• Breast cancer sometimes comes back, even if it can no longer be detected after you complete treatment.
• Details about your type of breast cancer, such as estrogen receptor (ER) status, can influence if and when you might have a recurrence.
• HER2-positive breast cancer, triple-negative breast cancer (TNBC), and inflammatory breast cancer (IBC) have higher recurrence rates than other types.

After you complete breast cancer treatment, your doctor will monitor you closely to make sure your cancer doesn’t come back. Almost 30 percent of people with breast cancer experience a recurrence in the first five years after treatment. If breast cancer comes back after treatment, it’s called recurrent breast cancer.

Your health history, which treatment you receive, and the type of breast cancer you have will influence your risk of breast cancer recurrence. Read on to learn about steps you can take to help lower your risk for recurrence and to help catch cancer early if it does recur.

What Is Recurrent Breast Cancer?

A breast cancer recurrence is breast cancer that has come back after a period of time when it could not be detected after completing initial therapy. Sometimes after surgery, chemotherapy, or radiation, some breast cancer cells remain and cause breast cancer to come back months or years after you have completed treatment and cancer can no longer be detected.

If you develop cancer, your doctor will run tests to see if it is the same type of cancer or a different type. Cancer found in other parts of the body, or even in the other breast, is called second cancer, not a recurrence. Even if you have had a mastectomy, it’s still possible to develop recurrent breast cancer.

There are three different types of breast cancer recurrence:

• Local recurrence — Cancer that comes back in the same breast or in the surgery scar with no signs that cancer has spread outside the breast
• Regional recurrence — Cancer that comes back outside the breast but nearby in the lymph nodes close to where the cancer started, like under the arm or near the collarbone or chest wall
• Distant recurrence — Cancer that comes back in a different part of the body than where it started, like the liver, bones, or brain

Why Does Breast Cancer Recur?

Several risk factors increase the likelihood of recurrence:

• The most important factor is whether cancer was found in the lymph nodes when breast cancer was first diagnosed. More lymph nodes involved indicates a higher chance of recurrence.
• Those who are diagnosed with breast cancer before the age of 35 are more likely to have more aggressive cancer.
• Those who are diagnosed with breast cancer before menopause have a higher risk of recurrence.
• Those who have larger tumors (bigger than 2 centimeters) have a higher risk of recurrence.
• Those who smoke have an increased risk of recurrence.

Timing of Breast Cancer Recurrence

When or whether breast cancer recurs is different for everyone. It depends on the type of cancer and treatment and unique factors different for each person.

The risk of recurrence is the highest in the first five years after treatment, especially in the first two years. The risk of recurrence slowly decreases every year after treatment until 10 years, after which the risk remains about the same.

Recurrence Rates for Different Types of Breast Cancer

The type of breast cancer is defined by the details of cancer cells. Your doctor will run tests on the cancer cells from a biopsy (a procedure to remove a piece of tissue or a sample of cells from your body) to see what type of cancer you have.

It is possible to have multiple types of breast cancer tumors at the same time or to have a tumor with characteristics of several different types.

Hormone Receptor Status

Hormone receptors can be present on normal breast cells and some breast cancer cells. Two hormones, estrogen and progesterone, attach to these receptors (proteins) on the surface of the cell and encourage cell growth. Breast cancer cells can have one, both, or neither of these receptors. Breast cancers can be called hormone receptor-positive or hormone receptor-negative based on whether the cancer cells have the hormone receptor.

Estrogen receptor status can help your doctor predict your risk of recurrence. However, more research is needed to see if progesterone receptor status can also predict recurrence.

People with estrogen ER-negative breast cancer can experience early recurrences (within five years after treatment) more often than those with ER-positive breast cancer. However, ER-positive breast cancer is more likely to recur later, more than five years after treatment is completed.

HER2 Status

Between 15 percent and 20 percent of breast tumors have higher levels of a protein that helps cells grow faster, known as human epidermal growth factor receptor 2 (HER2). When breast cancer cells have higher than normal levels of HER2, it is known as HER2-positive breast cancer. HER2-positive breast cancer is an aggressive type of breast cancer that has a high risk of recurrence.

Targeted drugs, like trastuzumab (Herceptin), have improved the outlook for people with HER2-positive breast cancer. However, about 20 percent of people with HER2-positive cancer develop a recurrence even when treated with targeted drugs.

Triple-Negative Breast Cancer

Triple-negative breast cancer cells do not have estrogen receptors, progesterone receptors, or HER2. TNBC often occurs at a younger age and usually grows and spreads quickly.

About 40 percent of people with TNBC develop recurrent breast cancer.

Inflammatory Breast Cancer

Inflammatory breast cancer is a type of invasive ductal carcinoma that accounts for 1 percent to 5 percent of all breast cancers. It can grow and spread quickly, often involving the lymph nodes. IBC tends to occur at a younger age.

IBC is associated with early recurrence. One study found that almost 65 percent of people with IBC experienced a recurrence in the first five years after diagnosis. In contrast, about 43 percent of those with other types of locally advanced breast cancer had a recurrence within the same time period after treatment.

What Are the Symptoms of Breast Cancer Recurrence?

It’s important to know the signs and symptoms of recurrence to watch out for. The symptoms can be different depending on where the cancer comes back.

If you have a recurrence in the same area as your initial breast cancer, you may notice:

• A new lump in your breast
• New lumps on the armpit or collarbone
• Changes in your breast shape or size
• Changes to your nipple
• Nipple discharge
• Changes to the skin of your breast

If you have a recurrence in a different part of your body, you may notice:

• Tiredness
• Changes in appetite
• Weight loss without trying
• Severe headaches
• Pain that won’t go away
• Nausea

How Can You Prevent Recurrence?

Breast cancer treatments like surgery, radiation, chemotherapy, hormone therapy, and targeted therapy can help reduce the risk of recurrence.

After you complete breast cancer treatment, your doctor will follow up with you several times a year to watch for signs of recurrence. You may also need a mammogram once or twice a year if you had breast-conserving surgery.

People with hormone-positive cancers may reduce their risk of recurrence by taking hormone therapy such as tamoxifen (Nolvadex).

There is no way to guarantee breast cancer won’t come back, but you can decrease the likelihood of recurrence if you maintain a healthy weight, stop smoking, and exercise regularly.

There have been great advances made in the treatment of breast cancer. The actual recurrence rate now, with current treatments, may be lower than existing studies reflect. This is because there hasn’t been enough time for clinical trials to show the effect of newer treatments. Even newly published studies include people diagnosed and treated years ago.

If you develop recurrent breast cancer, there are now more treatments than ever.

Talk With Others Who Understand

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

Do worries about breast cancer recurrence affect your daily life? Have you found ways to manage those concerns? Share your experience with recurrence or fear of recurrence in the comments below, or start a conversation by posting on your Activities page.