After completing breast cancer treatment, many patients worry about the possibility of a recurrence. In most cases, doctors can’t predict breast cancer recurrence until it actually happens.

About 90% of breast cancer patients are diagnosed with a growth in the breast or in both the breast and the lymph nodes beneath the arm, which can range from Stage 1 to Stage 3.

According to Dr. Angela DeMichele, co-director of the 2-PREVENT Breast Cancer Translational Center of Excellence at Penn Medicine’s Abramson Cancer Center, between 70 and 80 percent of these women are cured by current treatments like chemotherapy, radiation, and anti-estrogen medicines.

The cancer returns as Stage 4, or metastatic, in the remaining 20–30% of cases, indicating that it has spread beyond the breast and nearby lymph nodes.  According to the American Cancer Society, only around 31% of people with metastatic breast cancer survive for more than five years, making treatment more difficult.

Factors Affecting Breast Cancer Recurrence Risk

Many women choose to have a double mastectomy because they are concerned that breast cancer may return. However, the greater threat lies in metastatic recurrence— which occurs when cancer spreads to other organs including the liver, lungs, or bones. Metastatic breast cancer is much more difficult to treat, according to Yale Cancer Center head Dr. Eric Winer.

To determine which individuals may be at higher risk of having breast cancer recurrence, doctors consider several factors about a patient’s cancer.

Cancer in the Lymph Nodes

According to Dr. Winer, the spread of early-stage cancer to a lymph node indicates the possibility of future metastatic disease.

Additionally, cancer exhibits a propensity to expand if it has progressed to a lymph node, according to Dr. Arif Kamal of the American Cancer Society.

Since stage 0 and stage 1 breast tumors do not spread to lymph nodes, early identification is still beneficial in avoiding recurring metastatic illness.

Cancer Grade
According to the MD Anderson Cancer Center, while cancer grade quantifies the irregularity of cancer cells in relation to normal cells, cancer stage describes the extent of the cancer’s spread.

Does it appear angry when viewed under a microscope? Does this appear to be a cancer that causes trouble? “Kamal says.” Aggressive, rapidly dividing cancer cells are indicated by a higher grade.

Tumor Size

According to Kamal, a larger tumor—say, three centimeters as opposed to one—may be a sign of a higher chance of breast cancer recurrence because it has probably been in the body for a longer period of time.

Cancer Stage

People with later-stage cancers are more likely to experience a metastatic recurrence, according to Kamal. According to him, bigger tumors that have already spread to the lymph nodes and look more aggressive under a microscope are frequently found in later-stage cancers.

Genetic Mutations

The risk of breast cancer recurrence is increased by genetic abnormalities such as Lynch syndrome or BRCA1 or BRCA2. Because the risk is so much higher, women with these mutations frequently have double mastectomies to prevent cancer from returning in the same or opposite breast.

People with multiple first-degree relatives who’ve had breast or ovarian cancer or any cancer before age 50 may also be higher risk for breast cancer recurrence and therefore undergo a double mastectomy.

According to study, a lumpectomy plus radiation therapy can offer patients with early-stage cancer the same chance of survival as a double mastectomy, says Dr. Winer.

A New Trial to Detect “Sleeping” Cancer Cells

For breast cancer patients, finishing treatment can be an emotional milestone. But it’s often followed by worry over the future. ‘OK, I’m done with treatment. … Now what?’”

Conventional treatments are effective in preventing breast cancer recurrence for the majority of individuals with a diagnosis. DeMichele explains that the approach is frequently “watchful waiting.” “The problem was that we didn’t really know what to do (after) the end of that initial therapy that was designed to get a patient to the point where they don’t have any cancer,” she adds.

Following treatment, “watchful waiting” has been the standard strategy, with regular scans for roughly five years to identify any return of breast cancer. However, patients are left wondering what might happen after this time.

Dr. DeMichele and her colleagues have discovered “sleeping” cancer cells—those that escape the breast, enter the bloodstream, and are unaffected by therapies. In locations such as the bone marrow, these cells “hibernate,” yet they have the potential to reactivate and spread as metastatic breast cancer.

A technique to identify and treat these sleeping cells before they reawaken, spread to other areas of the body, and develop into cancer is currently being tested by the study team. They initiated research to track the bone marrow of women and treat those who

According to DeMichele, “(Breast Cancer recurrence)” is the cause of death for the majority of breast cancer patients.

Additional patients are being enrolled in the phase 3 expansion of the experiment. DeMichele hopes that more individuals will want to take part.

“Patients desire to take the initiative.” “This information is what they want,” she explains. “People find it very stressful to wait for that other shoe to drop.”

According to DeMichele, they anticipate results in a few years and will improve the testing procedure to make sure it works if it is made publicly accessible.

“They’re still working out what the surveillance would look like to be able to do this testing,” says Dr. DeMichele. “To be sure, we’ll probably need to repeat the testing on a regular basis.”

She encourages patients to stay hopeful, adding, “Part of this cancer journey is knowing that there are things we can’t control, but we certainly can do everything we can for ourselves and for our fellow patients and keep supporting that ongoing research,”.