For women who have been through breast cancer treatment, this is usually the million-dollar question. During treatment, women often feel empowered, cared for, well-monitored, and protected by the treatment regimen they are following. But after completing treatment, it can feel like you are flying without a compass. And this can cause real fear and anxiety.
One useful response: Learn all you can about the chances of recurrence, the signs of recurrence and any steps that can be taken towards prevention. Knowing that you are taking action -- informing yourself about these possibilities -- may go a long way toward alleviating your sense of vulnerability.What Is Recurrence?
After cancer has been successfully treated, there will be a cancer-free period. A woman may never again have that particular form of cancer. But if the same cancer is detected later, she is said to have had a recurrence. A recurrence can be:
- Local: Occurring in the vicinity of the initial tumor (for example, in remaining breast tissue or in skin or tissues where the breast was removed)
- Regional: Occurring in lymph nodes within the region of the original cancer
- Distant : Occurring at a distance from the original site (for example, in bone, liver or brain)
If cancer is discovered within three months of the initial treatment, doctors generally do not consider it to be a recurrence. Instead, it is seen as cancer progression or treatment failure. To be classified as a recurrence, the cancer must reemerge at least a year after completion of a successful cancer treatment.
What Is The Likelihood Of Recurrence?
It is important to remember that not every woman who has had breast cancer will face a recurrence. Some women receive treatment and live the rest of their lives cancer-free.
Because there are so many factors that figure into a woman's risk of recurrence, it is difficult to cite meaningful statistics. There are different types of breast cancer, and in different women, the cancer may have been at different stages when diagnosed. In addition, different treatments (for example, some women have breast-conserving surgery; others, a mastectomy) may affect recurrence rates.
Other treatment choices, including chemotherapy, radiation, hormone therapy, targeted therapy or bone marrow or stem cell transplant, may play a role as well. Family cancer history can factor in, as can individual risk factors, such as weight, diet or history of exposures. Furthermore, the risk of recurrence varies with the time elapsed since diagnosis and treatment.
That said, most studies suggest that patients treated with a combination of local lumpectomy and radiation have a 10% to 20% chance of recurrence within ten years of diagnosis -- although that estimation is on the high end, and it really depends on the type of cancer. Most recurrences happen within five years of initial treatment. After five years, the more time that passes without a recurrence, the less likely that a woman will experience one.
What Are The Signs And Symptoms Of Recurrence?
You should check with your doctor if you notice any changes in the area where you had your original breast surgery or in your other breast, including:
- Skin changes, such as reddening, swelling, scaling, puckering or puckering -- or a hot area, rash, streaks of color or "orange peel" appearance
- Any mass, lump, or thickening in the breast tissue, scar tissue or under your arm.
- Nipple changes, including retracted (pulled in) nipple, redness, scaling, or clear or bloody discharge.
You should also be alert to other possible symptoms, including:
- Weight loss
- Fever or chills, or both (unrelated to an acute illness, such as a virus)
- New cough or shortness of breath
- Bone pain
- Abdominal pain
- Headaches or vision changes
- Yellow eyes or skin
The best thing you can do after receiving a breast cancer diagnosis is to try to line up care with experts in breast cancer, including a breast surgeon, medical oncologist, and radiation oncologist. Track down reputable educational materials to help you understand the various treatment options. Once you and your medical team have chosen the treatments that are appropriate for your specific situation, make sure to follow the recommendations closely. Keep all of your scheduled follow-up appointments.
You should consider making various healthy lifestyle choices. Consult with your doctor about issues such as weight management, exercise, and stress reduction. These lifestyle choices can directly affect your chances of recurrence, and they can have a positive effect on your quality of life.
How Do I Live With The Fear Of Recurrence?
Perhaps the hardest aspect of having breast cancer the constant feeling of threat or dread. It is difficult not to cringe at any new ache or pain -- or resist thinking that it means a recurrence. Women cope with this issue in various ways. You should seek support, reassurance, and a sense of calm in whatever way seems most appealing and helpful. Some women find organized support groups of breast cancer survivors to be invaluable; others find an outlet in meditation, yoga, psychotherapy, religion, journaling, or the arts or music.
What Happens If I Have A Recurrence?
Over the years, the philosophy of recurrent breast cancer has changed. In some ways, breast cancer has come to be viewed almost like a chronic disease -- if one treatment does not work for you, another might. New and better treatments continue to be found, addressing various types of recurrence. Have faith that, depending on the details of your recurrence, there may well be a number of options to stop its progression.
Sources:Abeloff M.D., et al. "Cancer of the Breast." Clinical Oncology. Third ed. Eds. MD Abeloff et al. Philadelphia: Elsevier, 2004. 817-31.
"Breast Cancer Recurrence." Cleveland Clinic Health System. 6 May 2008.
Iglehart J.D. and B.L. Smith. "Diseases of the Breast." Sabiston Textbook of Surgery. 18th ed. Eds. CM Townsend, et al. Philadelphia: Elsevier, 2008. 851-897.
"When Your Cancer Comes Back: Cancer Recurrence." American Cancer Society. 6 May 2008.