• Triple-negative breast cancer (TNBC) is a fast-growing cancer that, after it is treated, may return months or years later in what is known as a recurrence or relapse.
• Your doctor may recommend certain treatments and lifestyle changes to help lower your risk of breast cancer returning.
• TNBC recurrences can be treated with traditional therapies like surgery, radiation therapy, or chemotherapy, as well as clinical trials testing treatments that are under development.

Triple-negative breast cancer often leads to worse outcomes compared with other types of breast cancer. There are also fewer therapies effective against TNBC, making it less likely to be cleared during treatment and more likely to recur or relapse.

However, there is still hope. As researchers learn more about the condition, treatment options improve, and knowledge increases regarding individual factors can lead to recurrence. If you’re diagnosed with TNBC, it’s important to understand facts about relapses so that you can arm yourself with information and potentially reduce your risk.

1. Breast Cancer Can Come Back in Different Areas

One goal of breast cancer treatment is to get rid of as many cancer cells as possible. In some cases, treatments like surgery (lumpectomy or mastectomy), chemotherapy, and radiation therapy successfully kill all the cancer cells.

In other cases, a few cancer cells remain behind. They may stay near their original location and then later regrow. For example, a tumor could form again in nearby breast tissue or the skin of the breast. This is known as a local recurrence.

Cancer cells could also spread to lymph nodes near the breast and form a tumor there, called a regional recurrence. There’s also a chance of metastasis or distant recurrence when surviving cancer cells spread to other locations in the body and form tumors there. This means that it’s possible to develop a breast cancer recurrence in a different area from where it first appeared.

2. Risk of Relapse Is Highest in the First 3 Years

TNBC recurrence statistics show that about 40 percent of people with this disease will have a recurrence after it is treated. In a study of more than 2,500 people with TNBC, 3 out of 4 recurrences happened within the first three years after the cancer was diagnosed.

Five years after diagnosis, TNBC recurrence rates drastically drop. One study found that, among those with TNBC who did not have a recurrence within the first five years, 97 percent remained relapse-free 10 years later, and just 5 percent had a relapse within 15 years.

Although TNBC is harder to treat initially, it is less likely to come back many years after treatment, unlike some breast cancer subtypes that often return a decade or two later.

3. Certain Factors Make Recurrence More Likely

One important factor that helps predict whether breast cancer will relapse is the stage — an estimate of how much cancer there is within the body. Breast cancer’s stage is based on how big a tumor is, how many tumors there are, and whether cancer cells have spread to other locations.

Among people with TNBC, those who have stage 3 cancer are 89 percent more likely to have a recurrence compared with those who have early-stage (stage 2 or 3) cancers. Additionally, a person’s risk of relapse more than doubles if breast cancer has spread to the lymph nodes.

Other factors can also increase the risk of recurrence for all types of breast cancer, including TNBC. Your cancer is more likely to return if:

• You were 35 years old or younger when you were diagnosed.
• Your tumors are large.
• Surgery did not successfully remove all the cancer.
• You don’t receive radiation therapy after a lumpectomy (surgery to remove cancer tissue in the breast).
• You have a type of breast cancer called inflammatory breast cancer.
• Your body mass index (BMI) score is in the obese range.

Whether you experience a relapse also depends on how successful your treatments were. When no signs of cancer remain after treatment, it is known as a pathologic complete response (pCR). A recurrence after pCR is less likely — your chances of relapse decrease if your cancer completely responds to treatment.

4. Lifestyle Choices Can Lower Your Risk of Recurrence

Getting to and maintaining a healthy weight may lower your chances of having your cancer return. Additionally — regardless of whether you lose weight — getting more exercise, eating a healthy diet, and drinking less alcohol can help protect you.

Try to get some physical activity each day. This doesn’t necessarily mean working out intensely at the gym. Taking a walk or doing housework counts as being active. You should also try to eat more fruits, vegetables, and whole grains.

