Understanding Breast Cancer Recurrence: Types, Detection, and Next Steps

Breast cancer recurrence may appear in the original breast area, nearby lymph nodes, or in distant organs. DCIS treated with lumpectomy without radiation and other clinical factors can increase local recurrence risk. Suspected recurrence requires a clinical exam, tissue biopsy to confirm disease and reassess ER/PR/HER2, and imaging chosen based on symptoms. Routine whole-body imaging in asymptomatic survivors is generally not recommended. Treatment decisions depend on location of recurrence, prior therapies, and current tumor biology.

Overview

Breast cancer can return after initial treatment. When it does, the return most often occurs near the original tumor site, but it can also appear in regional lymph nodes or at distant organs. Recurrence does not happen to everyone; risk depends on the original diagnosis, the tumor biology, and the treatments used.

Who is at higher risk?

People treated for ductal carcinoma in situ (DCIS) with breast-conserving surgery (lumpectomy) have a higher chance of a local return than those who also had radiation. Mastectomy lowers the risk of cancer returning in the remaining breast tissue but does not eliminate the possibility of recurrence elsewhere. Whether a recurrence is invasive or noninvasive matters clinically: invasive recurrences have a greater potential to spread.

Types of recurrence

Local recurrence

Local recurrence means cancer comes back in the same breast, scar, or chest wall after prior breast-conserving surgery or mastectomy. It can reflect residual cells that regrow or new tumor development in nearby tissue.

Regional recurrence

Regional recurrence appears in nearby lymph nodes - most commonly the axillary (underarm) nodes, but it can also involve internal mammary or supraclavicular nodes. This spread indicates a greater likelihood of systemic disease than a purely local return.

Distant recurrence (metastasis)

Distant recurrence, or metastatic disease, means cancer has spread to other organs such as bone, liver, lungs, or brain. Symptoms depend on the organ involved and may include bone pain, shortness of breath, weight loss, or neurologic changes.

How recurrence is evaluated

If recurrence is suspected, the clinician will start with a focused history and physical exam. Confirming recurrence requires tissue - a biopsy of any suspicious lesion is the standard to establish diagnosis and to retest tumor markers such as estrogen receptor (ER), progesterone receptor (PR), and HER2, which can change from the original tumor and guide treatment.

Imaging choice depends on symptoms and the exam. Options include diagnostic mammography and breast ultrasound, breast MRI, CT of the chest/abdomen/pelvis, bone scan, and PET/CT in selected cases. Routine whole-body imaging in asymptomatic patients is not generally recommended; tests are guided by clinical findings.

Blood tests and tumor markers (for example, CA 15-3 or CEA) may be used selectively but are not replacements for clinical assessment and imaging.

What to do if you suspect recurrence

Contact your oncology team or primary care provider promptly. Expect a targeted workup: physical exam, imaging based on symptoms, and tissue biopsy to confirm recurrence and reassess receptors. Treatment will depend on the recurrence type, prior therapies, and current tumor markers.

If you need help deciding which tests are appropriate, ask your provider why each test is recommended and how results will change management.