Breast Cancer Recurrence: Causes, Symptoms, Risk Factors, and Prevention

What Is Breast Cancer Recurrence?

Breast cancer is a deadly disease, and though fear of 'recurrence' is common in patients, even after early intervention, it can be managed. Even after the cancer treatment and breast removal (mastectomy), cancer sometimes returns, and it is called breast cancer recurrence. It may reoccur in the area where it was primarily diagnosed or in any other area in the body. There are also instances where early-stage breast cancer recurrence happens even when the cancer was diagnosed as stage 1 or 2 despite successful initial treatments. It can either occur in the same spot or spread to nearby structures.

What Are the Types of Breast Cancer Recurrence?

This type depends on the place where cancer comes back, such as:

1. Local: Cancer reappears in the same area, such as the breast or chest wall. Symptoms include nipple discharge, skin changes, swelling, or lumps. Treatment depends on the initial surgery and may involve mastectomy, tumor removal, radiation, or additional therapies like hormonal therapy, etc.

2. Regional Recurrence: Regional recurrence occurs when cancer returns in nearby tissues or lymph nodes, such as under the arm, above or below the collarbone, or in the neck. Affected lymph nodes include axillary, supraclavicular, infraclavicular, and internal mammary nodes. Treatment involves surgery to remove the lymph nodes, followed by radiation, chemotherapy, targeted therapy, or hormone therapy.

3. Distant Recurrence (Metastatic): Metastatic recurrence happens when cancer spreads to distant areas like the bones, liver, or lungs. Symptoms may include fever, weight loss, pain, persistent cough, and difficulty breathing. Treatment is more challenging, often involving chemotherapy, immunotherapy, targeted therapy, or hormone therapy.

What Are the Causes of Breast Cancer Recurrence?

The causes of breast cancer recurrence include the following:

• When the cancer cells that are a part of the original breast cancer break away from the original site and hide in the breast or any other parts of the body, later, these hidden cells begin to grow again, causing recurrent breast cancer.

• However, chemotherapy, hormone therapy, targeted therapy, or other treatments are intended to kill all the remaining cancer cells after surgery. Still, sometimes, these treatments fail to kill all the cancer cells, leading to recurrence.

• In a few conditions, cancer cells remain dormant (sleeping) for many years, but later on, due to unknown factors, they get triggered, become active, grow rapidly, and spread to other parts of the body.

• Also, the consumption of alcohol and breast cancer recurrence is highly anticipated, specifically if the affected person is obese, overweight, or in the postmenopausal phase.

What Are the Signs and Symptoms of Breast Cancer Recurrence?

Breast cancer recurrence symptoms are:

Local recurrence of breast cancer may cause:

• Lumps or bumps in the breast on or under the chest.

• Changes in the nipple, such as flattening or nipple discharge.

• Swelling in the skin or skin that pulls near the site of lumpectomy.

• Thickenings on or near the scar from surgery.

• Breast tissue feels unusually firm.

• Thickening or a lump in the scar tissue.

Regional breast cancer recurrence may cause:

• Chronic chest pain.

• Swallowing problems.

• Numbness, pain, or swelling in one arm or shoulder.

• Swollen lymph nodes under the armpit or in or around the collarbone area.

Distant (metastatic or Stage 4) breast cancer can involve any organ, including the bones, lungs, brain, or liver. Symptoms and signs of breast cancer recurrence depend on where the cancer spreads. One might experience:

• Bone pain due to the spread of breast cancer.

• Chronic dry cough.

• Dizziness or loss of balance and seizures.

• Extreme fatigue or tiredness.

• Loss of appetite, nausea, and weight loss.

• Severe headache.

• Numbness.

What Are the Recurrent Rates of Breast Cancer?

The American Cancer Society stated that the chances of recurrence are higher in cases of inflammatory breast cancer and triple-negative breast cancer than in many other breast cancer types.

Findings on IBC indicate it is very aggressive, and its recurrences occur more often within the first few years after treatment. Similarly, TNBC, which lacks both hormone receptors and expression of HER2, holds a higher risk for recurrence during three to five years, usually presenting as distant metastasis. Comparatively, both IBC and TNBC have poorer long-term outcomes compared to those breast cancers that are hormone receptor-positive or HER2-positive, where the prognosis is usually considered good, and progression rates are relatively low.

The likelihood of IBC recurrences depends largely on the stage of cancer and the approach for treatment. Local recurrences are most common five years after the lumpectomy, but radiation therapy after the surgery reduces this risk. With lumpectomy combined with radiation, recurrence rates decline between three percent and 15 percent over ten years, but genetic testing results determine further treatments.

