Monitoring for Recurrence

After receiving treatment for breast cancer, you will make a plan with your healthcare team for follow-up care. This plan is important because it will help you stay in good overall health, manage treatment side effects, and monitor for recurring cancer.¹

Thinking about your cancer coming back can be scary. But getting regular checkups and mammograms can help your care team catch and treat it early if it happens. And staying healthy by adopting certain lifestyle habits can help prevent many health problems.²

What is breast cancer recurrence?

Breast cancer recurrence means that the cancer comes back after you have finished the original cancer treatment. The cancer might come back in the same place or elsewhere in the body. Even people who have entered remission can have a cancer recurrence.^3,4

Breast cancer recurrence can be 1 of 3 possible types:^3,4

• Local – The cancer returns in the same breast as the original cancer. If cancer is found in the other breast, it is considered a new cancer, not a recurrence.
• Regional – The cancer returns in lymph nodes near the breast.
• Distant – The cancer returns in a completely different part of the body. Because the cancer has spread, this is considered metastatic breast cancer.

Fast-growing and widespread cancers are the most likely to recur. People who are more likely to have a breast cancer recurrence include those whose original cancer:^3,4

• Occurred before age 35
• Was an aggressive type of cancer, like inflammatory or triple-negative breast cancer
• Was diagnosed at a later stage (such as stage 3)

How do I monitor for cancer recurrence?

After your treatment is finished, your doctor will want to monitor your overall health and watch for any signs of recurrence over time. They will let you know when you need to come back for checkups, mammograms, and other tests. It is important to keep these appointments. A good way to keep track of this appointment schedule is with a survivorship care plan.¹

A survivorship care plan collects in one place the information you need to follow up on your breast cancer treatment. Along with your medical records, this plan allows you to easily share your treatment information with new doctors. And it helps you keep track of when to schedule follow-up appointments.¹

A survivorship care plan might include:¹

• A summary of your breast cancer history, including diagnosis, tests, and treatment methods
• A schedule of follow-up exams and tests focused on monitoring for recurrence
• A schedule for tests to look for long-term complications from the cancer or side effects of its treatment
• A schedule for other screening tests you may need
• A list of potential health problems you should watch for and when to contact your doctor
• Suggestions for lifestyle changes that can help you stay healthy

You can print out a survivorship care plan template and take it to your doctor to fill out together.

You also can monitor yourself for recurrence with breast self-exams you do at home. Check with your doctor to determine what is right for you. You may be able to find a new lump before your doctor can.³

What symptoms should I look for?

Your doctor will let you know which specific cancer recurrence symptoms to watch for. Symptoms may depend on the type and stage of cancer you had. But, in general, tell your doctor right away if you have any of the following:^2,3

• A new lump or mass in your breast or elsewhere
• Changes to a nipple, including discharge or flattening
• Swelling, firmness, or thickened skin of the breast
• Unexplained body pain that does not go away
• Fatigue, nausea, loss of appetite, or unintentional weight loss
• More headaches than usual or severe headaches
• Shortness of breath or a cough that will not go away

Can I prevent breast cancer from recurring?

There is no sure way to prevent cancer from coming back. But if you stay in good health and stick to your follow-up care plan, you can potentially reduce the chance of recurrence.²

The American Cancer Society recommends making some of the same healthy lifestyle changes to prevent cancer recurrence that you would to prevent cancer in the first place. These changes focus on reducing risk factors for cancer like obesity, lack of physical activity, and overuse of alcohol.^2,5

These changes are a good idea for everyone, whether or not they have previously had cancer. Healthy habits you can adopt include:^2,5

• Stop smoking if you smoke
• Keep your weight in a healthy range
• Get regular moderate-intensity exercise, at least 2.5 hours per week
• Limit sedentary time (sitting still or lying down)
• Eat a nutritious diet that includes lots of vegetables, fruits, and whole grains and limits processed and sugary foods and drinks
• Limit alcohol, ideally to none at all

What happens if my breast cancer comes back?

Breast cancer can come back months or even years after initial treatment. If it does, your doctor will likely want to treat it right away.⁶

The specific treatment plan will depend on the features of your original cancer and how it was treated, as well as features of the recurrence. It may involve surgery, radiation, and other treatment methods. These methods may differ from your original treatment plan.⁶

For example, a local recurrence of breast cancer that was originally treated with a lumpectomy might be treated with a mastectomy. A local recurrence that was originally treated with a mastectomy may require surgery and radiation. Regional recurrences may be treated with lymph node removal and radiation or other treatments.⁶

Other possible treatments include:^3,6

• Hormone therapy
• Targeted therapy
• Chemotherapy
• Immunotherapy
• Admission to a clinical trial

Make sure to talk through each treatment option with your doctor so you understand its goals and possible health effects.

Taking care of your mental health

Worrying that your breast cancer will return after treatment is normal. Feelings like anger and hopelessness are also extremely common. You may feel guilty or blame yourself for the original cancer or its potential recurrence. It is important to allow yourself to feel and process all the emotions that come up for you.^3,7

But sometimes those emotions can become overwhelming. Lean on the sources of support available to you. Your doctor can give you information about your condition, which may help you feel less anxious. A mental health counselor or support group can provide a place to talk with people who understand what you are going through. Ask your friends and family for help, too.⁷

Above all, be kind to yourself. Cancer recurrence is not your fault, and you can take action to treat it effectively.