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Risk Factors for Breast Cancer Recurrence

It is important for breast cancer survivors to keep in mind that low risk does not mean no risk for breast cancer recurrence. Recurrences can occur any time after one year post treatment. Any recurrence prior to one year is actually a treatment failure.

Growth Rate

Research shows that larger tumors have a greater risk of recurrence. This is because tumors that are larger are also more invasive and will typically invade into lymphatic and blood vessels, which is how they spread to other parts of the body. The most common sites of breast cancer metastasis and recurrence are the lungs, brain, bones and liver.

Genetics and Hormone Receptors

Genetics do have a role in breast cancer recurrence risk as well. The HER2/neu gene codes for a protein HER2, and is a biomarker in breast cancer that indicates how aggressive the tumor is. In a study of 965 cases of breast cancer, it was found that approximately 10% were HER2 positive and this group had a much higher recurrence rate at both five and ten-year intervals. Patients with HER2-positive tumors had five times the rate of local recurrence and seven times the rate of distant recurrence when compared to other patients with hormone receptor-positive tumors.1

Studies concerning breast cancer patients with triple negative cancers, which means they are estrogen receptor, progesterone receptor and HER2/neu negative, showed that these patients had a dramatically increased risk of distant recurrence and even death within five years after treatment. However, if a recurrence did not occur within these first five years, specifically around the third year after treatment, this risk decreased to that near hormone receptor positive tumors.2 If a patient is found to be a triple negative, they are typically treated more aggressively initially, to try and prevent the possibility of recurrence later.

Weight and Alcohol Consumption

Other than genetic factors and hormone receptor status, which are both out of the patient’s control, there are components of one’s lifestyle that can be adjusted to try and prevent recurrence. Alcohol consumption has been shown to increase the risk of breast cancer recurrence in postmenopausal women.3

Obesity has also been shown to increase one’s risk of developing breast cancer and developing recurrences. Obese people tend to have elevated basal levels of insulin, putting them at risk for diabetes as well as many other cancers. Insulin is one of the most potent growth factors in the human body, therefore, a constant supply of it can cause cancer growth.4

Secondary Cancers

According to the American Cancer Society, breast cancer patients may develop a secondary cancer that is a direct result of treatment for the original cancer. This secondary cancer is not typically in the other breast but in other organs, including the bone marrow. The drug tamoxifen has been associated with the development of endometrial cancer, but the risk of this does not outweigh the benefit of treatment. These cancers can also be treated but the weakening of the immune system from the initial cancer treatment may delay treatment or even cause death. It is important to discuss these things with your doctor when discussing treatment.

References

1 Gonzalez-Angulo, A. M., Litton, J. K., Broglio, K. R., et al. (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.

2 Dent, R., Trudeau, M., Pritchard, K., et al. (2007). Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence. Clinical Cancer Research , 4429-4435.

3 Kwan, M. L., Kushi, L. H., Weltzien, E., et al. (2010). Alcohol Consumption and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast Cancer: The Life After Cancer Epidemiology Study. Journal of Clinical Oncology , 4410-4416.

4 Hede, K. (2008). Doctors Seek To Prevent Breast Cancer Recurrence by Lowering Insulin Levels. Journal of the National Cancer Institute , 530-532.

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