Fear of Recurrence
After treatment for early or locally-advanced breast cancer ends, many people are afraid they still have cancer or that their cancer will come back (breast cancer recurrence).
These fears are normal.
For some people, talking to a counselor or joining a support group can be helpful. Your health care provider may be able to help you find a counselor or support group.
Susan G. Komen® Support Resources
How is a local breast cancer recurrence or metastasis found?
Breast cancer can recur at or near the original site (called local recurrence). It can also return and spread to other parts of the body (called metastasis or distant recurrence).
- Local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change.
- Metastasis is usually found when symptoms are reported during follow-up office visits with your provider.
For people with no symptoms of metastases, blood and imaging tests (other than mammography) are not a standard part of follow-up care.
Using blood or imaging tests to check for early metastases in people with no symptoms of metastases does not increase survival or improve quality of life .
Learn about follow-up care after breast cancer treatment.
Learn more about breast cancer recurrence.
Risk of breast cancer recurrence
Most local recurrences occur within the first 5 years after diagnosis [108-109].
The risk of local recurrence varies from person to person and depends on the original breast cancer diagnosis and treatment.
Getting regular medical care after treatment is the best thing you can to do ensure a local recurrence is found early, when the chances of survival are highest.
If you have a local recurrence, you will need more treatment.
Learn more about the risk of local recurrence.
Learn more about treatment for local recurrence.
When breast cancer metastasizes, it most often spreads to the bones, lungs, liver or brain.
The risk of metastasis varies from person to person and depends on the original breast cancer diagnosis and treatment.
Learn more about the risk of metastasis.
Learn about treatment for metastatic breast cancer.
Risk of a new breast cancer
Breast cancer survivors have an increased risk of getting a new breast cancer compared to people who have never had breast cancer [110-113].
A new breast cancer is called a second primary breast cancer. Unlike a recurrence, which is a return of the first breast cancer, a second primary tumor is a new cancer unrelated to the first.
- Women treated with lumpectomy (also called breast conserving surgery) for their first breast cancer can get a second primary cancer in either breast.
- Women treated with mastectomy for their first breast cancer can only get a new cancer in the other breast (except in rare cases, from any remaining breast tissue).
Learn more about risk of a second primary breast cancer.
Preventive surgery does not improve survival for most survivors
Although breast cancer survivors are at risk of a new breast cancer, preventive mastectomy of the healthy breast (contralateral prophylactic mastectomy) is not recommended for most survivors . For most survivors, this surgery does not improve survival [3,114].
Only some breast cancer survivors with a very high risk of a new breast cancer should consider prophylactic mastectomy. This includes women with a mutation in one of these genes :
These women should talk with their health care providers about whether contralateral prophylactic mastectomy is right for them.
Risk of second cancers in people with family history or BRCA1/2 gene mutations
Compared to other survivors, the risk of a second primary breast cancer is higher for those with a strong family history and those who carry a BRCA1 or BRCA2 gene mutation [115-121].
For women with a BRCA1/2 gene mutation, the chance of a contralateral breast cancer 10 years after diagnosis of the first cancer is about 10-30 percent compared to about 5-10 percent for women diagnosed with breast cancer without a BRCA1/2 mutation [115-121].
The lifetime risk of a second primary contralateral breast cancer is about 40-70 percent for women with a BRCA1/2 mutation [118,121].
Women who have a BRCA1/2 mutation also have an increased risk of ovarian cancer .
Breast cancer survivors with a BRCA1/2 mutation should talk with their health care providers about whether contralateral prophylactic mastectomy and/or prophylactic oophorectomy (removal of the ovaries) is right for them .
Learn more about risk-lowering options for women with BRCA1/2 mutations.
Learn more about BRCA1/2 gene mutations and risk of breast and other cancers.
Learn more about family history and risk of breast cancer.
For a summary of research studies on BRCA1 and BRCA2 gene mutations and breast cancer, visit the Breast Cancer Research Studies section.
Lowering your risk of getting breast cancer again
Some healthy behaviors may lower the risk of breast cancer recurrence and improve survival.
Other healthy behaviors have not yet been shown to impact breast cancer survival, but are part of a lifestyle that may help protect against other cancers and diseases.
A healthy lifestyle includes:
- Maintaining a healthy weight
- Eating a healthy diet
- Limiting alcohol intake
- Getting regular physical activity (exercise)
- Not smoking
Learn more about a healthy lifestyle for breast cancer survivors.
Taking hormone therapy as prescribed
If you are being treated with hormone therapy (tamoxifen or aromatase inhibitors), it’s important to take these drugs as prescribed. People who complete the full course of hormone therapy have a lower risk of [123-126]:
- The first cancer coming back
- Getting a second primary breast cancer
- Death from breast cancer
Learn more about the importance of following your treatment plan.
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