Breast cancer recurrence happens when cancer comes back after early treatment. The cancer cells may have survived without being seen and then later multiplied. While most people won't have cancer come back, everyone with breast cancer does face the chance it will. The odds are different for each person.
"The type of breast cancer impacts when the recurrence may occur," says Eleonora Teplinsky, MD, a clinical assistant professor of medicine at Icahn School of Medicine at Mount Sinai and head of breast and gynecologic medical oncology at Valley Health System in Paramus, NJ. "For example, the risk of recurrence for a triple-negative breast cancer is greatest in the first 5 years after diagnosis, whereas the risk of recurrence of a hormone receptor-positive breast cancer persists for a longer period."
There are many things your doctor can look at to decide what your risk level is, and that can help them suggest the best course of action for you. Along with your treatment plan, there are also a few things you can do to help lower your odds of early breast cancer recurrence.
How Doctors Estimate Your Risk of Recurrence
Your doctor will consider different risk factors for breast cancer recurrence than for first-time breast cancer. They'll mostly look at the makeup of your breast cancer to estimate how likely you are to have it again. Other things they'll take into account include:
Your age. The younger you were when you were first diagnosed, the higher the odds of breast cancer coming back. Generally, if you were younger than 35, your chances are higher. Your age also affects whether you're menopausal, which can change the choices your doctor offers you after finding out your likelihood of having cancer again.
Cancer type, stage, and size. Higher-stage and larger tumors have higher odds of recurrence. Certain aggressive types of breast cancer – like early-stage triple-negative breast cancer or inflammatory breast cancer – more commonly come back.
Hormone receptor status. HR-positive cancers are more likely to come back after 10 years or more.
HER2 status. HER2-negative cancers are less likely to come back than positive.
Number of lymph nodes that have cancer. The more you have, the more likely the cancer might come back.
Previous treatment. Your doctor will consider any treatment you've had and your reaction to it.
How fast the tumor grows. Your care team may run a test to see how quickly cancer cells in a tumor are growing to help decide your risk recurrence level.
Tumor profiling tests. These genomic tests – the most popular ones being the MammaPrint and Oncotype DX – look at specific genes in your cancer cells to help estimate the likelihood that the cancer could come back.
Risk calculators. Doctors may use calculators like the NHS Predict tool or CTS5 Calculator to gauge whether you have a higher chance of recurrence down the road.
How Does Risk of Recurrence Change Treatment Choices?
Your risk level – even with early breast cancer – will play a role in choosing your first treatment for HR+/HER2- cancer and any steps afterward.
"The first decision is how high is the risk? Do you need chemotherapy or not? And if you need chemotherapy, which one?" says Generosa Grana, MD, director of the MD Anderson Cancer Center at Cooper and a professor of medicine at Cooper Medical School of Rowan University. "The next decision is always going to be endocrine [hormone] therapy."
Doctors offer chemotherapy if you have a high chance of recurrence because it does a lot to lower your odds. They might couple this with hormonal therapy, too, for high risk. Chemo may also be a choice if you have a medium chance of cancer coming back. Your doctor might choose to skip chemotherapy and just move forward with endocrine therapy if you are less likely to get cancer again.
Issues to bring up with your doctor
It’s important to speak up and get more information from your care team so you can advocate for yourself as you weigh different treatment paths and your chance of recurrence.
"The selection of treatment always has to take the patient's values and perspective into the equation, because for some women, lowering the risk by 2% or 3% may be enough to walk to the moon," Grana says. "And for other women, that 2% to 3% is not enough for them to put themselves through five years of endocrine therapy."
Share any hesitations or concerns you have with your doctor so they can take them into account. Some things you may also want to ask about to make sure treatment aligns with your goals and needs include:
- Why they're suggesting these specific treatment choices
- If there are guidelines they use to figure out which ones to suggest
- If there's a specific choice they think is best
- The goals of each treatment
- What to expect while getting the treatment
- How the treatment is going to lower your odds of cancer coming back
- The pros and cons of each choice
- When treatment would need to start
- Any potential side effects so you can weigh whether it's worth the benefit
- What can be done to manage any side effects of a certain treatment
What You Can Do to Help Stop the Cancer From Coming Back
While it's not possible to avoid the possibility of cancer returning entirely, there are things that can help. The biggest one is to follow your treatment plan. If you're having any issues along the way, talk to your doctor.
"It's important for patients to be communicating with their oncologist about the side effects that they're having or anything that's preventing them from potentially completing that planned course of therapy," says Jenna Canzoniero, MD, an assistant professor in the Women's Malignancies Program at the Johns Hopkins Sidney Kimmel Cancer Center.
There are also treatments and lifestyle changes you can consider to help keep the chance of breast cancer recurrence as low as possible.
Treatments to help avoid breast cancer recurrence
Many choices after early breast cancer surgery are designed to lower the chances of getting cancer again. They’re called adjuvant therapy.
- Prolonging certain medications, such as targeted therapies with chemo
- Endocrine therapy
- Radiation therapy
- CDK4/6 inhibitor therapy
- Immunotherapy
- PARP inhibitor therapy
Lifestyle changes to help lower the odds of breast cancer recurrence
You can also change your daily habits to support your health and help keep cancer from coming back. Doctors recommend a few main things.
- Exercise and stay at a healthy weight.
- Don’t drink alcohol, or limit how much you drink.
- Eat healthy meals with lots of plants and less processed and red meat.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
American Cancer Society: "Understanding Your Options and Making Treatment Decisions," "Can I Lower My Risk of Breast Cancer Progressing or Coming Back?"
American Society of Clinical Oncology: "Breast Cancer: Types of Treatment."
Breastcancer.org: "Breast Cancer Recurrence Risk."
Canadian Cancer Society: "Risk of recurrence after surgery and additional treatments."
Johns Hopkins Medicine: "Breast Cancer Recurrence."
Mayo Clinic: "Recurrent breast cancer."
Susan G. Komen: "Early Breast Cancer Treatment."
Generosa Grana, MD, director, MD Anderson Cancer Center at Cooper; professor of medicine, Cooper Medical School of Rowan University; Living Beyond Breast Cancer Medical Advisory Board member.
Jenna Canzoniero, MD, MS, assistant professor, Women's Malignancies Program, Johns Hopkins Sidney Kimmel Cancer Center.
Eleonora Teplinsky, MD, clinical assistant professor of medicine, Icahn School of Medicine at Mount Sinai; head of breast and gynecologic medical oncology, Valley Health System, Paramus, NJ; Living Beyond Breast Cancer Medical Advisory Board member.
