After your first course of breast cancer treatment, it is very important to keep all scheduled follow-up appointments with your doctor. Most breast cancer recurrences occur within the first three to five years after initial treatment. However, most breast cancer recurrences are found by women while performing self-breast examinations in between appointments. For this reason, it is important to keep your doctor informed about any changes in your breasts.
Tests such as x-rays, bone scans, ultrasounds, MRIs, CT scans, PET-CT scans, and blood tests are not typically used to screen asymptomatic patients for a recurrence. These tests have no significant benefits on disease detection, survival rate, or survival quality, and can produce false-positive results. The following simple tests are recommended for routine screening for the recurrence of breast cancer.
Patient should perform a breast self-exam monthly to check for any abnormalities or noticeable changes.
After initial treatment, patient should visit a doctor once every three to six months for two to three years, then once every six months until year five. Patient should visit a doctor annually after year five.
Patient should have annual mammograms after initial treatment.
Patient should have annual pelvic exams after initial treatment. Tamoxifen increases the risk of uterine cancer.
Patients with a family history of cancer, triple negative breast cancer, and younger patients may benefit from genetic counseling. Breast cancer may run in your family if you have any of the following biological risk factors:
In general, women with more aggressive cancers are at the highest risk for recurrence. Women are often treated with adjuvant therapies to reduce this risk. Here are the major risk factors for recurrence:
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Risk of recurrence increases with primary tumor size.
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Risk of recurrence increases with lymph node involvement.
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This refers to the resemblance between cancer cells and normal cells when examined under a microscope. Risk of recurrence increases with histologic grade.
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This refers to the rate at which cancer cells divide and multiply. Cancer cells with high nuclear grade are high risk.
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Breast cancer tumors that are estrogen or progesterone-receptor positive tend to grow more aggressively and have a higher risk of recurrence. These tumors may respond well to hormone therapy.
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Tumors that produce too much of the HER2 protein grow more aggressively and are more likely to recur.
Cell growth rate is the percentage of cancer cells within a tumor that are actively growing and multiplying. Ki-67 is a protein in cells that increases when the cells are multiplying. The more cells that are positive for Ki-67, the higher the cell growth rate.
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The pathologist will also look closely at the small caliber blood and lymph vessels around the tumor to determine if any cancer cells have invaded them. When cancer cells invade these vessels, it is called a lymphovascular invasion.
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Cancer returns in the same location as the original cancer.
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Cancer that has spread beyond original location and nearby lymph nodes, but remains within the chest region.
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Cancer that has traveled (metastasized) through the lymph system or blood stream to a distant part of the body.
Cancer recurrences are most often local or metastatic. Regional recurrences occur in only 2% of all breast cancer cases. If the recurrence is metastatic, it usually spreads to the bone, lungs, or liver. It may also spread to the brain, ovaries, adrenal glands, or other parts of the body.
If medical exams and tests indicate a recurrence, a chest x-ray, CT scan, bone scan, PET-CT and/or biopsy may be performed to be sure. Treatment of recurrent breast cancer depends on the type of recurrence (local, regional, or metastatic) and how the disease was treated initially. Local recurrences after lumpectomy and radiation therapy are usually treated with a mastectomy. Regional recurrences after a mastectomy are usually treated with more surgery and radiation therapy. Treatment options may also include chemotherapy and hormone therapy for women whose cancer has metastasized to another part of the body.
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