Connect with others who understand.

Sign up Log in
Resources
About MyBCTeam
Powered By
See answer

How Is Your Risk of Breast Cancer Recurrence Calculated? 8 Risk Factors

Medically reviewed by Maybell Nieves, M.D.
Written by Zoe Owrutsky, Ph.D.
Posted on October 15, 2024

After you finish treatment for early-stage breast cancer, you might worry about the cancer coming back. This is called a recurrence. Even though treatment can lower the chances of recurrence, everyone who has had breast cancer has a risk of it returning.

Doctors use different tools and information to estimate this risk. Although knowing what factors increase the chances of recurrence can be helpful, it’s important to remember that these are just estimates. Each person’s situation is unique, and it’s impossible to predict exactly what will happen. In this article, we’ll go over the main risk factors that doctors consider when estimating the chance of breast cancer recurrence.

Many Factors Go Into Calculating Risk

Your oncologist (cancer specialist) will consider many factors when estimating your risk of breast cancer coming back. These factors depend on your medical history, cancer type, and treatments. Doctors use data from thousands of other people with breast cancer to guide them. Keep in mind that these are averages, and your case might not follow the same patterns.

In general, the larger the tumor, the higher the chance that it can come back.

Some online tools or apps can give you a general idea of your risk, but these have limitations. They don’t take into account every detail of your health. Even if you have several risk factors, it doesn’t mean your cancer will return. Only a trained oncologist can give you the most accurate picture of your risk.

1. Larger Tumor Size

The size and specific characteristics of your original tumor play a big role in estimating your risk of recurrence. In general, the larger the tumor, the higher the chance that it can come back. For example, a tumor that is more than 5 centimeters across has a higher chance of returning than a tumor that is smaller than 2 centimeters.

2. Greater Lymph Node Involvement

Lymph nodes are small, bean-sized glands, located throughout your body, that help fight infections. Breast cancer can spread to the lymph nodes that are located near the breast. During surgery, your doctor will check these lymph nodes for signs of cancer. Lymph node involvement is one of the strongest factors that can predict whether or not the cancer is likely to recur.

If cancer is found in your lymph nodes, this could increase the chances of recurrence. The more lymph nodes that were affected, the higher the risk. If no cancer is found in the lymph nodes, your risk of recurrence is usually lower.

3. Hormone Receptor Status

Breast cancer cells are often tested to see if they have receptors for certain hormones like estrogen or progesterone. Cancers that are hormone receptor-positive (ER+ for estrogen or PR+ for progesterone) tend to grow in response to these hormones.

Hormone receptor-negative cancers are considered more aggressive and might carry a higher risk of coming back in the short term.

If your breast cancer is hormone receptor-positive, it may be less likely to return than hormone receptor-negative (ER- or PR-) cancer within the first five years after diagnosis. This may be because treatment with hormone therapy, such as tamoxifen, can help lower the chances of recurrence. Hormone receptor-negative cancers are considered more aggressive and might carry a higher risk of coming back in the short term. However, after five years, people with hormone receptor-positive cancer may have a higher risk of recurrence.

4. Positive HER2 Status

Doctors also test breast cancer cells to see if they have too much of a protein called human epidermal growth factor receptor 2 (HER2). If the cancer has too much HER2, it’s called HER2-positive. These types of cancers tend to grow and spread faster than HER2-negative cancers.

In the past, HER2-positive cancers had a much higher risk of coming back. However, treatments like trastuzumab (Herceptin) have greatly improved the outlook for people with HER2-positive cancer. Even with these treatments, HER2 status is still important in estimating recurrence risk.

5. Higher Cancer Grade

Cancer grade refers to what cancer cells look like compared to normal cells under the microscope. This information gives doctors an idea of how fast the cancer is likely to grow and spread. Breast cancer is graded on a scale from 1 to 3. Grade 1 cells look more like normal cells and grow slowly, while grade 3 cells are highly abnormal and grow quickly. Cancer grade refers to cell appearance and growth speed, while cancer stage describes how much the cancer has spread.

There’s a link between the cancer stage at your first diagnosis, the cancer cell grade, and the risk of recurrence. A higher-grade cancer (grade 3) has a greater chance of coming back after treatment compared to a lower-grade cancer, (grade 1 or grade 2), especially when combined with a higher stage of disease.

