Breast Cancer Reccurence

Sometimes breast cancer returns after initial treatment. This is called breast cancer recurrence. Although the good news is that most breast cancer patients will remain in remission, some patients will experience recurrent breast cancer. The likelihood of recurrence depends on the type of breast cancer and the stage of breast cancer at diagnosis. 

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What Are the Types of Breast Cancer Recurrence?

Breast cancer recurrence is categorized as local, regional, or distant based on where it reappears in the body.

• Local recurrence: The cancer returns to the same breast. This could occur in the chest wall, skin, remaining breast tissue, or surgical scar.

• Regional recurrence: The cancer resurfaces in the lymph nodes near the breast but has not spread to distant parts of the body.

• Distant recurrence: The cancer has spread (metastasized) and is affecting other parts of the body, such as the bones, liver, lungs, and brain.

Risk Factors Associated with Recurrent Breast Cancer

The likelihood of breast cancer recurrence depends on several factors, including the initial type and stage of breast cancer diagnosed, the size of the original tumor, and whether any lymph nodes were affected. Prior treatment with radiation therapy or endocrine therapy can decrease the likelihood of breast cancer returning.

Certain lifestyle choices can also affect the risk of recurrence. We know that healthy lifestyle choices like avoiding smoking, maintaining a healthy body weight (goal BMI 18.5 - 25), reducing or avoiding alcohol intake, eating a healthy diet like the Mediterranean diet that is low in processed foods and red meats and rich in plants and fiber, and regular physical activity can all reduce the risk of breast cancer recurrence.

What Are the Symptoms of Recurrent Breast Cancer?

If you still have breast tissue, be sure you have regular mammograms after treatment. This is the best way to detect recurrent breast cancer located in the breast. 

Symptoms of breast cancer recurrence may not appear until the cancer is advanced. If the cancer has grown beyond the breast, your symptoms will depend on where the cancer has returned. Some symptoms may include:


• Swollen lymph nodes in the breast region

• New lumps, swollen areas, or unusual firmness

• Changes in the nipple

• Rash on the breast, nipple, or surgical scar site

• Bone pain, especially in the spine or pelvis

• Persistent chest pain or cough

• Unexplained shortness of breath

• Nausea or loss of appetite

• Unexplained abdominal pain

• Jaundice (yellowing of the skin or white of the eyes)

• Unexplained weight loss

• Seizures

• Numbness or limb weakness

• Severe headaches

If you experience any of these symptoms as a breast cancer survivor, or if you have any new, persistent, or unexplained symptoms, please schedule an appointment with your cancer care team to discuss whether further testing should be done.

Diagnosing Recurrent Breast Cancer

Recurrent breast cancer is most often discovered in one of the following ways:

• Mammography: Your annual mammogram can detect cancer that has returned in the breast or chest wall area.

• Follow-up appointments: During regular visits with your cancer care team, your doctor performs a physical exam and asks about any new symptoms you may be experiencing.

• New symptoms: Sometimes recurrence is first noticed when you develop new concerning symptoms discussed above, such as a new lump, bone pain, or shortness of breath, between scheduled visits.

You may wonder why your cancer team does not order more frequent scans or blood tests to look for recurrence. The National Comprehensive Cancer Network (NCCN) — a leading authority on cancer care — does not recommend routine blood tests, CT scans, bone scans, or PET scans to screen for recurrence in patients who are feeling well and have no new symptoms. Research has not shown that finding a distant recurrence earlier through routine advanced imaging improves outcomes. That is why keeping up with your annual mammograms and regular follow-up visits is so important.

If your doctor suspects the cancer may have returned, additional tests will be ordered to confirm the diagnosis and determine the extent of recurrence. These may include:

• Biopsy: removing a small sample of tissue to examine under a microscope and test for cancer cell characteristics.

• Imaging tests: such as a CT scan, bone scan, MRI, or PET scan to see if and where the cancer has spread.

These results help your care team develop the best treatment plan for your specific situation.

Recurrent Breast Cancer Treatment Options

The treatment options available for recurrent breast cancer depend on factors including where the cancer has come back, the size and extent of recurrence, and what treatments you received before and how long ago you received them. Receptor status is a critical part of the treatment planning process for recurrent breast cancer. Sometimes breast cancers that were originally hormone-positive or HER2-negative can change their receptor status at the time of recurrence. Your doctor may also order biomarker testing, or molecular testing, to look for specific genetic changes that can be treated with targeted therapies.

Learn more about advances in breast cancer treatment.

Your breast cancer doctor will also consider your overall health, personal preferences, and any previous treatments when developing a treatment plan. 

Treating Local Breast Cancer Recurrence

A local recurrence is typically treated with surgery. Women who initially had a lumpectomy are often treated with a mastectomy. For those who have already undergone a mastectomy, the new tumor, nearby lymph nodes, and a margin of healthy tissue will be surgically removed.

Additional treatments may include radiation therapy if not administered during the initial treatment. Other options for treating local breast cancer recurrence may include:


• Hormone Therapy: medications to block estrogen and progesterone, which can be effective for hormone-receptor-positive cancer.

• Targeted Therapy: drugs that circulate in the bloodstream and attach to specific features of cancer cells, such as the HER2 protein, while sparing healthy cells.

• Chemotherapy: strong medicines that circulate in the bloodstream to destroy cancer cells or stop them from growing and spreading throughout the body.

• Immunotherapy: drugs that enhance the body's immune system, enabling it to target and attack cancer cells.

Treating Regional Breast Cancer Recurrence

A regional recurrence typically affects nearby lymph nodes. In this case, any affected lymph nodes, along with any tumors, may be surgically removed. Patients may also receive a combination of radiation therapy, chemotherapy, hormone therapy, or targeted therapy to get rid of any remaining cancer cells.

Treating Distant Breast Cancer Recurrence

Treatment can be more challenging when the recurrence affects distant areas such as the bones, brain, liver, or lungs. This is referred to as metastatic breast cancer. Even though distant recurrence is generally not curable, it is very treatable, and many women live for years with effective treatment.

Surgery is rarely used to treat distant recurrence. Instead, treatment focuses on the whole body using medicines that travel through the bloodstream. These are called systemic treatments, including hormone therapy, chemotherapy, immunotherapy, and targeted therapy. Your cancer care team will choose the best treatment based on the specific type of breast cancer you have and where it has spread. If one treatment stops working, there are often many other options to try. 

The main goals of treatment for distant recurrence are to:

• Shrink the cancer or keep it from growing

• Relieve symptoms caused by the cancer

• Help you maintain the best possible quality of life

It is also very important to treat any symptoms the cancer may be causing, such as pain, nausea, or fatigue. For example, radiation therapy can be very helpful for relieving pain at specific sites where the cancer has spread, such as the bones. 

Your care team may also refer you to a palliative care provider. Palliative care is specialized medical care focused on relieving symptoms and improving quality of life. It is not the same as hospice care, and it can be provided alongside your cancer treatment at any stage.

Comprehensive Breast Cancer Treatment on the Peninsula, Southside, Western Tidewater, and Northeast North Carolina

If you have been diagnosed with a recurrence of breast cancer, our oncologists provide the most up-to-date treatments, including access to breast cancer clinical trials. 

If you are located on the Peninsula, Southside, Western Tidewater, or Northeast North Carolina and need a personalized treatment plan, choose one of our cancer centers in Chesapeake, Elizabeth City, NC, Newport News, Norfolk, Suffolk (Harbour View and Obici), Virginia Beach, and Williamsburg to schedule a consultation. In addition to caring for breast cancer patients we’ve previously treated, we can also see patients we did not treat initially, and we’re also available for second opinions.