Triple-negative breast cancer (TNBC) can be harder to treat than some other types of breast cancer. Because there are fewer treatment options, it may be more likely to come back for some people.

The good news is that cancer research keeps improving treatment options. Doctors are also finding better ways to lower the risk of cancer coming back. If you’re diagnosed with TNBC, it can help to learn the facts about relapse. You and your doctor can talk about steps you can take to lower 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. This is called recurrence. In local recurrence, a tumor could form again in nearby breast tissue or the skin of the breast.

Although TNBC is harder to treat initially, it’s unlikely to come back many years after treatment.

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 (spread) 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

While TNBC is more likely than other types of breast cancer to recur once it’s been treated, outcomes vary by stage and therapy. With current treatment options, many people remain disease-free. Although TNBC is harder to treat initially, it’s unlikely to come back many years after treatment.

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 stage is based on how big a tumor is, how many tumors there are, and whether cancer cells have spread to axillary lymph nodes and other locations.

Whether your cancer comes back can also depend on how well the treatment worked.

The risk of relapse increases significantly if breast cancer has spread to the lymph nodes. Among people with TNBC, about 40 percent of those with stages 2B and 3 cancer have a recurrence compared with about 20 percent of those who have early-stage (stages 1 and 2A) cancer.

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 didn’t successfully remove all the cancer.
• You don’t receive radiation therapy after a lumpectomy.
• You have a type of breast cancer called inflammatory breast cancer.
• Your body mass index (BMI) is in the obesity range (30 or higher).

Whether your cancer comes back can also depend on how well the treatment worked. When tests show no cancer cells are left after treatment, it’s called a pathologic complete response, and the cancer is less likely to come back.

4. Lifestyle Choices Can Lower Your Risk of Recurrence

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

Read more about foods to eat or avoid during or after TNBC treatment.

Try to get some physical activity each day. This doesn’t necessarily mean a strenuous workout at the gym. Taking a walk or doing housework counts as being active.

5. Certain Treatments Help Prevent Relapses

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

Adjuvant chemotherapy is chemotherapy given after surgery. It may lower the risk of the cancer coming back. 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’s used after surgery. Read more about how chemotherapy is used to treat TNBC.

If you have a high risk of relapse and you’re past menopause, your doctor may suggest bisphosphonates (drugs that help strengthen bones). These aren’t chemotherapy. Bisphosphonates can help reduce bone pain and lower the risk of broken bones, which can sometimes happen after cancer treatment.

Treatments like targeted therapy and hormone therapy can help prevent relapses in other types of breast cancer. Targeted therapies that can be added to chemotherapy and surgery include:

• Pembrolizumab (Keytruda) for high-risk, early-stage TNBC alongside chemotherapy and surgery
• Olaparib (Lynparza) for certain BRCA-mutated, high-risk breast cancers
• Capecitabine (Xeloda) for cancer left after neoadjuvant chemotherapy (residual disease)

Using targeted therapies in combination with other therapies can help reduce the risk of recurrence for TNBC.

6. New Symptoms Could Signal Recurrence

During and after breast cancer treatment, tell your doctor about any new symptoms 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 discoloration, 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 discoloration or swelling of the skin as a side effect.

If you do experience a relapse of TNBC, there are multiple treatment options available.

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

Metastatic breast cancer can cause different symptoms, depending on where it has spread. The most common places it can spread, and the possible symptoms, include:

• Bones — Bone, 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 to 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 may not be able to have it again. Radiation adds up over your lifetime, so there’s a limit to how much your body can safely receive. Only a radiation oncologist can tell you if more radiation is an option for you. 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. There are immunotherapy options, depending on what gene or protein changes cancer cells contain. For example:

• Pembrolizumab helps the immune system attack cancer by blocking the PD-1 pathway. It may work better in some cancers that have PD-L1.
• Pembrolizumab may also be used if testing shows the cancer is microsatellite instability (MSI)-high, meaning it has trouble fixing DNA damage.
• Poly (ADP-ribose) polymerase (PARP) inhibitors such as olaparib and talazoparib (Talzenna) may help if you have TNBC and mutations (changes) in the BRCA genes.
• Antibody-drug conjugates, such as sacituzumab govitecan-hziy (Trodelvy), are targeted medicines that deliver a chemotherapy drug into cancer cells. They might be tried if tests show that you don’t have any common gene or protein changes, and you’ve already tried other options.

You may also be eligible to participate in oncology 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 were diagnosed with TNBC, talk with your doctor about your chances of a relapse. Your oncologist can help you understand your personal risk factors and tell you if there’s anything you can do to help lower your risk.

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