Understanding Breast Cancer Recurrence
Breast cancer can come back, or recur, months or years after treatment. This is known as recurrent breast cancer or a breast cancer recurrence.
During surgery to remove the original breast cancer, the surgeon removes all the cancer that can be seen and felt. But a small number of cancer cells may remain after surgery or may survive radiation and chemotherapy. Tests may not be sensitive enough to detect them. Even a single cancer cell that remained after treatment may be able to multiply and grow into a tumor.
The risk of recurrence is unique to each individual and depends on a number of factors. For example, if the original cancer was a larger size or a higher stage, there may be a greater risk of recurrence.
In some cases, a person who has been treated for breast cancer in the past develops a new breast cancer that is unrelated to the first. This is known as a second primary breast cancer, and is different from a breast cancer recurrence.
The process of diagnosing a breast cancer recurrence or second primary breast cancer is similar to diagnosing the original cancer and typically involves some or all of the same tests. When working with you to decide on a treatment plan, your doctors will take into account the treatments you've received in the past.
Local breast cancer recurrence
Local recurrence means the cancer came back in the same breast or in the surgery scar.
The symptoms of a local recurrence are about the same as symptoms of invasive ductal carcinoma:
a new lump in the breast or the chest wall
an area of the breast that feels unnaturally firm
swelling of all or part of the breast
skin irritation or redness in the breast area
flattening or other nipple changes
skin pulling or swelling near the original breast cancer surgery site or thickening of surgery scars
After breast cancer surgery and radiation therapy, the breast area may be swollen and red for a few months after those treatments are completed. This is normal and not usually a sign of breast cancer recurrence. Still, if you have any concerns about any changes you notice in your breasts, talk to your doctor.
If you had a mastectomy and breast reconstruction, you may feel lumps caused by a build-up of scar tissue or dead fat cells in the reconstructed breast. These lumps also usually aren’t cancer, but tell your doctor about any lumps you feel in your breast so they can be monitored.
Diagnosing a local recurrence involves a combination of tests and almost always includes:
Other tests that may be used are:
The stage of a local recurrence is determined by the cancer’s characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor:
figure out your prognosis, which is the likely outcome of the disease
decide on the best treatment options for you
determine if certain clinical trials may be an option for you
The characteristics of a local recurrence may be different from the original breast cancer. For example, the original cancer may have been hormone receptor-negative and the local recurrence may be hormone receptor-positive. This is why your doctor will do tests on the local recurrence. The results of these tests, as well as the results of your biopsy, will be included in your pathology report.
Depending on the characteristics of the cancer, treatments for a local recurrence may include:
hormonal therapy, if the breast cancer is hormone receptor-positive
immunotherapy, if the cancer is triple-negative
Because you’ve received treatment for breast cancer before, you and your doctor will take your previous treatments into consideration when deciding on a treatment plan for the local recurrence.
If your original surgery was lumpectomy, your doctor will probably recommend mastectomy to remove the local recurrence. Doctors usually don’t recommend a second lumpectomy to treat local recurrence.
If the original surgery was mastectomy, a local recurrence near the mastectomy site is usually treated by removing the tumor.
If the local recurrence is in a reconstructed breast, your doctor may recommend removing the implant or tissue flap used to rebuild the breast. (You can discuss options for reconstructing the breast again with your medical oncologist and plastic surgeon.)
If you had radiation therapy as part of your original treatment plan, your doctor will consider the location of the local recurrence and the original dose of radiation you received when deciding if radiation treatment makes sense for the local recurrence.
If you had chemotherapy, hormonal therapy, targeted therapy, or immunotherapy as part of your original treatment plan, your doctor will consider the medicines used when deciding if any of these treatments make sense for the local recurrence.
Regional breast cancer recurrence
Regional recurrence means the cancer came back in the lymph nodes in the armpit or collarbone area near where the original cancer was diagnosed, or in the chest wall or skin of the breast.
The symptoms of a regional recurrence are:
a lump or swelling in the lymph nodes under the arm, above the collarbone or near the breastbone
pain, swelling, or numbness in one arm or shoulder
constant chest pain
Diagnosing a regional recurrence involves a combination of procedures and almost always includes:
Other tests that may be used are:
A regional recurrence is considered locally advanced breast cancer and is usually considered stage III breast cancer.
As with local recurrence, the characteristics of a regional recurrence may be different from the original breast cancer. For example, the original cancer may have been hormone receptor-negative and the regional recurrence may be hormone receptor-positive. This is why your doctor will do tests on the regional recurrence. These tests, as well as the results of your biopsy, make up the parts of your pathology report.
Depending on the characteristics of the cancer, treatments for a regional recurrence may include:
hormonal therapy, if the breast cancer is hormone receptor-positive
immunotherapy, if the cancer is triple-negative
Because you’ve been treated for breast cancer before, you and your doctor will take your previous treatments into consideration when deciding on a treatment plan for the regional recurrence.
If the regional recurrence is in the lymph nodes in the armpit or the collarbone, your doctor will likely recommend surgery to remove the affected lymph nodes.
If you had radiation therapy as part of your original treatment plan, your doctor will consider the location of the regional recurrence and the original dose of radiation you received when deciding if radiation treatment makes sense for the regional recurrence.
If you had chemotherapy, hormonal therapy, targeted therapy, or immunotherapy as part of your original treatment plan, your doctor will consider the medicines used when deciding if any of these treatments make sense for the regional recurrence.
Metastatic recurrence
Metastatic or distant recurrence means the cancer came back in a part of the body away from the breast, such as the liver, bones, or brain. Learn more at Metastatic Breast Cancer.
New (or second primary) breast cancer
A new (or second primary) breast cancer is thought to be unrelated to the first cancer. It may or may not have the same characteristics as the first cancer. For example, it may have the same or a different hormone receptor status. It can develop in the same breast as the first cancer or in the other breast. Most commonly, it develops in the other breast — particularly if most or all of the breast tissue is still intact and wasn't removed during surgery.
People who have a family history of breast cancer and/or certain inherited genetic mutations that raise the lifetime risk of breast cancer, such as a BRCA1, BRCA2, or CHEK2 mutation, have a higher risk of developing a second primary breast cancer.
Follow-up care after treatment for a recurrence or second breast cancer
After treatment for a breast cancer recurrence or second primary breast cancer, people usually transition to receiving follow-up (or “survivorship”) care. Good follow-up care should be customized to your unique needs and typically involves:
monitoring for a breast cancer recurrence or a second primary breast cancer
monitoring for other conditions — such as osteoporosis, heart disease, and certain other types of cancer — that you may be at increased risk for due to treatments you received
long-term treatments such as hormonal therapy
addressing treatment-related side effects
monitoring your overall health and well-being
Most people receive at least some of their follow-up care from an oncology care team. Follow-up care can also be provided by other cancer specialists or by a primary care provider or gynecologist who is knowledgeable about breast cancer. You may want to look into getting your follow-up care through a specialized breast cancer survivorship program or clinic.
Read our special report Beyond Treatment: Expecting More From Your Follow-Up Care and tips on how to get good follow-up care after breast cancer treatment.
This content is supported in part by Lilly; AstraZeneca; Biotheranostics, Inc., A Hologic Company; Pfizer; Gilead; Exact Sciences; Novartis; Seagen; and MacroGenics.
— Last updated on January 22, 2025 at 6:05 PM