Breast Cancer Recurrence

April 10, 2025

This page was reviewed under our medical and editorial policy by Nikhila Kethireddy, M.D., assistant clinical professor, and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

More than 4 million people in the United States are breast cancer survivors. While most will not develop cancer again, concerns about a recurrence are common and understandable. Despite advances in finding and treating breast cancer, it is always possible for cancer to come back years — and sometimes decades — later.

What Is Recurrent Breast Cancer?

Recurrent breast cancer occurs when cells from the original tumor are left behind after breast cancer treatment and then start growing again. A recurrence is generally cancer that has come back after a year or more with no signs of cancer.

Even with the most sensitive testing, it is not always possible to know for sure that every cancer cell has been destroyed after treatment. Undetectable cancer cells may sometimes stay in the body without ever dividing and growing into a cancerous tumor, and sometimes they will begin to grow again months or years later.

Cancer may recur either where it started before or somewhere else.

Breast Cancer Recurrence Rate

With advances in treatment, the percentage of people having breast cancer recurrence has gone down over time. In individuals, the risk of breast cancer recurrence is a complex process that varies from patient to patient, and it depends on many factors.

Two key factors in the risk of recurrence are how fast-growing the cancer cells are and how advanced the cancer has become in the body.

At initial diagnosis, genetic markers within the cancer cells are examined and included in a formula (recurrence score) to help the care team predict the likelihood that the patient’s cancer will return after treatment. This recurrence score also factors in the patient’s age and stage of breast cancer.

This final score (the risk of recurrence) is a key consideration in recommending treatment. A cancer that is more likely to come back may need more aggressive treatment originally than a lower-risk breast cancer. However, it is not possible to know for sure whether breast cancer will return after it has been successfully treated. Researchers continue to study why it happens and how likely it is based on cell features.

The patient’s doctor may be able to help her or him understand the risk of a recurrence. Researchers, such as those in a 2019 study, note that 20% to 40% of patients with no detectable cancer after treatment may experience a recurrence of their breast cancer at some point.

According to the National Cancer Institute:

• Rates of locoregional recurrence, where the cells have come back in the breast or nearby lymph nodes, have gone down over the years in patients treated for breast cancer
• Researchers estimate a locoregional recurrence rate of less than 3% in patients treated with breast-conserving surgery and breast cancer radiation therapy, and up to 10% in those treated with mastectomy
• At the time regional recurrence is diagnosed, in about 9% to 25% of patients, the cancer will be extensive in the region and/or also found in a distant site away from the original tumor

When Is Breast Cancer Most Likely to Recur?

Breast cancer is more likely to recur in the first few years after treatment. Breast cancers with cellular proteins called receptors that bind to specific hormones or proteins may recur sooner than others. Examples of these include hormone receptors (HR) and HER2 proteins. HR-positive breast cancer cells may have estrogen receptors (ERs), progesterone receptors (PRs) or both.

A 2023 study looked at recurrence rates among more than 8,000 patients with nonmetastatic invasive breast cancer. By type of cancer, the rates were found to be the following.

Triple-negative breast cancer (ER-, PR- and HER2-): 75% of recurrences happened within 1.92 years.

HR- or PR-positive (HR+, PR+) and HER2-negative (HER2-) breast cancer: 75% of recurrences happened within 2.65 years.

ER-, PR- and HER2+ breast cancer: 75% of recurrences happened within 2.79 years.

ER+ or triple-positive breast cancer (ER+, PR+, HER2+): 75% of recurrences happened within 3.05 years.

Sometimes, breast cancer recurs years later. Some factors that may increase the patient’s risk for developing a recurrence 10 years or more after their original diagnosis (called late recurrence) include:

• ER+ breast cancer
• Under 40 years of age at initial diagnosis
• Had breast-conserving surgery
• Had four or more cancerous lymph nodes
• Large initial tumor size

Breast Cancer Recurrence Symptoms

Some patients may have symptoms if breast cancer recurs. Local changes near the site where the cancer was removed may include a breast lump, texture or color changes, or soreness. However, symptoms may occur anywhere in the body, and a new breast cancer may develop at a site other than the original one.