5. Certain Treatments Help Prevent Relapses

People with stage 1, 2, or 3 cancer — tumors that have not spread to distant parts of the body — may receive treatments to reduce the risk of breast cancer relapse.

Adjuvant chemotherapy — anticancer drugs given after surgery — may make a relapse less likely. Some people with few relapse risk factors don’t need this treatment, but it’s usually recommended for those with TNBC. Radiation therapy can also reduce TNBC recurrence rates when it is used after surgery.

If you have a high risk of relapse, your doctor may suggest that you take bisphosphonates (bone-strengthening drugs) to help prevent cancer from coming back in your bones.

Treatments like targeted therapy and hormone therapy can help prevent relapses in other types of breast cancer but aren’t helpful in TNBC. This is because TNBC cells don’t contain estrogen or progesterone receptors or HER2 proteins, which these therapies target.

6. New Symptoms Could Signal Recurrence

During and after breast cancer treatment, tell your doctor about any new symptoms you experience that could be a sign of a relapse.

In some cases, symptoms of a breast cancer relapse are similar to initial breast cancer symptoms: a lump in your breast, swelling or redness, or changes to your skin’s appearance. However, not all these changes indicate that your cancer has returned — for example, radiation therapy can also cause redness or swelling as a side effect.

Regional recurrences that develop in nearby lymph nodes usually appear as a hard lump under the skin in your armpit, close to your collarbone, or in your neck.

Metastatic breast cancer causes various symptoms depending on where it has spread. The most common locations for distant recurrences and their associated symptoms include:

• Bones — Bone or joint, back, or hip pain
• Lungs — Breathing problems or coughing
• Liver — Decreased appetite, weight loss, and abdominal pain
• Brain — Seizures or extreme headaches

Talk to your doctor anytime you start feeling differently or notice an ongoing health change.

7. Various Tests Can Help Diagnose a Relapse

If new symptoms or results from a mammogram point to a possible TNBC recurrence, your doctor may want to run tests. Imaging tests such as CT, MRI, and bone scans can help detect new tumors. Additionally, your doctor may perform a biopsy and remove a small sample of cells so they can be examined under a microscope to see if they are cancerous.

8. Multiple Therapies Can Treat Recurrences

If your TNBC returns, the therapy your doctor recommends will depend on your previous treatments, your overall health, and how widespread your cancer is.

TNBC recurrences in the breast or nearby lymph nodes are often treated with surgery to take out the tumors and multiple lymph nodes.

If you underwent radiation therapy the first time you had a breast cancer diagnosis, you might not get it again. If you didn’t receive radiation before, you may receive this treatment during a recurrence. Chemotherapy is also frequently recommended.

Some newer treatments can also be helpful when treating TNBC relapses, especially if your cancer is advanced or has metastasized. For example, there are a few recently approved immunotherapy options, depending on what gene or protein changes cancer cells contain:

• Pembrolizumab (Keytruda) can target cancer cells that make a protein called PD-L1.
• Pembrolizumab may also be beneficial if you have TNBC with other changes, including changes in mismatch repair genes (genes that help fix damaged DNA).
• PARP inhibitors such as olaparib (Lynparza) and talazoparib (Talzenna) may help if you have TNBC and mutations in BRCA genes.
• A medication called sacituzumab govitecan-hziy (Trodelvy), which blocks multiple processes within cancer cells, might be tried if tests show that you don’t have any common gene or protein changes.

You may also be eligible to participate in clinical trials researching new drugs or other treatments under development for TNBC. You can ask your doctor about clinical trials for which you may be eligible, or search for studies at ClinicalTrials.gov.

Living With Triple-Negative Breast Cancer

TNBC cases can vary widely. Keep in mind that most people treated for TNBC will never experience a relapse.

If you have TNBC, talk with your doctor about your individual chances of a relapse. Your oncologist can help you understand your personal risk factors and tell you if there is anything you can do to help lower your risk.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 60,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you been diagnosed with triple-negative breast cancer? Do you still have questions about the possibility of relapse? Share your experiences in the comments below, or start a conversation by posting on your Activities page.