6. Positive Margins After Surgery

When your doctor removed the tumor, they also took out a small amount of healthy tissue around it, known as the margins. These margins are checked for any remaining cancer cells. If the margins are clear, meaning there are no cancer cells found, your risk of recurrence is lower.

But if cancer cells were found in the margins (called positive margins), there’s a higher chance the cancer could come back in the same area. If this happens, your doctor might recommend more surgery or radiation to lower the risk of recurrence.

7. Younger Age at Diagnosis

Your age at the time of your breast cancer diagnosis can also affect the risk of the cancer coming back. According to Breast Cancer Trials, a clinical research organization focused on breast cancer studies, younger women — especially those under 35 — are more likely to develop aggressive breast cancer, which increases the risk of recurrence. Older women, especially those diagnosed after menopause, generally have a lower risk of recurrence.

Age is just one piece of the puzzle, though. Your doctor will look at your age, along with other risk factors, to get a full picture of your recurrence risk.

8. Cancer Type and Subtype

The type of breast cancer you have also plays a role in estimating the risk of it returning. Certain types of breast cancer are more aggressive and come with a higher risk of recurrence, while others tend to grow more slowly.

Triple-Negative Breast Cancer

Triple-negative breast cancer doesn’t have receptors for estrogen, progesterone, or HER2. It accounts for about 15 percent of all breast cancers. This subtype of breast cancer tends to grow and spread quickly and is more likely to recur than other types. Around 40 percent of people with triple-negative breast cancer experience a recurrence, often within the first three years after treatment.

Inflammatory Breast Cancer

Inflammatory breast cancer is a rare and aggressive form of breast cancer that grows quickly and often involves the lymph nodes. Studies from Breastcancer.org have shown that around 50 percent of people with inflammatory breast cancer experience a recurrence in the first five years after diagnosis, making it one of the highest-risk types.

The type of breast cancer you have can greatly affect what your treatment plan is and what steps you should take to lower your recurrence risk. If you have triple-negative or inflammatory breast cancer, your doctor may recommend more frequent follow-up appointments or additional treatments to help lower your chances of recurrence.

Talk to Your Doctor

If you’re concerned about your risk of breast cancer returning, talk to your doctor. They can review your medical history, look at the factors mentioned here, and explain how they apply to your specific situation. It’s important to remember that having one or more of these risk factors doesn’t mean your cancer will come back. Many people with several risk factors go on to live cancer-free after their initial treatment.

Find Your Team

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 73,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

What concerns do you have about the risk of your breast cancer returning, and have you found ways to manage them? Share your experience with recurrence or fear of recurrence in the comments below, or start a conversation by posting on your Activities page.

References
  1. Survival and Risk of Breast Cancer Recurrence After Treatment — Susan G. Komen
  2. Breast Cancer Risk Assessment Tool: Online Calculator (The Gail Model) — National Cancer Institute
  3. Breast Cancer Recurrence — Cleveland Clinic
  4. About the Breast Cancer Risk Assessment Calculator (The Gail Model) — National Cancer Institute
  5. Breast Cancer Recurrence Rates: Understanding the Risk That Your Cancer Will Return — Breast Cancer Trials
  6. Factors Associated With Breast Cancer Recurrences or Mortality and Dynamic Prediction of Death Using History of Cancer Recurrences: The French E3N Cohort — BMC Cancer
  7. Lymph Nodes and Cancer — American Cancer Society
  8. Estrogen Receptor, Progesterone Receptor Tests — MedlinePlus
  9. HER2-Positive Breast Cancer — Cleveland Clinic
  10. Prediction of HER2-Positive Breast Cancer Recurrence and Metastasis Risk From Histopathological Images and Clinical Information Via Multimodal Deep Learning — Computational and Structural Biotechnology Journal
  11. Cancer Grade vs. Cancer Stage — MD Anderson Cancer Center
  12. Breast Cancer Grade — American Cancer Society
  13. 20-Year Risks of Breast-Cancer Recurrence After Stopping Endocrine Therapy at 5 Years — New England Journal of Medicine
  14. Cancer Staging — Cleveland Clinic
  15. Margin Status and Survival Outcomes After Breast Cancer Conservation Surgery: Prospectively Registered Systematic Review and Meta-Analysis — British Medical Journal
  16. Treatment of Triple-Negative Breast Cancer — American Cancer Society
  17. Triple-Negative Breast Cancer — Cleveland Clinic
  18. Breast Cancer Recurrence Risk — BreastCancer.org
  19. Inflammatory Breast Cancer (IBC) — BreastCancer.org

Posted on October 15, 2024
All updates must be accompanied by text or a picture.

