Recurrent breast cancer

Diagnosis

Your healthcare professional may suspect you have recurrent breast cancer based on a mammogram, a physical exam, or your signs and symptoms. When this is the case, your healthcare professional may recommend testing to confirm a recurrent breast cancer diagnosis.

Blood tests

Your healthcare professional may use blood tests to learn more about your overall health and look for signs that breast cancer may have returned or spread. Blood tests alone usually can't confirm a recurrent breast cancer diagnosis.

Researchers also are studying blood tests that look for tiny pieces of DNA from cancer cells in the blood. These tests, called circulating tumor DNA (ctDNA) tests, may detect signs of recurrent breast cancer before changes appear on imaging tests. More research is needed to understand who may benefit from these tests and how they should be used.

Imaging tests

Imaging tests make pictures of the body that healthcare teams can use to look for signs of cancer. What imaging tests you'll have depends on your specific situation. Imaging tests may include:

• Bone scan.
• Computerized tomography (CT).
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET).
• X-ray.

Not every person needs every test. Your healthcare professional determines which tests are most helpful in your situation.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. Your healthcare professional may recommend a biopsy procedure to collect suspicious cells for testing. This is the only way to confirm whether your cancer has returned.

A pathologist can tell whether the cancer is a recurrence or a new cancer. Tests also can show whether the cancer is sensitive to estrogen blocker therapy or targeted therapy. These features may have changed since your first cancer diagnosis.

Treatment

The treatments used for recurrent breast cancer may depend on several factors. These include:

• Extent of the disease.
• HER2 status.
• Hormone receptor status.
• Type of treatment you received for your first breast cancer.
• Your overall health.

Your healthcare professional also considers your goals and your preferences for treatment.

Treatment for a local recurrence

Treatment for a local breast cancer recurrence typically starts with an operation and may include radiation if you haven't had it before. Chemotherapy and estrogen blocker therapy also may be recommended.

• Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue.

  If your first cancer was treated with a lumpectomy, your healthcare professional may recommend a mastectomy to remove all your breast tissue. This typically includes removing all of the lobules, ducts, fatty tissue, skin and nipple.

  If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with some healthy tissue.

  A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all the nearby lymph nodes if they weren't removed during your initial treatment.

• Radiation therapy. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. If you didn't have radiation therapy for your first breast cancer, your healthcare professional may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects.
• Chemotherapy. Chemotherapy treats cancer with strong medicines. Your healthcare professional may recommend chemotherapy after surgery to lower your risk of another cancer recurrence.
• Estrogen blocker therapy. Estrogen blocker therapy medicines that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive.
• Targeted therapy. Targeted therapy for cancer is a treatment that uses medicines to attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Your healthcare team may test your cancer cells to see if targeted therapy might help you. For example, if the cells make extra HER2 protein, your care team may recommend medicines that target that protein.
• Immunotherapy. Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be an option for treating triple-negative breast cancer.

Treatment for a regional recurrence

Treatments for a regional breast cancer recurrence include:

• Surgery. If it's possible, surgery to remove the cancer is the recommended treatment for a regional recurrence. Your surgeon also may remove the lymph nodes under your arm if they're still present.
• Radiation therapy. Sometimes radiation therapy may be used after surgery. If surgery isn't possible, radiation therapy may be used as the main treatment for a regional breast cancer recurrence.
• Medicines. Chemotherapy, targeted therapy or estrogen blocker therapy also may be recommended as the main treatment or may follow surgery or radiation.

Treatment for a distant recurrence

Many treatments exist for a distant breast cancer recurrence, also called a metastatic recurrence. Your options depend on where your cancer has spread. If one treatment doesn't work or stops working, you may be able to try other treatments.

In general, the goal of treatment for metastatic breast cancer isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your healthcare professional works to achieve a balance between managing your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.

Treatments may include:

• Estrogen blocker therapy. If your cancer is hormone receptor positive, you may benefit from estrogen blocker therapy. In general, estrogen blocker therapy has fewer side effects than chemotherapy. So it's often the first treatment used for metastatic breast cancer.
• Chemotherapy. Your healthcare professional may recommend chemotherapy if your cancer is hormone receptor negative or if estrogen blocker therapy is no longer working.
• Targeted therapy. If your cancer cells have certain characteristics that make them vulnerable to targeted therapy, your healthcare professional may recommend these medicines.
• Antibody-drug conjugates. Antibody-drug conjugates are medicines that combine targeted therapy with chemotherapy. These medicines use targeted therapy to target the cancer cells and deliver chemotherapy directly to the cells. Antibody-drug conjugates are typically used alone or with other medicines to treat breast cancer that spreads.
• Immunotherapy. Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen or progesterone and don't make extra HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that's spread to other parts of the body.
• Bone-building medicines. If cancer has spread to your bones, your healthcare professional may recommend a bone-building medicine to lower your risk of broken bones or reduce bone pain.
• Other treatments. Radiation therapy and surgery may be used in certain situations to manage symptoms of advanced breast cancer.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Prognosis

The prognosis for breast cancer recurrence depends on where the cancer comes back. When it comes back in the breast, chest wall or lymph nodes, a cure may be possible. If the cancer spreads to other parts of the body, a cure often isn't possible. Treatments focus on slowing the growth of the cancer, helping manage symptoms and extending your life.