Patients should report any of these symptoms to their cancer care team:

• New lump
• Lymph node swelling
• New or worsening pain
• Unexplained weight loss
• Feeling out of breath
• Feeling more tired than usual

The patient’s care team will evaluate any new symptoms to make sure they are not due to a recurrence. It is also important for patients to know that breast cancer may recur without causing noticeable symptoms. Staying current with recommended posttreatment screenings may help find breast cancer recurrences earlier.

Why Does Breast Cancer Come Back?

Sometimes, some cancer cells survive treatment. Either the treatment did not affect them or the cancer cells changed (mutated) enough to outlive treatment and start growing again. Researchers are still trying to understand why some cells start dividing again — sometimes many years later.

Recurrent Breast Cancer Risk Factors

Researchers are working to learn why some patients treated for breast cancer have recurrences while other patients do not. The patient’s cancer care team is able to gauge risk by assessing their:

• Hormone tumor markers
• Presence of HER2 in biopsy sample
• Genetic tumor markers
• Which cancer treatment(s) they received
• The type of cancer surgery they had
• Their age and overall health
• The type and duration of hormone therapy (if breast cancer is HR+)

These factors may offer clues about how likely the patient’s cancer is to come back. For example, patients with triple-negative breast cancer have a higher risk of recurrence than those with HR+ breast cancer. However, it is not possible to predict with certainty which patients will have a recurrence.

Breast Cancer Recurrence Types

Breast cancer may recur anywhere in the body, but it most often comes back in the bones, liver, lungs or brain. While cells from the initial tumor may stay close to the original site, cancer cells may travel through the blood or lymphatic system to other sites.

Breast cancer recurrence is classified according to the site where cancer cells are found — local, regional or distant.

Local Breast Cancer Recurrence

The recurrent breast cancer is found near the site of the initial tumor in the breast.

Regional Breast Cancer Recurrence

Breast cancer cells are found in lymph nodes near the site of the initial breast tumor (for example, under the arm or near the collarbone).

Distant Breast Cancer Recurrence

Cancer is found at sites far from the initial breast cancer. Cancers that start growing in distant sites are called metastatic. Breast cancer most often travels to the bones, brain, liver or lungs.

Recurrent Breast Cancer Treatment

Treatment of recurrent breast cancer depends on many factors, including where the cancer is recurred and how the patient was treated in the past.

Local recurrence: In patients who had lumpectomy, the breast is usually removed (mastectomy) and followed by radiation therapy, if it was not previously given.

Distant (regional) recurrence: The affected lymph nodes are removed, and radiation therapy for breast cancer is usually recommended if the patient did not have it before.

Advanced recurrence: Treatment choices depend on the site where cancer has spread.

After surgery and/or radiation therapy, the patient may receive medications for recurrent breast cancer. These medications may be used alone for patients who are unable to have surgery and radiation therapy. One or more medication treatments may be used:

• Chemotherapy for breast cancer
• Immunotherapy for breast cancer
• Hormone therapy for breast cancer
• Targeted drug therapy for breast cancer (like HER2 therapy)

Recurrent Breast Cancer Survival Rate

While the American Cancer Society provides survival rate estimates for newly diagnosed breast cancer, it also has similar estimates for breast cancers that returned after treatment. Recurrent breast cancer outcomes are more difficult to predict. Patients are encouraged to discuss possible outcomes with their cancer care team.

How to Prevent Breast Cancer Recurrence

Following recommended treatments for the initial breast cancer may lower the risk that the patient’s cancer will return. For patients with hormone-positive breast cancer, taking hormone therapy for at least five years may also help reduce this risk. The patient’s cancer care team will help him or her weigh the pros and cons of continuing hormone therapy even longer.

While no specific diet or supplements have been proven to prevent breast cancer recurrence, patients may be advised to follow general health habits to reduce their risk, including:

• Avoiding tobacco products
• Maintaining a healthy weight
• Engaging in regular physical activity
• Eating a diet rich in fruits, vegetables and whole grains
• Limiting sugary drinks, red meat and processed foods
• Avoiding alcohol (or having no more than one drink per day)

Following these guidelines may help prevent recurrence or the development of a secondary breast cancer (new breast cancer unrelated to the initial tumor).