Breast cancer recurrence rates vary in people who get mastectomies:

• There is a six percent probability that cancer will return within five years if healthcare providers fail to detect cancer in the axillary lymph nodes when an individual initially undergoes surgery.

• If the axillary lymph nodes contain cancer, the chances of cancer coming back are at 25 percent. If one is exposed to radiation therapy after undergoing mastectomy, this risk is decreased to six percent.

What Are the Complications of Breast Cancer Recurrence?

• Breast cancer that recurs or spreads is more difficult to treat, but the same treatment that worked before may not work this time. Thus, the healthcare provider will look into other treatments. For example, they may advise one to join clinical trials.

• Metastatic breast cancer means an individual will have cancer spread in more than one area of the body; it can even spread to the blood.

How Can Breast Cancer Recurrence be Diagnosed?

The doctor will repeat some of the same tests that a person has undergone at the time when they were first diagnosed with breast cancer, like:

• Mammogram (an X-ray of the breast).

• Ultrasound.

• MRI (magnetic resonance imaging).

• CT (computed tomography) scan.

• PET (positron emission tomography) scan.

• Blood tests (for tumor markers).

• Biopsy.

What Are the Treatments for Recurrent Breast Cancer?

Breast cancer recurrence treatment depends on where the recurrent cancer is and what earlier treatments one has had. For instance:

• Suppose one has undergone the procedure of lumpectomy for a local or regional tumor. In that case, the provider may recommend a mastectomy to remove one or both of the breasts and nearby lymph nodes.

• If one has had a lumpectomy, they might be eligible for another lumpectomy with radiation. Discuss this with the doctor.

• If the cancer is recurrent in a reconstructed breast, the surgeon might suggest removing a breast implant or a skin flap.

• If one has once received a mastectomy, an extensive procedure might be suggested to remove the newly formed tumor and remove nearby tissue or structure, followed by radiation therapy.

• Other treatments can be considered, like hormone therapy, chemotherapy, immunotherapy, and targeted therapy.

What Are the Risk Factors for Breast Cancer Survivors?

The risk factors for breast cancer survivors are:

1. Involvement of Lymph Node: Finding a cancer site near the lymph nodes at the first or original diagnosis increases the chances of recurrence due to metastases.

2. Size of the Tumor: The larger the size, the greater the risk of recurrence.

3. Positive Tumor Margins: During a mastectomy, the cancer and surrounding healthy tissue are removed. A biopsy of the healthy tissue checks for cancer cells. If the margins are clear, recurrence risk is lower; if cancer cells are found, the risk increases.

4. Lack of Radiation Therapy After Lumpectomy: Lumpectomy should always be followed by radiation therapy; those patients who do not undergo radiation after lumpectomy are more prone to recurrence.

5. Age: The younger the age at the time of first diagnosis, the more likely there is a recurrence.

6. Lack of Hormone Therapy: Also increases the chances of recurrences in hormone receptor-positive breast cancer and triple-negative breast cancer.

7. Obesity and Lifestyle: The higher the body mass index, the more the recurrence.

How to Prevent Breast Cancer Recurrence?

The following methods can prevent the recurrence of breast cancer:

1. Radiation Therapy: Patients with lumpectomy or mastectomy should choose radiation therapy for lower chances of recurrence.

2. Hormone Therapy: Opting for this therapy in patients with hormone receptor-positive breast cancer may increase the life span without recurrence.

3. Chemotherapy: Patients who receive chemotherapy live longer than those who do not.

4. Targeted Therapy: If the cancer cells have the extra protein HER2 (human growth factor receptor 2), drugs should target this protein to prevent a recurrence.

5. Maintaining a Healthy Weight: Exercising regularly, eating a healthy diet, and avoiding alcohol and smoking.

6. Breast Cancer Recurrence Genomic Testing: Breast cancer recurrence genomic testing analyses the breast tissue sample to rule out the specific genetic markers that can predict the chances of cancer recurring after therapies are detected.

What Is the Success Rate in Treating Recurrent Breast Cancer?

The success rate depends upon the following factors:

• Type of cancer.

• When and where it recurs.

• The time gap between the original diagnosis and recurrence.

• How much it had spread (aggressiveness of cancer).

• The overall health of the patient.

• Depends on how the patient tolerates the treatment.

• Most important is the individual values and wishes of the patient.

Conclusion:

Breast cancer recurrence is hard to treat, and most patients fear recurrence or new cancer. It may reoccur from months to years after the initial treatment is completed. The breast cancer recurrence risk calculator, merely a tool that estimates the likelihood of recurrence based on medical reports like size, hormone receptor status, lymph node involvement, etc, can be used to assess the chances of breast cancer recurrence. With the utilization of these tools, one can be alert and should be under regular follow-up appointments and undergo screening tests to detect breast cancer recurrence as early as possible.