During surgery, doctors try to remove as much cancer as possible. Still, it is possible that some cancer cells may remain in your body and could continue to multiply. Recurrence is the term used to describe the return of cancer following primary treatment (e.g., surgery), either in the same place as the original tumor or somewhere else in the body.

Risk of recurrence basics

• There is no definite way to identify cancer cells that remain in the body because they cannot always be seen with medical tests
• Recurrence is possible, even if you've had a mastectomy

Breast cancer can recur in the following ways:

• Local recurrence occurs in the breast where the cancer first started, or in the skin and underlying tissues where the breast used to be. This type of recurrence can happen even if you've had a mastectomy. In the soft tissues of the chest, cancer can grow from breast cancer cells close to the skin or behind the breast area, against the muscle of the chest wall. This type of local recurrence is called a chest wall recurrence
• Regional recurrence occurs in the lymph nodes near the affected breast. These "regional" lymph nodes include nodes found under the arm (axillary nodes) and in the chest wall, such as those under the breastbone or under the pectoral muscle at the front of the chest. With regional recurrence, the cancer grows from cells that were present but undetectable at the time of the original surgery
• Metastatic recurrence occurs in other parts of the body, such as in the lung, liver, bone, or brain

The chart below shows the chance of breast cancer recurrence in each year during the 10-year period after a diagnosis of early breast cancer in patients who received no adjuvant treatment (treatment following surgery with or without radiation).

As indicated by the chart:

• The chance of breast cancer recurrence without adjuvant treatment was highest within the first 5 years after an initial diagnosis of early breast cancer, peaking within the first 3 years
• Some risk of recurrence was seen even 10 years following diagnosis

 

This chart was obtained by evaluating results from a total of 55 clinical trials involving 37,000 patients. When results from different studies are combined and evaluated in this way, it is called a "meta-analysis."

• Clinical trials included in this meta-analysis all began before 1990 and compared patients who took adjuvant treatment with tamoxifen to patients who took no adjuvant treatment at all
• The Early Breast Cancer Trialists' Collaborative Group (EBCTCG) conducted this meta-analysis

ARIMIDEX can help reduce the risk of breast cancer recurrence. Watch a doctor explain the important results of the ATAC trial.

 

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How hormones affect the risk of breast cancer coming back

The presence or absence of hormone receptors in the original tumor cells is important in assessing the risk of breast cancer coming back. A hormone receptor is a place on the tumor where hormones, such as estrogen and progesterone, can connect like two puzzle pieces.

• Tumors that depend on hormones for growth are called hormone receptor positive
• Hormone receptor-positive tumors appear to grow less aggressively than those that are hormone receptor negative
• Women whose tumors are hormone receptor positive have a lower risk of recurrence than women whose tumors are hormone receptor negative
• Adjuvant hormonal treatment such as ARIMIDEX may reduce the risk of recurrence in women with hormone receptor-positive tumors
• Among aromatase inhibitors, ARIMIDEX has the longest track record in demonstrating efficacy and safety in the initial treatment of early breast cancer in postmenopausal women. Learn more about the clinical trial results for ARIMIDEX

 

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How doctors determine your risk of breast cancer coming back

Your doctor may consider several factors when assessing your risk for recurrence:

• Cancer cells in the lymph nodes in the underarm area: Surgeons often remove some of these nodes to see if cancer cells are present. If you have cancer cells in your lymph nodes (called node positive), you are more likely to have a recurrence than if you don't have cancer cells in your nodes (node negative)
• Size of the tumor: In most cases, the smaller the tumor, the lower the risk
• Cancer grade: Doctors use a microscope to determine how cancer cells look. The more cancer cells resemble normal cells, the lower the grade and the lower your risk for recurrence
• Cell growth rate: Cancer cells that grow more slowly are linked to a lower risk for recurrence
• Hormone receptor status: If your tumor is estrogen receptor positive, you are more likely to respond to adjuvant hormonal treatment. Women whose tumors are hormone receptor-positive have a lower risk for recurrence than women whose tumors are hormone receptor negative.

 

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