Breast cancer: Checking for cancer recurrence

Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment. Breast cancer can come back as a local recurrence (in the treated breast or near the mastectomy scar) or as a distant recurrence somewhere else in the body. The most common sites of recurrence outside the breast include the lymph nodes, the bones, liver, or lungs.

How do I know if there is a recurrence?

If you have been treated for breast cancer, you should continue to practise breast self-examination, checking both the treated area and your other breast each month. You should report any changes to your doctor straight away. Breast changes that might indicate a recurrence include:

• An area that is distinctly different from any other area on either breast.
• Lump or thickening in or near the breast or in the underarm that persists throughout the menstrual cycle.
• A change in the size, shape, or contour of the breast.
• A mass or lump, which may feel as small as a pea.
• A marble-like area under the skin.
• A change in the feel or appearance of the skin on the breast or nipple, including skin that is dimpled, puckered, scaly, or inflamed (red, warm or swollen)
• Bloody or clear fluid discharge from the nipples
• Redness of the skin on the breast or nipple

In addition to performing monthly breast self-examinations, keep your scheduled follow-up appointments with your specialist. During these appointments, your specialist will perform a breast examination, order laboratory or imaging tests as needed, and ask you about any symptoms you might have. Initially, these follow-up appointments may be scheduled every three or four months. The longer you are cancer-free, the less often you will need to see your specialist. Continue to follow your specialist’s recommendations on screening mammograms (usually recommended once a year).

What factors determine the likelihood of a recurrence?

Prognostic indicators are characteristics of a patient and her tumour that may help a doctor to predict a cancer recurrence. These are some common indicators:

• Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence.
• Tumour size. In general, the larger the tumour, the greater the chance of recurrence.
• Hormone receptors. About two-thirds of all breast cancers contain significant levels of oestrogen receptors, which means the tumours are oestrogen receptor positive (ER+). ER-positive tumours tend to grow less aggressively and may respond favourably to treatment with hormones.
• Histologic grade. This term refers to how much the tumour cells resemble normal cells when viewed under the microscope. The higher the histologic grade, the greater the chance of recurrence.
• Nuclear grade. This is the rate at which cancer cells in the tumour divide to form more cells. Cancer cells with a high nuclear grade (also called proliferative capacity) are usually more aggressive (faster growing).
• Oncogene expression. An oncogene is a gene that causes or promotes cancerous changes within the cell. Tumours that contain certain oncogenes may increase a patient's chance of recurrence.