 treated as a new primary tumour.

How is breast cancer recurrence diagnosed?

Although you will receive regular check-ups after your first treatment with follow-up mammograms, remaining breast aware is crucial. 

Many cases of breast cancer recurrence are first discovered by you. For example:

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 doctor will again use the triple assessment- examination, mammogram or ultrasound and biopsy.

Regional breast cancer recurrence can cause a lump or swelling in the lymph nodes

They are found in your underarms, neck, above your collarbone or around your breastbone. You may also experience pain, difficulty breathing or swallowing if the recurrence develops in your lungs or food pipe (oesophagus). If you have these symptoms, a physical examination, CT or MRI scan and biopsy will be able to give you a full diagnosis.

Distant breast cancer recurrence can cause a wide range of symptoms depending on the location 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. Full 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?

You are more at risk of developing breast cancer recurrence if you previously have had:

• Lymph node involvement
• A large tumour, greater than 5cm or 2 inches
• Inflammatory breast cancer
• Histology reports showing that small or no margins of healthy tissue were removed with the primary tumour
• No follow-up radiation after lumpectomy
• First diagnosis at a young age, as 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 worrying 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 and support when you need it the most.