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Breast Cancer Recurrence

The American Cancer Society reports that the risk of breast cancer recurrence is quite low for most women. However, that does not mean that breast cancer survivors do not live in fear of recurrence.1 Understanding your individual risk for recurrence of breast cancer and knowing what symptoms to watch for can help keep this fear at bay. You should also be aware that there are treatment options for breast cancer recurrence.

Cancers that recur within one year of completing treatment are typically not recurrences at all, but failure to treat the original cancer. Recurrence of cancer that is due to treatment failure is greatest in the first two years after treatment. After that, overall breast cancer recurrence drop to 4.3% per year, as shown in a meta-analysis of over 3500 breast cancer patients.2

An Ounce of Prevention…

One of the best things you can do to prevent recurrence or catch it early is continue going to your primary care physician and all of your oncology follow-up appointments. You should also report any kind of new or unusual symptoms including pain, just to make sure that it is nothing to be concerned about. Although most breast cancer recurrences will occur within five years, you must continue screening for life, or until your doctor tells you that you do not need to anymore.

Risk Factors

There are different classifications of breast cancer recurrence according to their location in the body. Nevertheless, all are breast cancer recurrences since the initial cancer was in the breast. A local recurrence is in the breast tissue itself, or if a mastectomy was done, on the chest wall near the original site of the tumor. A regional recurrence typically involves the regional lymph nodes that may or may not have been sampled for cancer during initial therapy. Distant recurrences are often metastases to other parts of the body. For breast cancer the most common sites of metastasis are the brain, bone, liver or lungs, but metastasis can be to anywhere in the body.

The risk of a breast cancer recurrence is dependent on several factors. Large tumors, cancer that has spread to the lymph nodes and an aggressive biology of the tumor are all factors that increase risk of recurrence. The risk of recurrence when cancer has spread to the lymph nodes is an especially high, approximately 50%, compared to 32% for those that were node-negative.3

A study investigating rates of recurrence was completed in 2008 with 2,838 stage I to III breast cancer patients treated with adjuvant systemic therapy. The study found that the 5-year recurrence rate was 11% and the 10-year recurrence rate was 20%. They reported that the tumor grade, hormone receptor status, stage and use of endocrine therapy were the most influential factors for recurrence. 4

Newer research is looking into the presence or absence of the HER2/neu gene, which when present, enhances cell growth and division making tumors more aggressive. Studies have shown that women who are positive for the HER2/neu gene have an 11% greater 5-year risk of distant recurrence than those who are HER2/neu negative.5

Questions To Ask

It is important to consider your individual risk of recurrence when discussing breast cancer treatment with your doctor. The initial risk can be determined after a biopsy, which will give information concerning the hormone receptor status, how rapidly the tumor is dividing, and the type of breast cancer that is present. This information will determine which chemotherapy drugs are selected, whether or not endocrine therapy is indicated and your overall treatment plan. You must participate in determining your treatment plan. After all, your life depends on it.

References

1 American Cancer Society. (2004). A Breast Cancer Journey: Your Personal Guidebook. Atlanta: American Cancer Society.

2 Saphner, T., Tormey, D. C., & Gray, R. (1996). Annual hazard rates of recurrence for breast cancer after primary therapy. Journal of Clinical Oncology , 2738-2746.

3 Early Breast Cancer Trialists’ Collaborative Group. (1998). Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet , 1451-1466.

4 Brewser, A. M., Hortobagyi, G. N., Broglio, K. R., & etal. (2008). Residual Risk of Breast Cancer Recurrence 5 Years After Adjuvant Therapy. Journal of the National Cancer Insititute , 1179-1183.

5 Gonzalez-Angulo, A. M., Litton, J. K., Broglio, K. R., & etal. (2009). High Risk of Recurrence for Patients With Breast Cancer Who Have Human Epidermal Growth Factor Receptor 2–Positive, Node-Negative Tumors 1 cm or Smaller . Journal of Clinical Oncology , 5700-5706.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.