• Breast cancer can sometimes recur (come back), even after it is no longer detectable following treatment.
• Details about your breast cancer type, such as estrogen receptor (ER) status, can influence the likelihood and timing of recurrence.
• Human epidermal growth factor receptor 2 (HER2)-positive breast cancer, triple-negative breast cancer (TNBC), and inflammatory breast cancer (IBC) have higher recurrence rates than other types.

After you complete breast cancer treatment, your doctor will monitor you closely to make sure your cancer doesn’t come back. Breast cancer that comes back after treatment is called “recurrent breast cancer.”

Your health history, which treatment you receive, and the type of breast cancer you have will influence your risk of breast cancer recurrence. Read on to learn about steps you can take to lower your risk of recurrence and to help catch cancer early if it does recur.

What Is Recurrent Breast Cancer?

Breast cancer recurrence refers to the return of cancer after a period when it was undetectable following initial treatment. Even after surgery, chemotherapy, or radiation therapy, some cancer cells may remain in the body. These cells can lead to the cancer returning months or even years after treatment, despite no signs of cancer being present at the time.

If cancer does reappear after successful breast cancer treatment, your doctor will run tests to determine whether it’s the same type of cancer or a new one. Cancer that appears in other parts of the body or the opposite breast is considered a second cancer, not a recurrence. Even after a mastectomy, breast cancer can still return.

There are three different types of breast cancer recurrence:

• Local recurrence — This occurs when cancer returns in the same breast or near the original surgery scar, without any signs that it has spread beyond the breast.
• Regional recurrence — Cancer reappears in nearby lymph nodes, such as under the arm, near the collarbone, or along the chest wall, but remains close to where it first started.
• Distant recurrence — This type happens when cancer returns in a different part of the body, such as the liver, bones, or brain, far from the original site.

Why Does Breast Cancer Recur?

Several risk factors increase the likelihood of recurrence:

• The most significant factor is whether cancer was found in the lymph nodes when breast cancer was first diagnosed. More lymph nodes involved indicates a higher chance of recurrence.
• Those who are diagnosed with breast cancer before the age of 35 are more likely to have more aggressive cancer.
• Those who are diagnosed with breast cancer before menopause have a higher risk of recurrence.
• Those who have larger tumors have a higher risk of recurrence.
• Those who smoke or who have excess weight have an increased risk of recurrence.

Timing of Breast Cancer Recurrence

When or whether breast cancer recurs is different for everyone. It depends on the type of cancer and treatment and unique factors different for each person.

The risk of recurrence is the highest during the first few years after treatment. A 2022 study of 265 people with breast cancer recurrence found that the average time to recurrence was 47.7 months, or about four years. However, the time varied significantly by cancer subtype. Researchers found that people with luminal A, the most common subtype, had the longest average time to recurrence at 56 months. Those with triple-negative breast cancer had the shortest at 26.9 months.

Recurrence Rates for Different Types of Breast Cancer

Breast cancer type is determined by the characteristics of the cancer cells. Your doctor will perform tests on cells from a biopsy — a procedure that removes a small sample of tissue or cells — to identify the type of cancer you have.

It’s possible to have multiple types of breast cancer tumors simultaneously or a tumor with characteristics of several types.

Hormone Receptor Status

Hormone receptors may be present on both normal breast cells and some breast cancer cells. Two hormones, estrogen and progesterone, attach to these receptors (proteins) on the surface of the cell and encourage cell growth. Breast cancer cells can have one, both, or neither of these receptors. Breast cancers can be called hormone receptor (HR)-positive or hormone receptor-negative based on whether the cancer cells have the hormone receptor.

Estrogen receptor status can help your doctor predict your risk of recurrence. However, more research is needed to see if progesterone receptor status can also predict recurrence.

People with estrogen receptor-negative breast cancer can experience early recurrences (within five years after treatment) more often than those with estrogen receptor-positive breast cancer. However, ER-positive breast cancer is more likely to recur later, 10 or more years after treatment is completed.

Targeted drugs, like ribociclib (Kisqali), may help reduce the chances of breast cancer recurrence for some people with HR-positive breast cancer.

HER2 Status

Between 15 percent and 20 percent of breast tumors have higher levels of a protein that helps cells grow faster, known as human epidermal growth factor receptor 2. When breast cancer cells have excess HER2, the condition is referred to as HER2-positive breast cancer. This is an aggressive type of breast cancer that has a high risk of recurrence.

Targeted drugs, such as trastuzumab (Herceptin), have significantly improved outcomes for people with HER2-positive breast cancer. However, even with these treatments, about 30 percent of people with HER2-positive cancer still experience recurrence with metastasis (cancer spreading).

Triple-Negative Breast Cancer

Triple-negative breast cancer cells do not have estrogen receptors, progesterone receptors, or HER2. TNBC often occurs at a younger age and usually grows and spreads quickly.

About 40 percent of people with stage 1 through stage 3 TNBC develop recurrent breast cancer after standard treatment.

Triple-Positive Breast Cancer

Triple-positive breast cancer cells have estrogen and progesterone receptors, along with higher-than-average levels of HER2 proteins on their surface.

One study found that about 15 percent of people with stage 3 triple-positive breast cancer experienced a recurrence within five years.

Inflammatory Breast Cancer

Inflammatory breast cancer is a type of invasive ductal carcinoma that accounts for
1 percent to 5 percent of all breast cancers. It can grow and spread quickly, often involving the lymph nodes. IBC tends to occur at a younger age.

Inflammatory breast cancer typically has a poor prognosis (outlook) and a high likelihood of early recurrence. However, recent research suggests that outcomes have improved with neoadjuvant (presurgical) chemotherapy, followed by localized and regional treatments.

What Are the Symptoms of Breast Cancer Recurrence?

It’s important to recognize the signs and symptoms of recurrence, which can vary depending on where the cancer returns.

If you have a recurrence in the same area as your original breast cancer, you may notice:

• A new lump in your breast
• New lumps under the arm or near the collarbone
• Changes in your breast shape or size
• Nipple changes or discharge
• Changes in the skin of your breast
• Changes in the mastectomy scar or wound

If you have a recurrence in a different part of your body, you may notice:

• Fatigue
• Changes in appetite
• Unexplained weight loss
• Severe headaches
• Pain that won’t go away
• Nausea

How Can You Prevent Recurrence?

Treatments such as surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy can reduce the risk of recurrence.

After completing breast cancer treatment, your oncology specialist will schedule follow-up appointments several times a year to monitor for signs of recurrence. If you had breast-conserving surgery, you may also need a mammogram once or twice a year. If you had a mastectomy, a postmastectomy ultrasound may be recommended to evaluate the surgical area.

People with hormone-positive cancers may reduce their risk of recurrence by taking hormone therapy such as tamoxifen (Soltamox).

There is no way to guarantee breast cancer won’t come back, but you can decrease the likelihood of recurrence by:

• Maintaining a healthy weight
• Not smoking
• Reducing alcohol consumption
• Exercising regularly

There have been great advances made in the treatment of breast cancer. The actual recurrence rate now, with current treatment options, may be lower than existing studies reflect. This is because there hasn’t been enough time for clinical trials to show the effect of newer treatments. Even newly published studies include people diagnosed and treated years ago.

If you develop recurrent breast cancer, there are now more treatments than ever.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 73,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Do worries about breast cancer recurrence affect your daily life? Have you found ways to manage those concerns? Share your experience with recurrence or fear of recurrence in the comments below, or start a conversation by posting on your Activities page.