Your healthcare team can help you understand your prognosis. Your care team may consider many factors when thinking about your outlook, including:

• HER2 status. If the cancer cells make a lot of HER2, treatment that targets that protein may help. HER2-positive cancer has a better prognosis.
• Hormone receptor status. If the cancer cells are hormone receptor positive, treatment with estrogen blocker therapy and other treatments that target hormone-sensitive cells might help. Hormone receptor positive cancer has a better prognosis.
• Symptoms. Breast cancer that spreads to other parts of the body but causes few or no symptoms may have a better prognosis than cancer that causes significant symptoms.
• The length of time since your first diagnosis. Breast cancer that comes back soon after the first diagnosis tends to have a worse prognosis. Cancer that comes back many years later has a better prognosis.
• Where the cancer comes back. Cancer that comes back in the breast or chest wall has a better prognosis than cancer that spreads to other parts of the body.
• Where the cancer spreads. When the cancer spreads, where it goes also may affect prognosis. Cancer that spreads to the bones has a better prognosis than cancer that spreads to organs.
• Your overall health. Having other serious health conditions may affect the ability to tolerate treatments and give a worse prognosis.

Your healthcare team knows the details of your cancer and treatment. Care team members can give you a personalized outlook and help you make sense of what it means for you. Some people want to know as much as possible about prognosis, while others choose to focus on treatment and day-to-day life. The amount of information that feels helpful is different for everyone.

Alternative medicine

No alternative medicine treatments have been found to cure recurrent breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your healthcare professional's care.

For instance, many people diagnosed with cancer experience distress. If you're distressed, you may feel sad or worried. You may find it difficult to sleep, eat or focus on your usual activities.

Complementary and alternative treatments that can help you cope with distress include:

• Art therapy.
• Dance or movement therapy.
• Exercise.
• Meditation.
• Music therapy.
• Relaxation exercises.
• Yoga.

Your healthcare professional can refer you to professionals who can help you learn about and try these alternative treatments. Tell your healthcare professional if you're experiencing distress.

Coping and support

Finding out your breast cancer has returned can be as or more upsetting than your initial diagnosis. As you sort through your emotions and make decisions about treatment, the following suggestions might be helpful:

• Learn more about recurrent breast cancer. Ask your healthcare professional about your recurrent breast cancer, including your treatment options and, if you like, your outlook. As you learn more about recurrent breast cancer, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong may help you deal with your recurrent breast cancer. Friends and family can provide the practical support you may need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

• Find someone to talk with. Find a good listener who you can talk to about your hopes and fears. This may be a friend or family member. You also may find it helpful to talk with a counselor, medical social worker or clergy member. Or join a cancer support group for understanding and guidance.

  Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

• Look for a connection to something beyond yourself. Many people find that having a strong faith or a sense of something greater than themselves helps them cope with cancer.

Preparing for your appointment

If you have any signs or symptoms that worry you, make an appointment with your healthcare professional.

Your healthcare professional can recommend the necessary tests and procedures to confirm a diagnosis of recurrent breast cancer. Then you'll likely be referred to an oncologist. This is a doctor who specializes in diagnosing and treating cancer.

What you can do

• Be prepared to discuss your new symptoms and any other health problems you've had since your first cancer diagnosis.
• If you're seeing a new healthcare professional, request your medical records from your former healthcare professional. If you already have these, bring your medical records and any imaging tests you have with you. Otherwise, you'll need to sign an information release form so that your new healthcare professional's office can get the records.
• Make a list of all medicines, vitamins or supplements that you're taking. Let your healthcare professional know if you have tried any alternative treatments for your cancer.
• Consider asking a family member or friend to come with you. It may be hard to remember all the information you hear during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Some basic questions to ask your healthcare professional include:

• Has my cancer come back?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What are the hormone receptor status and the HER2 status of the cancer recurrence?
• What treatments are available to me and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the approach that you're suggesting?
• Are there any clinical trials open to me?
• What's my outlook?

What to expect from your doctor

Your healthcare professional is likely to ask you several questions. Being ready to answer them may allow time to go over points you want to discuss in more detail. Your healthcare professional may ask:

• When did you first notice symptoms again?
• Has there been a change in the symptoms over time?
• Do these symptoms feel different from when you were first diagnosed with cancer?
• How do you feel overall?
• Have you had any unexpected weight loss? Have you lost your appetite?
• Are you having any pain?

Living with recurrent breast cancer?

Connect with others like you for support and answers to your questions in the Breast Cancer support group on Mayo Clinic Connect, a patient community.

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