Breast Cancer Recurrence Risk
Breast cancer recurrence is when breast cancer comes back after treatment is completed. DCIS or early-stage invasive breast cancer can recur months or years after treatment ends. A 2021 Danish study found that some women had a recurrence up to 32 years after diagnosis.
Breast cancer recurrence can be local (in the same breast), regional (in the lymph nodes or area near the breast), or metastatic (in parts of the body away from the breast).
Doctors don’t know why breast cancer comes back in some people but not in others. It’s important to know that, whatever the reasons, recurrence isn’t your fault.
Breastcancer.org Medical Adviser Brian Wojciechowski, MD, explains how doctors determine a person’s risk of breast cancer recurrence on The Breastcancer.org Podcast.
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Breast cancer risk versus recurrence risk
Everyone who has been diagnosed with breast cancer has some risk of recurrence and this risk is different for each person. Still, when doctors estimate recurrence risk, they look at factors that are different from the risk factors for being diagnosed with a first-time breast cancer.
Although lifestyle factors, such as maintaining a healthy weight and exercising regularly, can help reduce your recurrence risk, the features of the breast cancer are some of the most important factors doctors consider when determining your risk of recurrence. The treatments you have (or don’t have) also affect your risk of recurrence.
Risk factors for breast cancer recurrence
The risk of recurrence is unique to each person diagnosed with DCIS or early-stage breast cancer and depends on the features of the original cancer. Generally speaking, some of the features linked to higher recurrence risk include:
Inflammatory breast cancer: This rare type of breast cancer is usually diagnosed at a more advanced stage and has a high risk of recurrence.
Higher cancer stage: Cancer staging is based on the size of the cancer and the number of positive lymph nodes.
Higher number of positive lymph nodes: The risk of recurrence increases as the number of positive lymph nodes increases, no matter the subtype of the breast cancer.
Larger cancer size: Larger cancers tend to have a higher risk of recurrence than smaller cancers; this is especially true if the lymph nodes have no cancer.
Triple negative breast cancer: This subtype has a higher risk of recurrence than other subtypes, no matter the stage.
HER2-positive cancers: This subtype of breast cancer carries a higher risk of recurrence, regardless of stage.
Higher cancer grade: A higher grade usually, but not always, means a higher risk of recurrence, no matter the subtype of the breast cancer.
Younger age at diagnosis: A 2025 study found that among people diagnosed with breast cancer between the ages of 15 and 39, about 15% had a metastatic recurrence — meaning the cancer came back in a part of the body away from the breast — within five years of being diagnosed.
How often does breast cancer return?
There isn’t an average rate of breast cancer recurrence because the risk of breast cancer coming back depends so heavily on the breast cancer’s features. Each breast cancer and each treatment plan is unique, so doctors have to consider a number of factors when figuring out recurrence risk.
Doctors try hard to estimate each person’s recurrence risk so they can create a personalized treatment plan that keeps that risk as low as possible.
The risk of recurrence also depends on the treatments you receive. For most DCIS and early-stage breast cancer, surgery is considered the main treatment. Treatments after surgery (called adjuvant treatments) — like radiation therapy, hormonal therapy, chemotherapy, targeted therapies, and immunotherapy — aim to destroy any cancer cells that may be left behind after surgery to reduce the risk of recurrence. In some cases, chemotherapy, targeted therapy, and immunotherapy may be used before surgery (called neoadjuvant treatment) to reduce recurrence risk and help determine next steps in treatment.
And so the treatment plan is important. For example, many studies have shown that radiation therapy after lumpectomy lowers the risk of recurrence more than lumpectomy alone.
Depending on the features of the cancer, your doctor may recommend you have a genomic test (also called a genomic assay), which analyzes the activity of specific genes in the cancer cells, to help estimate your risk of breast cancer recurrence and help figure out if chemotherapy would offer benefits.
Breast cancer recurrence rates by stage
In general, higher stage cancers have a higher risk of recurrence. So if you’re diagnosed with stage III breast cancer, you usually have a higher risk of recurrence than someone diagnosed with stage I disease.
