Recurrent Breast Cancer
Recurrent breast cancer is cancer that progresses during treatment or recurs after a remission. Although breast cancer may recur almost anywhere in the body, common locations include the liver, bones, lungs, brain, and skin. Treatment for recurrent breast cancer depends on prior treatment, hormonal and menopausal status, location of the recurrence, and whether a precision medicine can be applied.
Medicine has made—and continues to make—great strides in treating breast cancer and in making cancer treatment more tolerable, both physically and emotionally. The greatest recent advances are in Precision Medicine. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. By defining the consequences of these genetic abnormalities doctors can identify specific treatments directed against each genetic abnormality for each individual patient’s unique DNA profile. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of cells. Standard chemotherapy typically destroys both normal and cancerous rapidly dividing cells in a wide range of tissues, often causing side effects by damaging normal cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed.
Recurrent breast cancers that are confined to the breast or area immediately surrounding the breast, called local-regional recurrences, are typically treated with surgery with or without radiation therapy. Most patients who experience a recurrence of their cancer have disease that has metastasized, or spread, throughout the body. These patients require systemic treatment that can reach the cancer anywhere in the body; systemic therapy may consist of chemotherapy, hormonal therapy, or targeted therapy.
- Hormone therapy is usually the first treatment for hormone receptor metastatic breast cancers. Hormone therapy drugs work by preventing the cancer cells from getting the estrogen they need to grow.
- Chemotherapy is used for people with hormone receptor negative cancers, hormone receptor positive cancers that no longer respond to hormone therapy and in combination with targeted therapies such as those directed at HER2.
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- Treatment of Local-Regional Recurrence of Breast Cancer
- Systemic Treatment for Recurrent Breast Cancer
- Managing Bone Metastases
- Strategies to Improve Treatment
Following primary surgical treatment of breast cancer with mastectomy or breast-conserving surgery (lumpectomy plus radiation), patients may experience a local recurrence, which is defined as cancer recurring within the previously affected breast, chest wall, or skin over the breast. Patients may also experience a regional recurrence of cancer, which is defined as cancer involving the supraclavicular, internal mammary, or axillary lymph nodes.
Recurrence after mastectomy: Local recurrence of breast cancer following initial treatment with mastectomy may be effectively controlled with additional radiation treatment. Surgery prior to radiation therapy may also be beneficial in selected circumstances. Additional local recurrences may be preventable depending on the size of the cancer, the amount of radiation delivered, and the size of the radiation field (the amount of tissue irradiated).1
Despite effective local control with surgery and radiation, the majority of patients experiencing a local recurrence ultimately develop systemic recurrence of their cancer. For this reason, many doctors believe additional treatment with chemotherapy or hormonal therapy may be useful.
Recurrence after breast-conserving surgery: A recurrence following breast-conserving therapy that is limited to the local–regional area around the original cancer is typically treated with a mastectomy. With this approach, approximately 60-75% of patients are likely to survive five years or longer without another cancer recurrence. Mastectomy may be followed by radiation in some circumstances. Patients with regionally recurrent breast cancer are at a higher risk of a future systemic relapse2 and may benefit most from the addition of radiation therapy or another treatment.
1 Recht A, Hayes DF, Everlein TJ, Sadowsky NL. In: Harris JR, Lippman ME, Morrow M, Hellman S, eds. Diseases of the Breast. Philadelphia: Lippincott-Raven Publishers; 1996:649-667.
2 Doyle T, Schultz DJ, Peters C, et al. Long-term results of local recurrence after breast conservation treatment for invasive breast cancer. International Journal of Radiation Oncology, Biology and Physics. 2001;51:74-80.