We'd love to hear from you! Please share your name and email to post and read comments.

You'll also get the latest articles directly to your inbox.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service.
Privacy Policy
All updates must be accompanied by text or a picture.

Subscribe now to ask your question, get answers, and stay up to date on the latest articles.

Get updates directly to your inbox.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service.
Privacy Policy
Maybell Nieves, M.D. graduated from Central University of Venezuela, where she completed medical school and general surgery training. Learn more about her here.
Zoe Owrutsky, Ph.D. earned her Bachelor of Science from the University of Pittsburgh in 2014 and her Ph.D. in neuroscience from the University of Colorado Anschutz Medical Campus in 2023. Learn more about her here.

Related Articles

Breast cancer can sometimes recur (come back), even after it is no longer detectable following t...

Which Types of Breast Cancer Have the Highest Recurrence Rates?

Breast cancer can sometimes recur (come back), even after it is no longer detectable following t...
Breast cancer is diagnosed at stage 3 when it’s locally advanced, meaning the tumor has begun sp...

Navigating Treatments and Prognosis for Stage 3 Breast Cancer

Breast cancer is diagnosed at stage 3 when it’s locally advanced, meaning the tumor has begun sp...
Breast cancer is diagnosed as stage 2 if there’s a tumor greater than 20 millimeters in size, if...

Stage 2 Breast Cancer: Treatment and Prognosis

Breast cancer is diagnosed as stage 2 if there’s a tumor greater than 20 millimeters in size, if...
Breast cancer relapse — also known as breast cancer recurrence or recurrent breast cancer — happe...

4 Ways To Lower Your Risk for Breast Cancer Relapse

Breast cancer relapse — also known as breast cancer recurrence or recurrent breast cancer — happe...
Breast cancer develops when genetic mutations (changes) cause cells in the breast to grow and div...

10 Causes of Breast Cancer: Inherited Genes, Environmental Factors, and More

Breast cancer develops when genetic mutations (changes) cause cells in the breast to grow and div...
Doctors diagnose different types of breast cancer based on many factors. Where the breast cancer ...

11 Types and Subtypes of Breast Cancer: Inflammatory, DCIS, HER2, and More

Doctors diagnose different types of breast cancer based on many factors. Where the breast cancer ...

Recent Articles

Drugs that target glucagon-like peptide 1 (GLP-1) have gained lots of attention for their potenti...

Can You Take GLP-1 Drugs With Breast Cancer? Are They Safe for Survivors?

Drugs that target glucagon-like peptide 1 (GLP-1) have gained lots of attention for their potenti...
After completing breast cancer treatment, you and your loved ones might worry about the possibili...

What’s the Risk of Breast Cancer Recurrence After Mastectomy? 11 Symptoms To Watch For

After completing breast cancer treatment, you and your loved ones might worry about the possibili...
The foods you choose to eat or avoid can play an important role in supporting your health during ...

Breast Cancer Diet: 3 Foods To Avoid and 3 Foods To Eat

The foods you choose to eat or avoid can play an important role in supporting your health during ...
When breast cancer is diagnosed, it’s given a grade and a stage. These different but related clas...

Staging vs. Grading for Breast Cancer: What’s the Difference?

When breast cancer is diagnosed, it’s given a grade and a stage. These different but related clas...
After you receive a breast cancer diagnosis, your oncologist (cancer specialist) will recommend a...

6 Breast Cancer Treatments: Radiation, Hormones, and More

After you receive a breast cancer diagnosis, your oncologist (cancer specialist) will recommend a...
For individuals navigating a breast cancer diagnosis or caring for someone affected, you’re likel...

7 Facts About Breast Cancer You Probably Don’t Know

For individuals navigating a breast cancer diagnosis or caring for someone affected, you’re likel...

Thank you for subscribing!

Become a member to get even more: