One of the tools a woman can use against breast cancer recurrence is compliance with her doctor’s follow-up guidelines. These will certainly include continuation of monthly breast self-examinations, screening mammograms (usually once per year), and scheduled appointments with the physician, which may be as often as every three months at first. At these appointments, he will perform a breast exam, discuss possible symptoms and order lab work or imaging tests he may feel are indicated. Most breast cancer tends to recur in the first two to five years after initial treatment. Breast cancer recurrence can occur in the same breast previously treated or it can recur in the other breast or in another part of the body, most often the lymph nodes, lungs, liver or bones (still called breast cancer).

There are several factors related to the first breast tumor that can influence the probability of recurrence: tumor size, prior involvement of lymph nodes, histologic grade (high number of abnormal cells in cancerous tissue), hormone receptors (presence of estrogen receptors in cancer cells; can be favorable), nuclear grade (refers to rate of division of cancer cells; faster growing not favorable), oncogene presence (promotes abnormal changes in cells; may increase recurrence). During monthly breast self-exams, women should use the recommended guidelines for technique and report any changes in the previously treated breast or other breast.

If a new area of concern becomes apparent in the previously treated breast and it turns out to be a breast cancer recurrence, treatment will depend on how the prior involvement was handled. If there was a lumpectomy and radiation, the surgeon may want to perform a mastectomy since radiation was most likely used on that same tissue. If there was a mastectomy done, the tumor will be removed and followed with radiation. In both instances, chemotherapy and/or hormonal therapy will be prescribed.

When cancer is found in the other breast, the new breast cancer recurrence may be of a type entirely different from the first. After tests and staging are complete, the patient’s doctors will recommend a treatment plan, with probably a lumpectomy or mastectomy and chemotherapy and/or hormonal therapy.

If the cancer is a metastasis into a distant area of the body, such as bones, lungs, brain or other organs, the treatment will involve chemotherapy or hormonal therapy or both together. In order to relieve other unfavorable symptoms of the patient, radiation may be performed; or the need for more surgery may be recommended at the new site. Immunotherapy may be used alone or with chemotherapy for certain patients and can generally be started after chemotherapy or hormonal therapy is no longer effective.

Janet Brown is a medical writer and graduate of Loyola University New Orleans. Her personal experiences with breast cancer have drawn her to her current work developing breast cancer patient education and awareness materials. She currently lives in Georgia.