The breast and cancerUnderstanding the risk of breast cancer recurrence

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 (for example, surgery), either in the same place as the original tumor or somewhere else in the body.

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Risk of breast cancer recurrence

  • 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 nearby tissues where the tumor 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 breast cancer recurrence occurs in other parts of the body, such as in the lungs, liver, bone, or brain

The Early Breast Cancer Trialist's Collaborative Group conducted a meta-analysis 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. Evaluation of the results showed

Yearly risk of recurrence in early breast cancer

  • 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
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How hormones affect breast cancer recurrence

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 adjuvant 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 recurrence

Your doctor may consider several factors when assessing your risk for breast cancer 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 there are cancer cells in the lymph nodes (called node positive), there is a greater possibility of recurrence than if there are no 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
  • Tumor growth rate: cancer cells that multiply 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 breast cancer recurrence than women whose tumors are hormone receptor negative
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Important Information About ARIMIDEX

ARIMIDEX is approved for adjuvant treatment (treatment following surgery with or without radiation) of postmenopausal women with hormone receptor-positive early breast cancer.

ARIMIDEX is approved for the initial treatment of postmenopausal women with hormone receptor-positive or hormone receptor-unknown locally advanced or metastatic breast cancer and for the treatment of postmenopausal women with advanced breast cancer that has progressed following treatment with tamoxifen. Patients with hormone receptor-negative disease and patients who did not previously respond to tamoxifen therapy rarely responded to ARIMIDEX.

Important Safety Information About ARIMIDEX

  • Prescription ARIMIDEX is only for postmenopausal women. ARIMIDEX should not be taken if you are pregnant because it may harm your unborn child
  • Based on information from a study in patients with early breast cancer, women with a history of blockages in heart arteries (ischemic heart disease) who take ARIMIDEX may have a slight increase in this type of heart disease compared to similar patients who take tamoxifen
  • ARIMIDEX can cause bone softening/weakening (osteoporosis) increasing the chance of fractures. In a clinical study in early breast cancer, there were more fractures (including fractures of the spine, hip, and wrist) with ARIMIDEX (10%) than with tamoxifen (7%)
  • In a clinical study in early breast cancer, some patients taking ARIMIDEX had an increase in cholesterol. Skin reactions, allergic reactions, and changes in blood tests of liver function have also been reported
  • In the early breast cancer clinical trial, the most common side effects seen with ARIMIDEX include hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache
  • In advanced breast cancer trials, the most common side effects seen with ARIMIDEX versus tamoxifen include hot flashes, nausea, decreased energy and weakness, pain, back pain, headache, bone pain, increased cough, shortness of breath, sore throat, and swelling of arms and legs. Joint pain/stiffness has been reported in association with the use of ARIMIDEX
  • ARIMIDEX should not be taken with tamoxifen or estrogen-containing therapies

Please click here for full Prescribing Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088 (1-800-332-1088).