The goal of treating early stage and locally advanced breast cancer is to remove the cancer and keep it from coming back (called recurrence or relapse). With modern treatment, rates of survival without recurrence continue to improve. Unfortunately, there is always a chance that breast cancer may return. However most people diagnosed with breast cancer will never have a recurrence. Follow-up medical care helps ensure any recurrence is properly treated.
Understanding more about breast cancer recurrence and what your follow-up care should (and should not) include may help you feel more in control of your health. It may also help you to discuss these topics with your health care provider.
Breast cancer can recur at the original site (called recurrence or local recurrence), as well as spread to other parts of the body (called metastasis or distant recurrence).
The chance of breast cancer recurrence varies from person to person. It depends on the original diagnosis, the types of treatment given and many other factors. Most recurrences occur within the first 10 years after treatment.1-2
Talk to your health care provider about your chances of recurrence during follow-up visits. He/she will discuss any signs of recurrence and ask you about any symptoms or concerns you may have.
Breast cancer survivors have an increased risk of getting a new breast cancer (called a second primary breast cancer) compared to people who have never had breast cancer.3-4 Unlike a breast cancer recurrence (a return of the first breast cancer), a second primary tumor is a new cancer unrelated to the first.
All breast cancer survivors should see their health care providers on a regular basis. This care consists of the primary care and health screenings that everyone should get. In addition, the goals of follow-up care for survivors include:
Health care providers use these tests to check for signs of recurrence:5
Follow-up care for survivors also includes:5
Find a schedule of recommended care for breast cancer survivors.
A breast cancer recurrence is usually found during a mammogram or a physical exam. If a recurrence is found, tests will be done to see if there is also metastasis.
A recurrence is treated in much the same way as the first tumor. As with a first breast cancer, treatment varies from person to person. Learn more about treatment for breast cancer recurrence.
Metastasis is usually found when symptoms are reported during follow-up office visits. Symptoms may include:
Don't panic if you have symptoms like weight change or bone pain. These are common and usually do not mean the breast cancer has spread. However, any of these symptoms should be discussed with your health care provider.
Based on the symptoms above, tests will be done to check for metastases. The three main tests are:
Positron emission tomography (PET scans) and other tests for metastases may be done, depending on a person's symptoms and the findings from the three main tests.6 Learn more about tests for metastases.
Breast cancer most often metastasizes to the bones, lungs, liver or brain. Although it has spread to another part of the body, it is still considered and treated as breast cancer. For example, breast cancer that has spread to the bones is still breast cancer (not bone cancer) and is treated with breast cancer drugs, rather than treatments for a cancer that began in the bones. Learn more about treatment of metastatic breast cancer.
For people with no symptoms of metastases, blood and imaging tests (other than mammography) are not a standard part of follow-up care. Using these tests to check for recurrence or early metastases in people without symptoms does not increase survival.7 After reviewing the scientific evidence, the American Society of Clinical Oncology (ASCO) determined these tests should not be part of routine follow-up care for breast cancer survivors.7
In 2012, ASCO identified five ways health care providers could choose procedures more wisely to avoid using tests and treatments that have not been shown to benefit cancer patients (see all five ASCO Choosing Wisely recommendations). Two of the five recommendations were related to follow-up care for breast cancer survivors.7
1. Don't use PET scans, CT scans and bone scans to stage ductal carcinoma in situ (DCIS) or early breast cancer (stage I or stage II) at low risk for metastasis.
2. Don't use routine blood and imaging tests (other than mammography) for breast cancer survivors with no symptoms of metastasis. These tests include:
ASCO concluded these tests do not improve survival for people without symptoms of metastasis. And, for some people, these tests may cause harm by leading to more invasive tests, unneeded treatment and/or exposure to radiation. The benefits of these tests are limited to breast cancer survivors with metastasis or symptoms of metastasis (learn more).
Follow-up visits with your provider are a good time to talk about how you're coping emotionally. Many survivors are afraid they still have breast cancer or that it will come back. These fears are normal. For some people, talking to a counselor or joining a support group can be helpful. Your provider may be able to help you find a counselor or support group.
If the breast cancer returns, you may have a strong emotional and physical effect. A support group, especially one focused on breast cancer recurrence, may help you address these concerns. Your provider may be able to help you find a support group.
Learn more about support groups and other types of social support.
Komen Support Resources
Dr. Julie Gralow, M.D., a Komen Scholar and Director of Breast Medical Oncology at Seattle Cancer Care Alliance and Professor of Medical Oncology at the University of Washington School of Medicine sums it nicely. "Once breast cancer treatment ends, it's important to establish a survivorship care plan with your health care team. Breast cancer diagnosis and treatment frequently result in long-lasting effects, impacting both physical and emotional health. Regular follow-up visits can help address long-term effects of treatment, and also detect recurrence. Communication is key – even in between visits if issues arise. Healthy lifestyle behaviors, such as physical activity and maintaining a healthy body weight have been shown to improve overall health and may also help reduce the risk of recurrence. Take charge of the factors over which you have control!"
What is Komen doing?
Since 2006, Komen has invested nearly $100 million into nearly 200 research grants that focus on metastasis and recurrence. Examples of some projects include:
In addition, a few grants focus on the fear of recurrence and the effect that these fears have on treatment outcomes as well as quality of life issues related to recurrence and metastasis.
For more information on Komen's research into metastasis, please see the Research Fast Facts: Metastasis.
Posted July 16, 2013