Recurrent Breast Cancer

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A breast cancer recurrence, or "recurrent breast cancer," is cancer that has come back in the same or opposite breast or chest wall after a period of time when the cancer couldn't be detected.

During surgery to remove an original diagnosis of breast cancer (lumpectomy or mastectomy), the surgeon removes all the cancer that can be seen and felt. But tests for cancer aren't sensitive enough to detect tiny groups of cancer cells that may be left over after surgery. It is possible for isolated groups of cells to survive radiation therapy and chemotherapy intended to reduce the risk of recurrence. Even a single cell that escaped treatment may be able to multiply and grow into a tumor.

Breast cancer can come back in three general areas:

  • the breast area where the cancer was originally diagnosed; this is called local recurrence
  • the lymph nodes in the armpit or collarbone area near where the cancer was originally diagnosed; this is called regional recurrence
  • another part of the body such as the lungs, bones, or brain; rarely, the opposite breast; this is called metastatic or distant recurrence

Some doctors believe that local and regional breast cancer recurrence share many of the same characteristics, so they may use the term "locoregional" recurrence.

Research has shown that the "personality" of the cancer may change when breast cancer comes back. For example, the hormone-receptor status may change from hormone-receptor-positive to hormone-receptor-negative. The HER2 status also may be different than the original breast cancer. If you were already treated for breast cancer and now have a new diagnosis of recurrent breast cancer, your doctor may want to biopsy the area of metastasis to find out whether there have been any changes in hormone-receptor or HER2 status.

Local Recurrence

A local breast cancer recurrence means that the breast cancer has come back in or near the same place it was originally found in the breast.

Symptoms of local recurrence

A local breast cancer recurrence may lead to any of the following symptoms:

  • a new lump in the breast
  • a new area of the breast that seems unnaturally firm
  • redness or swelling of the skin in or around the breast area
  • flattening or other changes to the nipple
  • bumps on or under the skin of the chest wall
  • new pulling of skin or swelling at the lumpectomy site
  • a new thickening on or near the mastectomy scar

After breast cancer surgery and radiation, the entire breast area can be swollen and red for as long as a few months. But if you have concerns about any changes you notice in your breasts, talk to your doctor. Redness also can be a sign of infection, so it's a good idea to have your doctor look at any areas of concern.

If you had a mastectomy and had your breast reconstructed, you may get harmless lumps caused by a build-up of scar tissue or dead fat cells in the reconstructed breast. These types of lumps aren't cancer. Still, your doctor needs to know about any lumps you feel in your breast so they can be monitored for any change in size or tenderness. Since mastectomy and reconstruction usually removes all of the breast tissue and replaces it with other tissue and/or an implant, mammogram is not usually recommended for reconstructed breasts. Your doctor can monitor any new lumps on a reconstructed breast by performing a clinical breast exam. He or she may also recommend additional screening methods such as MRI.

Tests to diagnose local recurrence

If you had a lumpectomy and experience a new lump later, your doctor will likely have you get a mammogram. If the results of the mammogram are unclear or suspicious, your doctor may want you to have an ultrasound, an MRI, or a PET scan. If these tests suggest a recurrence, you doctor will biopsy the lump.

To learn more about tests used to screen for recurrence, please visit the Breast Cancer Tests: Screening, Diagnosis, and Monitoring section.

Treatment for local recurrence

If you have local breast cancer recurrence (cancer that comes back in the same area it was originally diagnosed), and your original treatment was lumpectomy and radiation therapy, your doctor may recommend mastectomy. Doctors very seldom recommend having a second lumpectomy to treat local recurrence; it's usually only an option if you've never had radiation before and the risk of the cancer spreading is very, very low.

If breast cancer comes back in a reconstructed breast, your doctor may recommend that the implant or skin flap used to rebuild the breast be removed. It’s possible that at a later time the breast can be fully reconstructed again. You can discuss your options with your medical oncologist and plastic surgeon.

If breast cancer comes back locally, your doctor may recommend some or all of the following treatments, depending on the characteristics of the cancer:

  • surgery to remove the affected lymph nodes
  • chemotherapy
  • radiation therapy
  • hormonal therapy if the cancer is hormone-receptor positive
  • targeted therapy

If you’re diagnosed with a local recurrence of breast cancer, you and your doctor will decide on a treatment plan based on the characteristics of the cancer. Visit the Treatments and Side Effects section for more detailed information on types of treatment.

Regional Recurrence

A regional breast cancer recurrence means that the breast cancer has come back in the lymph nodes in the armpit or collarbone near the area where the cancer was originally detected.

Symptoms of regional recurrence

A regional breast cancer recurrence may lead to any of the following symptoms:

  • a lump or swelling in the lymph nodes under the arm, above the collarbone, or near the breastbone
  • swelling in the arm on the same side where the breast cancer was first found
  • constant pain in the arm and shoulder
  • loss of feeling in the arm and shoulder
  • constant pain in the chest
  • problems swallowing

Tests to diagnose regional recurrence

For people who’ve had lumpectomy in the past and experience any of the above symptoms, doctors will often recommend mammograms. Mammograms can sometimes detect enlarged lymph nodes. If you have an enlarged lymph node or any of the other symptoms of regional recurrence, your doctor will biopsy the lymph nodes to determine if the cancer has come back. Your doctor also may want you to have an ultrasound, an MRI, CT, or a PET scan.

For people who’ve had mastectomy in the past and experience any of the above symptoms, doctors will most likely recommend a PET scan or a CT scan.

To learn more about tests used to screen for recurrence, please visit the Breast Cancer Tests: Screening, Diagnosis, and Monitoring section.

Treatment for regional recurrence

If breast cancer comes back in the lymph nodes in the armpit or collarbone, your doctor may recommend some or all of the following treatments, depending on the characteristics of the cancer:

  • surgery to remove the affected lymph nodes
  • chemotherapy
  • radiation therapy if the area has never been treated with radiation
  • hormonal therapy if the cancer is hormone-receptor positive
  • targeted therapy

If you’re diagnosed with a regional recurrence of breast cancer, you and your doctor will decide on a treatment plan based on the characteristics of the cancer. Visit the Treatments and Side Effects section for more detailed information on types of treatment.

Metastatic, or Distant, Recurrence

When breast cancer comes back in other areas of the body, it is called "metastatic." Metastatic breast cancer is stage IV breast cancer.

The most common breast cancer metastasis sites are the bones, the lungs, the brain, and the liver. Symptoms can vary depending on the location, and can include bone pain, numbness or weakness anywhere in the body, constant dry cough, loss of appetite, severe headaches, vision problems, constant nausea, weight loss, seizures, loss of balance, or confusion.

Tests to diagnose a metastatic breast cancer recurrence include blood tests, X-ray, MRIs, CT scans, PET scans, bone scans, and biopsy.

For more detailed information about symptoms and treatment of metastatic breast cancer, whether the metastasis is a recurrence or a first-time diagnosis of breast cancer ("de novo metastatic"), visit Metastatic Breast Cancer Symptoms and Diagnosis.


The medical experts for Recurrent Breast Cancer are:

  • Marisa Weiss, M.D., chief medical officer of Breastcancer.org; breast radiation oncologist, Lankenau Medical Center, part of Main Line Health, a five-hospital health system in the suburbs of Philadelphia, PA
  • Brian S. Wojciechowski, M.D., medical oncologist, Crozer-Keystone Health System, Philadelphia area, PA; Breastcancer.org medical adviser
  • Sameer Gupta, M.D., M.P.H., medical oncologist, Bryn Mawr Hospital, Bryn Mawr, PA

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