Breast Cancer Recurrence Risk

Breast cancer recurrence means DCIS or early-stage breast cancer comes back after initial treatment is completed. 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.

Doctors don’t know why breast cancer comes back for some but not for others. It’s important to know that, whatever the reasons, recurrence isn’t your fault.

 

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Beyond Treatment: How to Get the Follow-Up Care You Need

 

Listen to a podcast with Breastcancer.org Medical Adviser Brian Wojciechowski, MD, explaining how doctors determine a person’s risk of breast cancer recurrence.

Breast Cancer Recurrence Risk

Jun 9, 2021

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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 consider different factors than the risk factors for a first-time breast cancer.

Although lifestyle factors, such as maintaining a healthy weight and exercising regularly, can help reduce your recurrence risk, the characteristics of the breast cancer are the main factors doctors consider when determining your risk of recurrence. How closely you follow your treatment plan also can affect the risk of recurrence.

There is no way to figure out an average risk rate for breast cancer recurrence because the risk of breast cancer coming back mainly depends on the breast cancer’s characteristics. Each breast cancer and each person’s treatment plan are unique, so doctors have to consider a number of factors when figuring out recurrence risk.

Doctors work very hard to estimate recurrence risk so they can create a tailored treatment plan after surgery that keeps recurrence risk as low as it can be. Treatments after surgery may include hormonal therapy, chemotherapy, targeted therapies, and immunotherapy to destroy any cancer cells left behind after surgery and reduce the risk of recurrence.

Depending on the characteristics of the cancer, your doctor may recommend you have a genomic test (also called a genomic assay), which analyzes specific genes in the cancer cells, to help estimate your risk of breast cancer recurrence.

Listen to a podcast with Breastcancer.org Medical Adviser Brian Wojciechowski, MD, discussing the six genomic tests used for breast cancer.

Genomic Assays: What Are the Different Kinds and How Do They Work?

Jul 28, 2023

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The risk of recurrence is unique to each person diagnosed with DCIS or early-stage breast cancer and depends on the characteristics of the original cancer, including:

Cancer stage: In general, the higher the stage, the higher the risk of recurrence.

Cancer size: Larger cancers tend to have a higher risk of recurrence than smaller cancers.

Number of positive lymph nodes: Lymph nodes that contain cancer are called positive. The more positive nodes, the higher the risk of recurrence.

Hormone receptor status: Estrogen receptor-positive cancers have a higher risk of recurring 10 or more years after diagnosis. Hormone receptor-negative cancers have a higher risk of recurring in the first five years after diagnosis.

HER2 status: Cancers that are HER2-positive have a higher risk of recurrence than cancers that are HER2-negative.

Age at diagnosis: The younger you are when you’re diagnosed, the higher the risk of recurrence. Someone who is, say, age 45 when diagnosed is likely to live many years during which the cancer might come back than someone who is older when diagnosed, say age 75.

Cancer subtype: More aggressive breast cancer subtypes have higher recurrence rates. Research suggests that about 40% ¹ of people diagnosed with early-stage triple-negative breast cancer are likely to have a recurrence and up to 50% of people ² diagnosed with inflammatory breast cancer are likely to have a recurrence. These two subtypes are more likely to recur than other subtypes of breast cancer.

One of the best ways to keep your risk of recurrence as low as it can be is to stay on track with your treatment plan after surgery.

Following the treatment plan completely and as scheduled is the best way to destroy any cancer cells that may be left behind 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. If you’re receiving an immunotherapy medicine, such as Keytruda (chemical name: pembrolizumab) with chemotherapy, you may continue to receive Keytruda for up to nine months after completing chemotherapy.

Radiation therapy after surgery can be completed in one to seven weeks.

Most people take hormonal therapy medicine 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.

It’s important to let your doctor know about any side effects you have as soon as they start, especially hormonal therapy side effects. 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 acupuncture, that can help ease side effects. You also may be able to switch to a different treatment that causes fewer or less severe side effects.

It’s also important to remember that hormonal therapy medicines help reduce recurrence risk most effectively when you take them as prescribed.

Let’s say you’ve been diagnosed with early-stage, hormone receptor-positive breast cancer and have had surgery to remove the cancer. Your doctor has told you your risk of recurrence is 14%. This is your absolute risk of recurrence.

Your doctor recommends that you take Arimidex (chemical name: anastrozole), an aromatase inhibitor, for 10 years after surgery to reduce the risk of the hormone receptor-positive cancer coming back. Your doctor tells you the hormonal therapy medicine can reduce your risk of recurrence by 50%. This 50% decrease is relative risk. It means your absolute risk will be 50% lower if you take 10 years of Arimidex.

Since your risk of recurrence is 14%, reducing it by 50% would mean your risk would be 7% lower (.5 x .14 = .07). And 14%-7%=7%. So your risk would go from 14% to 7%.

Learn more about absolute and relative 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, but 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 processed foods — helps you feel good and gives you energy.

Avoid or limit alcohol: Although we know that 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. So many doctors recommend that anyone who’s been diagnosed with breast cancer avoid or limit alcohol.