Breast Cancer 10-Year Recurrence Risk Linked to Estrogen Receptor Status, Other Factors
The factors that affect the risk of early-stage breast cancer coming back 10 or more years after diagnosis — called late recurrence risk by doctors — include the size of the cancer, the number of lymph nodes that contain cancer, and whether the cancer is estrogen receptor-positive, according to a Danish study.
Overall, the study found that recurrence happened up to 32 years after diagnosis. This is the first time research has shown that breast cancer recurrence risk lasts longer than 30 years.
The research was published online on Nov. 8, 2021, by the Journal of the National Cancer Institute. Read the abstract of “The Incidence of Breast Cancer Recurrence 10-32 Years after Primary Diagnosis.”
About breast cancer recurrence
During surgery to remove early-stage breast cancer, surgeons try to remove all the cancer. But in some cases, there may be individual cancer cells in other places in the body. Treatments after surgery — such as hormonal therapy, chemotherapy, and targeted therapies — aim to destroy any cancer cells left behind and reduce the risk of recurrent breast cancer.
The risk of recurrence is unique to each person diagnosed with early-stage breast cancer and depends on a number of factors.
About the study
Because of more and more effective treatment options, the number of people alive with a history of early-stage breast cancer has been increasing each year. According to the American Cancer Society’s Breast Cancer Facts & Figures 2019-2020, more than 3.8 million U.S. women with a history of breast cancer were alive on Jan. 1, 2019. Some of the women were cancer-free and others still had evidence of cancer and were likely receiving treatment.
Many doctors talk about cancer survival in terms of five-year survival rates. This means the cancer hasn’t come back in the five years after diagnosis. But it doesn’t mean the cancer can’t come back more than five years after diagnosis. Research suggests that estrogen receptor-positive breast cancer is more likely to come back more than five years after diagnosis.
In this study, the researchers looked at the risk of late breast cancer recurrence, meaning the breast cancer came back 10 or more years after diagnosis. They also looked for any factors linked to the risk of late recurrence.
The researchers looked at information from 20,315 Danish women diagnosed with early-stage breast cancer between January 1987 and December 2004. None of the women had experienced a recurrence in the 10 years after diagnosis, so they were considered 10-year disease-free survivors.
The researchers followed the women starting 10 years after diagnosis and for up to 22 more years. This means they followed some of the women for 32 years after diagnosis.
At diagnosis:
half the women were younger than 55 and half were older
nearly 60% of the women were diagnosed between 1992 and 2001
62.5% of the women were post-menopausal
46.1% of the women had stage I breast cancer
44.5% of the women had stage II breast cancer
8.8% of the women had stage III breast cancer
64.1% of the women had negative lymph nodes, meaning there was no cancer in the lymph nodes
65.6% of the cancers were 2 centimeters or smaller in size
54% of the cancers were estrogen receptor-positive
52.4% of the women had a mastectomy
33.8% of the women had a lumpectomy and radiation therapy
27% of the women received chemotherapy
65.5% of the women received hormonal therapy
During follow-up, 2,595 women had a breast cancer recurrence:
1,234 recurrences happened 10 to 12 years after diagnosis
646 recurrences happened 13 to 15 years after diagnosis
353 recurrences happened 16 to 18 years after diagnosis
210 recurrences happened 19 to 21 years after diagnosis
105 recurrences happened 22 to 25 years after diagnosis
47 recurrences happened more than 25 years after diagnosis
Factors linked to a higher risk of late recurrence were:
having more positive lymph nodes
having a larger tumor
being a younger woman
being diagnosed with estrogen receptor-positive cancer
having lumpectomy versus mastectomy
“Our observed high cumulative incidence of late breast cancer recurrence is a concern given the increasing prevalence of long-term survivors,” the researchers wrote. “Our findings suggest that a subset of patients — with larger tumors, positive lymph nodes, or [estrogen receptor]-positive disease — are at risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapies.”
What this means for you
If you’ve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.
If you were diagnosed with hormone receptor-positive, early-stage breast cancer, it’s likely that your doctor will recommend you take some type of hormonal therapy medicine — either tamoxifen or an aromatase inhibitor depending on your menopausal status — for five to 10 years after surgery.
Chemotherapy after surgery is usually completed in three to six months. If you’re also receiving a targeted therapy, such as Herceptin (chemical name: trastuzumab), with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.
Radiation therapy after surgery can be completed in one to seven weeks.
So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early, in many cases because of troubling side effects.
Still, as this study shows, breast cancer — especially hormone receptor-positive breast cancer — can come back 10 to 30 years after diagnosis. So it’s very important that you take the medicine for as long as it’s prescribed and at the prescribed dose.
If you’re having troubling side effects, talk to your doctor right away. Don’t wait until the symptoms are intolerable and you have to stop taking the medicine. There are steps you can take to ease these side effects, including switching to a different type of hormonal therapy.
Learn more about Staying on Track With Treatment. You can read about why it’s so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.
— Last updated on January 21, 2025 at 4:01 PM