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Recurrence

We know you really don’t want to be here, reading about breast cancer recurrence or metastasis. If you’ve had breast cancer, the possibility of recurrence and spread (metastasis) of breast cancer stays with you. You may be reading this because you fear this possibility, or because it’s already happened.

Keep in mind that a recurrence of breast cancer or metastatic (advanced) disease is NOT hopeless. Many women continue to live long, productive lives with breast cancer in this stage. It is also likely that your experience with treatment this time will be somewhat different from last time. There are so many options for your care and so many ways to chart your progress as you move through diagnosis, treatment, and beyond.

When breast cancer comes back, it may return in the same place. This is called a “recurrence,” because it is not a new cancer. But a recurrence can also appear in a place not directly related to the first breast cancer. This is called a “metastasis,” and if cancer is detected in several areas, these are called “metastases.” When breast cancer comes back, it tends to show up in specific areas of the body:

  • the breast or the area where the breast used to be
  • the chest wall
  • the lymph nodes
  • the bones
  • the lungs or around the lungs
  • the liver
  • the brain

Cancers from other parts of the body rarely spread to the breast or the chest wall. If you have a tumor in your lymph nodes, lungs, liver, bones, or brain, it probably is a re-growth or recurrence of the original breast cancer rather than a new and different cancer. In other words, if you had breast cancer and you now have cancer in your bones, liver, or other places, it is probably not bone or liver cancer, but breast cancer that has spread to the bones or the liver. This is important because breast cancer—even when it has spread—is usually more treatable than a cancer that starts in the bones or liver.

Breast cancer that returns in other parts of the body is invasive cancer. However, cancer that comes back in the breast after surgery and/or radiation therapy can be either non-invasive or invasive.

If you have developed a cancer in the opposite breast from the one that was originally treated, it is probably not a recurrence. Most cancers that develop on the other side represent a new cancer rather than a recurrence.

Breast cancer can return in three general locations. It can be:

  • Local: in the breast where it started, or in the skin and underlying tissues where the breast used to be.
  • Regional: in the lymph nodes next to the breast.
  • Metastatic: in another part of the body, such as the lung, liver, bone, or brain, or in lymph nodes far from the breast.

Twenty to thirty percent of all women first diagnosed with cancer limited to the breast eventually develop it elsewhere. In 30% to 60% of women with cancer in their lymph nodes when first diagnosed, breast cancer eventually spreads to other parts of the body. The risk of cancer spread depends largely on the tumor size and the number of positive lymph nodes.

The best thing to do is to remind yourself that recurrence is not a death sentence. No matter what your circumstances are, something can always be done to help you. Breast cancer that returns to just the breast or nearby lymph nodes may be treated effectively with an excellent outcome. Disease that has spread to other parts of the body may be put in long-term remission.

Also keep in mind that you won’t have the same experience with recurrent or metastatic breast cancer as women you know who had it years ago. New treatments for recurring cancer have improved survival. One large recent study showed that over the past few decades, women diagnosed with breast cancer have had significantly improved survival. And new treatments that have been widely used only in the past few years might mean even longer survival in the years to come.