Breast cancer recurrence

1. What is recurrence?
2. Types of recurrence 
3. Symptoms of recurrence 
4. Diagnosis
5. Treatment for recurrence 
6. Recurrence and prognosis 

1. What is recurrence? 

Recurrence is the term used for cancer that has come back after treatment. 

There are several different types of breast cancer recurrence, depending on where in the body the cancer has returned.

Recurrence means the same breast cancer has come back. It is not a new breast cancer, although people who have had breast cancer also have a slightly higher risk of developing a new primary breast cancer. 

2. Types of recurrence 

Local recurrence 

If breast cancer comes back in the chest, breast or armpit area, or in the skin near the original site or scar, it’s called local recurrence. 

Having local recurrence doesn’t mean the cancer has spread.

Locally advanced breast cancer (sometimes called regional recurrence) 

If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, it’s called locally advanced breast cancer.  Sometimes breast cancer is locally advanced when it is first diagnosed.

People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.

Find out more about breast cancer stages.

Secondary breast cancer

Sometimes breast cancer cells can spread from the primary cancer in the breast to other parts of the body. This is called secondary or metastatic breast cancer. 

Secondary breast cancer commonly affects the bones, lungs, liver and brain.

3. Symptoms of recurrence

Find out about the symptoms of breast cancer recurrence, including tips on coping with worries about your cancer returning. 

Sometimes a breast cancer recurrence may be found during a mammogram or scan before it causes any symptoms. 

4. Diagnosis

Diagnosing a local or regional recurrence usually involves similar tests to those used to diagnose primary breast cancer. 

You will usually have a breast or chest examination to assess any symptoms followed by one or more of the following tests:

• mammogram
• ultrasound scan
• core biopsy
• punch biopsy
• fine needle aspiration (FNA)

If you are diagnosed with a local or regional recurrence, your doctors may use tests to check if there is cancer in any other parts of your body before starting treatment. 

This doesn’t necessarily mean they think your cancer has spread, but your doctors will want to check to make sure you’re being offered the most appropriate treatment. 

Tests may include blood tests, a bone scan, chest x-ray, CT scan, MRI scan or PET scan.

Diagnosing secondary breast cancer involves different tests depending on what symptoms you have and where they are in the body.

Find out more about tests for secondary breast cancer.  

5. Treatment for recurrence 

Treatment for local recurrence 

Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.

Surgery

If you had breast-conserving surgery (also known as wide local excision or lumpectomy) then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.

If you previously had a mastectomy, surgery may be possible to remove the affected areas.

Nearby lymph nodes may also be removed.

Radiotherapy

Radiotherapy is usually only an option if you haven’t previously had radiotherapy in the same area.

The way radiotherapy is given for a recurrence is similar to how it’s given to someone newly diagnosed. 

Radiotherapy may be offered if surgery isn’t possible. 

Hormone therapy

If the cancer is oestrogen receptor positive you may be offered hormone therapy.

Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.

Chemotherapy

It’s not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases. 

If you have previously had chemotherapy then different chemotherapy drugs may be used.

Targeted therapy

Targeted therapies are a group of drugs that block the growth and spread of cancer.

The most widely used targeted therapies are for HER2 positive breast cancer.

Treatment for locally advanced breast cancer (regional recurrence)

Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body (known as systemic treatment). 

This might be chemotherapy, hormone therapy or targeted therapy.

Chemotherapy

If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.

Hormone therapy

If the cancer is oestrogen receptor positive you may be offered hormone therapy. 

If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.

Targeted therapy

Targeted therapies are a group of drugs that block the growth and spread of cancer.

The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.  

Radiotherapy and surgery 

You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. It’s not usually possible to remove the cancer using surgery in this situation.

If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.

When recurrence affects the skin of the breast, treatment will usually consist of systemic treatment. Surgery or radiotherapy may also be offered but this will depend on the amount of skin affected, its position and any previous radiotherapy treatment you have had. Some people with locally advanced breast cancer may be offered electrochemotherapy, which combines a low dose of a chemotherapy drug with electrical impulses.

Treatment for secondary breast cancer 

If breast cancer has spread to another part of the body, it can be treated but it cannot be cured.

The aim of treatment for secondary breast cancer is to:

• control and slow down the spread of the cancer
• relieve symptoms
• maintain health and wellbeing
• give you the best quality of life for as long as possible

Find out more about treatment for secondary breast cancer. 

6. Recurrence and prognosis

If your breast cancer has come back, your outlook (or prognosis) will depend on the type of recurrence.

Find out more about recurrence and prognosis.