1. What is recurrence?
Recurrence is the term used when breast cancer has come back.
It’s not a new breast cancer, although people who have had breast cancer also have a slightly higher risk of developing a new primary breast cancer.
If you’re concerned about a new symptom after treatment, you can read our information on symptoms of recurrence.
2. Types of recurrence
There are 3 different types of breast cancer recurrence depending on where in the body the cancer has returned.
Tests, including a biopsy, will help to confirm the type of recurrence.
Local recurrence
If breast cancer comes back in the chest, breast or in the skin near the original site or scars, it’s called local recurrence.
If you’ve had a or breast-conserving surgery, the cancer could come back in the remaining breast tissue.
If you’ve had a , the cancer could come back in the chest wall or in the skin.
Having local recurrence doesn’t mean the cancer has spread to other parts of the body.
Locally advanced breast cancer (sometimes called regional recurrence or locally recurrent breast cancer)
If breast cancer has spread to the lymph nodes around the chest, neck, and under the arm or breastbone, but has not spread to other areas of the body, it’s called locally advanced breast cancer.
Locally advanced breast cancer may also affect the chest wall or skin of the breast.
It may be referred to as stage 3 breast cancer.
Sometimes breast cancer is locally advanced when it’s first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
Secondary breast cancer
Sometimes breast cancer cells can spread from the primary cancer in the breast to other parts of the body. This is called secondary or metastatic breast cancer.
Secondary breast cancer commonly affects the:
- Bones
- Lungs
- Liver
- Brain
Other parts of the body, such as lymph nodes in the chest, armpit or neck area, the skin or abdomen (belly), may also be affected.
3. Diagnosis
Diagnosing a local or regional recurrence usually involves similar tests to those used to diagnose primary breast cancer.
You will usually have a breast or chest examination to assess any symptoms followed by 1 or more of the following tests:
- Punch biopsy
If you are diagnosed with a local or regional recurrence, your doctors may use tests to check if there is cancer in any other parts of your body before starting treatment.
This doesn’t necessarily mean they think your cancer has spread, but your doctors will want to check to make sure you’re being offered the most appropriate treatment.
Tests may include:
- Blood tests
- A bone scan
- Chest x-ray
- CT scan
- MRI scan
- PET scan
Diagnosing secondary breast cancer involves different tests depending on what symptoms you have and where they are in the body.
Find out more about tests for secondary breast cancer.
4. Treatment for recurrence
Treatment for local recurrence
Treatment for local recurrence will depend on a number of factors, including what treatments you’ve had previously.
Surgery
If you had then you’ll usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.
If you previously had a mastectomy, surgery may be possible to remove the affected areas.
Nearby lymph nodes may also be removed.
Radiotherapy
is usually only an option if you haven’t previously had radiotherapy in the same area.
The way radiotherapy is given for a recurrence is similar to how it’s given to someone newly diagnosed.
Radiotherapy may be offered if surgery isn’t possible.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered .
Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.
Chemotherapy
It’s not clear how much benefit will be if you have a local recurrence, but it might be offered in some cases.
Different chemotherapy drugs may be used if you’ve previously had chemotherapy.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
They target and interfere with processes in the cells that help cancer grow. The type of targeted therapy you’re offered will depend on the features of your breast cancer recurrence.
Treatment for locally advanced breast cancer
This is likely to include a treatment that affects the whole body (systemic treatment).
This might be chemotherapy, hormone therapy or targeted therapy.
Chemotherapy
If you have previously had , you may be offered different chemotherapy drugs this time.
Some people with locally advanced breast cancer may be offered electrochemotherapy, which combines a low dose of a chemotherapy drug with electrical impulses.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered .
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
They target and interfere with processes in the cells that help cancer grow. The type of targeted therapy you’re offered will depend on the features of your breast cancer recurrence.
Radiotherapy and surgery
You may be offered if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. It’s not usually possible to remove the cancer using surgery in these situations.
If the recurrence has affected the muscles on the chest wall, you may be offered surgery as well as radiotherapy.
When recurrence affects the skin of the breast, it is usually treated with systemic treatment.
Surgery or radiotherapy may also be offered but this will depend on:
- The amount of skin affected
- Where the affected skin is
- Any previous radiotherapy you have had
Treatment for secondary breast cancer
If breast cancer has spread to another part of the body, it can be treated but it cannot be cured.
The aim of treatment for secondary breast cancer is to:
- Control and slow down the spread of the cancer
- Relieve symptoms
- Maintain health and wellbeing
- Give you the best quality of life for as long as possible
Find out more about treatment for secondary breast cancer.
6. Recurrence and prognosis (outlook)
What's my prognosis?
Everyone’s prognosis will be different, but is likely to depend on:
- The type of recurrence you have
- The features of your breast cancer
- How much time has passed since your primary breast cancer was diagnosed and treated
Your treatment team can talk to you about your prognosis if you want to know this.
Local recurrence prognosis
Local recurrence can often be successfully treated, particularly if it has been a long time since you first had treatment.
There’s some uncertainty about how local recurrence affects your overall prognosis.
Some breast cancer specialists believe that a local recurrence does not mean the cancer is more likely to spread in the future.
Other specialists think that local recurrence does increase the risk of the cancer spreading elsewhere.
Research is ongoing to try to answer this question and to find out who may be at most risk.
Locally advanced breast cancer prognosis
If you’re diagnosed with locally advanced breast cancer, there may be an increased risk of cancer cells spreading to other areas of the body.
This means the overall prognosis can be harder to predict.
Treatments such as chemotherapy, hormone and targeted therapies are given for locally advanced breast cancer because they work throughout the whole body.
Secondary breast cancer prognosis
If cancer has spread from the breast to another part of the body, it can be treated but it cannot be cured.
Cancer progresses in different ways for different people, and as treatments have improved more and more people are living longer after a diagnosis of secondary breast cancer.
Your specialist will have an understanding of the likely progression of your secondary breast cancer and can talk to you about what you might expect.
7. Coping with a breast cancer recurrence
Finding out that your cancer has come back can cause a mix of emotions.
It’s important you have a chance to ask questions. Your cancer specialist can give you information that’s tailored to your individual situation. Your breast care nurse can also be a helpful source of information and support.
Ongoing treatment and an uncertain prognosis can cause you to feel worried and anxious about your future. There’s no easy way to deal with this uncertainty, but you might want to get in touch with other people who are going through something similar.
You can exchange tips on coping with uncertainty and side effects of treatment, ask questions, share experiences and talk through concerns on our online forum.
You can also call our free helpline on 0808 800 6000 for information and support, and to find out about our services.