But this doesn’t mean all stage III breast cancers come back. And it also doesn’t mean that all stage I breast cancers never come back.
A 2024 meta-analysis that analyzed data from 26 studies found that rates of metastatic recurrence were:
5.9% for people diagnosed with stage I or IIa breast cancer
34.5% for people diagnosed with stage IIb, IIIa, IIIb, and IIIc breast cancer.
It’s important to know that the studies analyzed came from around the world and included some done in countries where the most up-to-date treatments may not be available. For example, metastatic recurrence rates in Africa were more than twice as high as they were in Europe (26.4% vs. 11%).
The treatments a person decides to have also greatly affect recurrence risk by stage. For example, a study of women ages 65 and older diagnosed with stage I hormone receptor-positive breast cancer who had a lumpectomy found that recurrence rates were 3.6% for women who only took hormonal therapy after surgery and 1.4% for women who took hormonal therapy and had radiation after surgery.
Breast cancer recurrence rates by subtype
In general, breast cancers considered more aggressive, such as triple-negative, inflammatory, and HER2-positive breast cancer have higher rates of recurrence.
But the length of time after diagnosis also plays a role in determining recurrence rates by breast cancer subtype.
Triple-negative breast cancer is more likely to recur within five years of diagnosis. This applies to stages I to III. If the cancer doesn’t recur within five years, it’s unlikely you’ll have a recurrence.
Hormone receptor-positive breast cancer is much different. Research shows that hormone receptor-positive disease can come back 10, 20, or even 30 years after diagnosis.
A study found that the risk of recurrence of hormone receptor-positive early-stage breast cancer is about 1%, on average, each year for at least 20 years. This is why sticking to your long-term treatment plan is so important. (If you have side effects that make you want to stop treatment, talk to your doctor about your options.)
How to lower your risk of breast cancer recurrence
Following the treatment plan completely and as scheduled is the best way to destroy any cancer cells that may be left behind after surgery. Healthy habits, like maintaining a healthy weight and not drinking alcohol, also help to lower risk.
Keeping up with your treatments
It can be hard to stick with treatments, especially when you have to do it for long periods of time, but doing so can drastically lower your recurrence risk. While radiation after surgery can be completed in a matter of weeks, other treatments can go for months. And then there’s hormonal therapy, which most people take for five to 10 years after surgery for hormone receptor-positive breast cancer.
The length of time people have to take hormonal therapy, along with side effects that can be very troubling for some people, mean that starting and sticking to hormonal therapy treatment can be challenging. Research suggests that up to 25% of people prescribed hormonal therapy after surgery for hormone receptor-positive breast cancer either don’t start the medicine or stop taking the medicine early. But taking hormonal therapy medicines as prescribed can reduce recurrence risk by up to 50%.
It’s important to let your doctor know about any side effects you have — from hormonal therapy as well as other treatments — as soon as they start. Don’t wait until they become so severe that you decide to stop treatment. In many cases, there are medicines or other techniques, such as exercise or acupuncture, that can help ease side effects. You also may be able to switch to a different treatment or a different dose that causes fewer or less severe side effects.
Lifestyle changes that can lower your recurrence risk
Besides staying on track with your treatment plan, there are lifestyle changes you can make to keep you as healthy as possible and your recurrence risk as low as it can be.
Maintain a healthy weight: Research suggests that carrying extra weight raises the risk of breast cancer recurrence.
Exercise regularly: A number of studies have shown that women who exercise have a lower risk of recurrence. Exercise also can help you maintain a healthy weight.
Eat a healthy diet: Most of the research on diet and recurrence risk has looked at broad eating patterns, not at specific foods. It’s not clear if following any specific diet can lower recurrence risk. But we do know that eating a variety of foods rich in the nutrients you need — and avoiding ultra-processed foods — helps you be as healthy as possible.
Avoid or limit alcohol: Drinking alcohol can increase the risk of a first-time breast cancer, the link between alcohol and breast cancer recurrence is not as clear. We know that alcohol can raise levels of estrogen in the body, which can make hormone receptor-positive breast cancer cells grow. Many doctors recommend that anyone who’s been diagnosed with breast cancer avoid or limit alcohol.
