Breast Cancer Recurrence - Chances, Fears, and Symptoms

Likelihood, Signs, Types, and Preventing the Return of Breast Cancer

Will my breast cancer come back and how will I know? How can I cope knowing it could?. Credit: Photo©DKart

Will my breast cancer come back?  Could I have a recurrence? For women who have been through breast cancer treatment, this is usually the million-dollar question. During treatment, women often feel empowered, cared for, well-monitored, and protected by the treatment regimen they are following. But after completing treatment, it can feel like you are flying without a compass. And this can cause real fear and anxiety.

One useful response: Learn all you can about the chances of recurrence, the signs of recurrence and any steps that can be taken towards prevention. Knowing that you are taking action -- informing yourself about these possibilities -- may go a long way toward alleviating your sense of vulnerability.

What Is a Breast Cancer Recurrence?

After cancer has been successfully treated, there will be a cancer-free period. A woman may never again have that particular form of cancer. But if the same cancer is detected later, she is said to have had a recurrence. A recurrence can be:

  • Local: Occurring in the vicinity of the initial tumor (for example, in remaining breast tissue or in skin or tissues where the breast was removed.)
  • Regional: Occurring in lymph nodes within the region of the original cancer.
  • Distant : Occurring at a distance from the original site (for example, in bone, liver or brain.)

If cancer is discovered within three months of the initial treatment, doctors generally do not consider it to be a recurrence.

Instead, it is seen as cancer progression or treatment failure. To be classified as a recurrence, the cancer must reemerge at least a year after completion of a successful cancer treatment.

What Is The Likelihood Of Recurrence?

It is important to remember that not every woman (or man) who has had breast cancer will face a recurrence.

Some women go through breast cancer treatment and live the rest of their lives cancer-free.

Because there are so many factors that figure into a woman's risk of recurrence, it is difficult to cite meaningful statistics. There are different types of breast cancer, and in different women, the cancer may have been at different stages when diagnosed. In addition, different treatments (for example, some women have breast-conserving surgery; others, a mastectomy) may affect recurrence rates.

Other treatment choices, including chemotherapy, radiation, hormone therapy, targeted therapy or bone marrow or stem cell transplant, may play a role as well. Family cancer history can factor in, as can individual risk factors, such as weight, diet or history of exposures. Furthermore, the risk of recurrence varies with the time elapsed since diagnosis and treatment.

That said, most studies suggest that patients treated with a combination of local lumpectomy and radiation have a 10% to 20% chance of recurrence within ten years of diagnosis -- although that estimation is on the high end, and it really depends on the type of cancer as well as lymph node involvement.

  Many recurrences happen within the first 5 years of treatment, but with estrogen-receptor positive cancers, the risk of recurrence may continue far beyond those 5 years.

What Are The Signs And Symptoms Of Recurrence?

You should check with your doctor if you notice any changes in the area where you had your original breast surgery or in your other breast, including:

  • Skin changes, such as reddening, swelling, scaling, or puckering -- or a hot area, rash, streaks of color or "orange peel" appearance.
  • Any mass, lump, or thickening in the breast tissue, scar tissue or under your arm.
  • Nipple changes, including retracted (pulled in) nipple, redness, scaling, or clear or bloody discharge.

You should also be alert to other possible symptoms, including:

  • Weight loss
  • Fever or chills, or both (unrelated to an acute illness, such as a virus)
  • New cough or shortness of breath
  • Bone pain
  • Abdominal pain
  • Swollen lymph nodes in your neck or groin
  • Headaches or vision changes
  • Yellow eyes or skin

Can I Prevent A Recurrence?

The best thing you can do after receiving a breast cancer diagnosis is to try to line up care with experts in breast cancer, including a breast surgeon, medical oncologist, and radiation oncologist. Track down reputable educational materials to help you understand the various treatment options. Once you and your medical team have chosen the treatments that are appropriate for your specific situation, make sure to follow the recommendations closely. Keep all of your scheduled follow-up appointments.

You should consider making various healthy lifestyle choices. Consult with your doctor about issues such as weight management and exercise. and stress. These lifestyle choices can directly affect your chances of recurrence, and they can have a positive effect on your quality of life. 

Though insomnia is a common problem for people in the months and even years following cancer treatment, talk to your doctor if you experience this symptom.  Sleep disturbances can increase fatigue, play havoc with your immune system, and insomnia may even impact survival for people who have had cancer.

Participating in a support group or talking with a counselor may be helpful in ways beyond worrying about a recurrence.  We all talk about being stressed, but studies suggest that - at least in women with estrogen receptor positive breast cancer - the likelihood of recurrence in the period from 5 to 10 years after a diagnosis of breast cancer is increased in those who have more stress.  Here are 25 ways you can reduce stress starting today.

How Do I Live With The Fear Of Recurrence?

Perhaps the hardest aspect of having breast cancer is the constant feeling of threat or dread. It is difficult not to cringe at any new ache or pain -- or resist thinking that it means a recurrence. Women cope with this issue in various ways. You should seek support, reassurance, and a sense of calm in whatever way seems most appealing and helpful. Some women find organized support groups of breast cancer survivors to be invaluable; others find an outlet in meditation, yoga, psychotherapy, religion, journaling, or the arts or music. check out these tips for coping with the fear of cancer recurrence.

What Happens If I Have A Recurrence?

Over the years, the philosophy of recurrent breast cancer has changed. In some ways, breast cancer has come to be viewed almost like a chronic disease -- if one treatment does not work for you, another might. New and better treatments continue to be found, addressing various types of recurrence. Have faith that, depending on the details of your recurrence, there may well be a number of options to stop its progression.

Coping and Support

Talk openly with your loved ones. Don't be afraid to ask for help.  You've been through a lot with your treatment, and at this time too little attention given to survivorship - getting back to living after cancer treatment is done. That said, survivorship isn't all a struggle of coping with the fear of recurrence and difficulties in other areas.  Research to date suggests that cancer may indeed change people for the better in many ways.

For Loved Ones

There are a few things about the fear of recurrence that aren't always obvious to someone who hasn't lived with the fear.  For example, you may think that someone with an advanced cancer would carry much more fear than someone with an early stage cancer.  That's not true.  The fear of recurrence is a universal phenomenon - it is present the same across different cancers, and is present at all stages of a particular cancer.  Take time to listen to your loved one's fears.  Don't try to "fix" it - as nobody truly can.  The best thing you can do is just listen, and in listening, leave her feeling less alone in her fears.

Also, recognize that she will be fatigued well beyond the end of treatment.  Many women claim that it takes 5 years before they feel their full energy return.  Be patient with her as she faces this frustration.  Returning to "normal life" after going through treatment takes time and a lot of love.

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