There are three reasons you should discuss your risk of recurrence with your doctor following initial breast cancer treatment, and we’re going to share them with you here.
While most people diagnosed with breast cancer will never have a recurrence, every person treated for breast cancer does have some level of risk of the cancer returning or recurring. It’s not uncommon to feel overwhelmed when you’re newly diagnosed and talking through treatment options. It’s also common to want to move on after a diagnosis.
Knowing that risk varies from person to person, and that it depends on many factors, can help you and your doctor plan for long-term health.
What is recurrence?
Breast cancer recurrence is when breast cancer returns after treatment. When it occurs in the same area as before, it’s called local recurrence, and when it returns near lymph nodes, it is considered regional. If the cancer comes back in a different part of the body like the bones or liver, then it’s referred to as distant or metastatic.
Recurrence is influenced by many factors, especially tumor biology, stage and how the cancer responds to treatment. It’s not something you can control through willpower or “doing everything right.” For some people, most of the risk of recurrence occurs within the first five years after diagnosis, while for others, that risk can remain beyond five to 10 years – particularly in the case of hormone receptor-positive (HR+) breast cancer.
Understanding your personal risk compared to average risk can help you and your doctor with future decisions and monitoring in the interest of your long-term health and quality of life. It’s natural to feel anxious when talking about recurrence, so let your care team know so they can support you emotionally in addition to helping you medically. It’s important to always remember that if recurrence happens, it’s not your fault.
What affects the risk of recurrence?
Your risk of recurrence is shaped by several pieces of information. Common factors include:
- Tumor type and biology – this includes biomarkers like hormone receptor status, HER2 status, etc.
- The tumor’s genetic expression (tumor profile), which looks at patterns in the tumor’s genes – usually done in early-stage HR+ tumors.
- The size and grade of the original tumor – the grade refers to how much the cancer cells resemble normal cells.
- Lymph node status – whether cancer was detected in the lymph nodes and, if so, how many?
- Whether the margins were clear (no cancer cells at the edge of the tissue removed during a lumpectomy or other breast surgery) and how well the cancer responded to treatment.
- Younger age at diagnosis may be associated with a higher recurrence risk.
- Obesity has also been linked to higher risk, particularly in postmenopausal women with HR+ breast cancer.
Here are three reasons why it’s worth talking to your doctor about your risk of recurrence:
- There are tests available to help you and your doctor determine your risk of recurrence and treatment options. Making some of these treatment decisions can be overwhelming. In recent years, several tumor profiling tests (sometimes called genomic tests) have become available that can estimate your risk of recurrence and even inform treatment – like if you might benefit from chemotherapy. These can help take the guesswork out when making these difficult decisions. At the same time, these tests don’t predict the future with certainty, and they are not appropriate for every breast cancer type or stage. Your doctor can explain whether a tumor profiling test applies to your diagnosis and how the result affects your cancer plan.
- You may be eligible for less aggressive treatment. Many people automatically associate chemotherapy with cancer treatment, but did you know that not everyone with breast cancer needs it? When doctors combine information about your tumor characteristics and your risk of recurrence, you may be able to safely avoid certain treatments, which can mean fewer side effects and less impact on your daily life.
- You may benefit from longer or additional treatment. You may discover that you have a higher risk of recurrence and would benefit from additional treatment (like staying on hormone therapy longer) or more aggressive interventions. This can feel discouraging at first, but understanding why your care team is recommending certain treatments can help you see it as a plan designed to protect you – shifting from a discouraging mindset to a more empowering one.
Things your care team may consider based on your risk include:
- Whether additional systemic therapy (like chemotherapy or targeted therapy) could reduce risk
- Whether certain treatments should be added or extended
- What follow-up schedule is ideal for your personal situation
How can I be proactive?
You may be wondering what steps you can take. Even though you can’t control every risk factor, you can take steps that help you feel more prepared:
- Ask for a survivorship care plan and do your best to stick to your follow-up schedule, recommended tests and instructions about who to contact with concerns.
- Take a list of questions to appointments.
- If you’re prescribed medication you’ll take long-term, such as hormone therapy, ask about side effects and how to manage or prevent them. That way, you can stay on treatment as comfortably as possible.
- Know what signs and symptoms of recurrence to be watching for. Many symptoms aren’t cancer, but it’s always okay to check.
- Ask about supportive care (physical therapy, lymphedema support, mental health, sexual health and sleep support).
- Maintain a healthy lifestyle as much as possible (stay at a healthy weight, limit alcohol consumption and aim for regular physical activity).
Talking with your doctor about recurrence risk is one more way to stay informed, feel prepared and stay involved in your long-term health. This blog is for educational purposes and is not medical advice. Your care team can help you understand what recurrence risk means for your diagnosis and which options are right for you.
Do you need help? We’re here for you. The Komen Patient Care Center is your trusted, go-to source for timely, accurate breast health and breast cancer information, services and resources. Our navigators offer free, personalized support to patients, caregivers and family members, including education, emotional support, financial assistance, help accessing care and more. Get connected to a Komen navigator by contacting the Breast Care Helpline at 1-877-465-6636 or email helpline@komen.org to get started. All calls are answered Monday through Thursday, 9 a.m. to 7 p.m. ET and Friday, 9 a.m. to 6 p.m. ET. Se habla español.
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Downloadable Resource: Breast Cancer Recurrence
Read More:
After Early Breast Cancer: Signs and Symptoms of Metastatic Breast Cancer (MBC)
Follow-up care after treatment
The Importance of Following your Treatment Plan
Watch More:
Tools to understand your risk of recurrence for treatment decisions
Breast Cancer 101: Survivorship and Recurrence
