A mastectomy, the surgical removal of the breast, is a highly effective treatment for breast cancer, significantly reducing the risk of the disease returning in the chest area. However, breast cancer can recur even after this procedure, though the likelihood varies widely among individuals. Recurrence rates depend on the tumor’s original characteristics, the extent of the disease at diagnosis, and the subsequent systemic treatments received. The overall risk is relatively low, with studies suggesting that approximately 5% of patients who have undergone a mastectomy may experience a recurrence on the same side of the chest within 10 to 12 years.
Understanding Recurrence Types and Locations
When breast cancer returns, it is categorized by where in the body the new cancer cells are found. The first type is local or regional recurrence, which involves cancer returning near the site of the original tumor. Local recurrence describes cancer cells growing on the chest wall, the skin flap, or within the surgical scar tissue of the mastectomy site. This occurs because a minute number of microscopic cancer cells may have remained in the area despite the removal of the entire breast.
Regional recurrence involves the cancer returning in the lymph nodes near the original site, such as those in the armpit (axillary nodes), above the collarbone (supraclavicular), or near the breastbone (internal mammary nodes). Both local and regional recurrences suggest that the original disease was not fully eliminated at the surgical site or in the immediate lymphatic drainage.
The second primary category is distant recurrence, also referred to as metastatic breast cancer. This signifies that cancer cells traveled through the bloodstream or lymphatic system before the mastectomy and settled in distant organs. Common sites for these distant metastases include the bones, lungs, liver, and brain. The cancer is still considered breast cancer, even though it is found in another part of the body, and it is treated with breast cancer therapies.
Key Factors That Influence Recurrence Risk
A patient’s specific risk of recurrence is based on biological and clinical data from their initial cancer diagnosis. The stage of the original cancer is a primary factor, particularly whether cancer cells had spread to the lymph nodes at the time of diagnosis. Having more lymph nodes involved substantially increases the likelihood of recurrence. The initial tumor size and grade, which describes how aggressive the cancer cells looked under a microscope, also correlate with a higher recurrence risk.
The molecular characteristics of the tumor play a role in determining recurrence risk and pattern. Tumors that are hormone receptor-positive (Estrogen Receptor-positive/Progesterone Receptor-positive) or HER2-positive have specific targeted therapies that can reduce recurrence. Triple-Negative Breast Cancer (TNBC), which lacks all three receptors, is often associated with a higher risk of early recurrence compared to hormone-positive cancers.
The administration of adjuvant therapy after surgery is another factor that modifies risk. Treatments such as chemotherapy, hormone therapy, and targeted therapy are used to eliminate any remaining microscopic cancer cells circulating throughout the body. Patients who received comprehensive systemic therapy tailored to their tumor profile have a lower risk of both local and distant recurrence.
Surveillance and Early Detection
Consistent medical follow-up is a core part of post-mastectomy care aimed at detecting any recurrence as early as possible. This surveillance typically includes regular clinical examinations by an oncologist or surgeon, often scheduled every three to six months for the first few years. For patients who have had a mastectomy, the physical exam focuses on the chest wall, the surgical scar, and the regional lymph node areas, such as the armpit and neck.
While mammography is not used on the mastectomy site, imaging tools like ultrasound and magnetic resonance imaging (MRI) are often used to monitor the chest wall, especially if breast reconstruction has taken place. The early detection of a recurrence, even if asymptomatic, is associated with a more favorable prognosis.
Patients are also encouraged to be vigilant for specific signs of recurrence. Local recurrence may manifest as a new, painless lump or nodule on or just under the skin of the chest wall or near the mastectomy scar. Other local signs include an area of skin thickening, a change in skin color or texture, or a persistent rash on the chest.
Symptoms of a distant recurrence indicate systemic spread and require immediate medical attention. These can include unexplained and persistent bone pain, a chronic cough or shortness of breath, or severe, persistent headaches and vision changes. While these symptoms can be caused by many other conditions, reporting them promptly to a doctor is important for timely investigation.
General Treatment Strategies for Recurrence
The treatment plan for a recurrence depends on its location and the biological profile of the cancer cells. For a local or regional recurrence, treatment typically involves localized approaches, such as surgery to remove the new tumor or affected lymph nodes. This is often followed by a course of radiation therapy, particularly if radiation was not part of the initial treatment plan.
Treatment for distant recurrence focuses on systemic therapies, utilizing medications like chemotherapy, hormone therapy, targeted drugs, or immunotherapy. The goal of systemic treatment is to control the cancer, slow its progression, and prolong a patient’s quality of life.