Being at "high" risk for being diagnosed with breast cancer is different than being at high risk for a recurrence of breast cancer.
Research shows breast cancer is more likely to come back after treatment in women who had:
- Cancer in the lymph nodes under the arms
- A large tumor
- An aggressive type of cancer
- Negative hormone receptors
- Positive HER2 receptor
Breast cancer can recur or come back in three ways:
- The cancer can return at the original site. This is called a local recurrence.
- The cancer can recur nearby, such as in the chest. This is called a regional recurrence.
- The cancer can spread to a distant location in the body, such as lymph nodes, bone marrow, or lungs. This is called a distant recurrence, or a metastasis.
Your doctor will order more tests to see if the breast cancer has spread, beginning with a physical exam and often a biopsy. The doctor is checking to see if cancer is present and, if so, if it is a recurrence of the same type of cancer or a completely new cancer (which is called a second primary cancer.)
If it is a recurrence, additional tests may include a bone scan, X-rays including CT scan, an MRI, blood tests, and PET scan.
Treatment will depend on whether the recurrence is local, regional, or distant.
- Local recurrence can be treated with a mastectomy if a lumpectomy was originally performed or radiation if a mastectomy has been performed.
- Regional breast recurrence is rare. Treatment may include a combination of surgery, medication, and radiation.
- Treating a distant recurrence of breast cancer that has spread (called metastatic) can include:
- Hormone therapy and/or chemotherapy, depending if your cancer is hormone receptor positive.
- Using radiation therapy to shrink tumors or surgery to remove tumors. This is done to relieve pain or reduce other symptoms.
- Targeted therapy, including Herceptin, if your cancer is positive for the HER2 gene.
- Immunotherapy, if your cancer is negative for hormone receptors and the HER2 gene and has a protein on the tumor cells called PD-L1.
- Enrolling in clinical trials for new chemotherapy or hormone therapy agents.
Before you begin treatment for breast cancer recurrence, print out these Questions to Ask your specialists so you can better understand your care.
For more information, see Breast Cancer Recurrence.
Before treatment begins for metastatic breast cancer, the patient should be well-informed of all their options, including the risks and benefits of treatment. The focus of treatment for metastatic cancer is on extending life and having a good quality of life rather than cure.
This is a time when you may want to get a second opinion.
Women are encouraged to continually reevaluate their breast cancer treatment plan and talk with their health care providers about whether treatment is helping their quality of life. During this time, women should take the best possible care of themselves by:
- Eating right.
- Getting enough rest.
- Seeking out emotional support when needed.
- Possibly making plans in the event their condition worsens.
At some point, the doctor may recommend a hospice program. Hospice care can either be delivered in a patient's home or in a separate facility. The focus of hospice care is to make the woman comfortable and help with arrangements for the future.