If receiving a diagnosis of breast cancer strikes fear in any woman’s heart, imagine how terrifying it is to be told the cancer has returned. The fear, it seems, is palpable. On the blogs at the American Cancer Society Web site, women describe what it’s like to anxiously await that “strike two” diagnosis. Regina writes, "I have a fear of recurrence to the point where I wish sometimes I had had a double mastectomy.”

"I constantly worry about it coming back. I was 30 in 2002 and was diagnosed with stage 1 breast cancer. I had a lumpectomy, heavy chemo, and radiation. One year later, I was diagnosed in the other breast. Thank God it wasn’t a metastasis. I’m now paranoid in my scans every three months,” says Stephanie.

Still, amidst the fear is courage. “Fear is normal. If we never felt fear, something would be wrong with our mental health. But it’s important to try something healthy that moves you in a positive direction, to accept it and survive. This has given me an increased appreciation of my life,” writes “StudioCheetah.”

Of the more than 5 million women living through breast cancer, recurrence actually brings the greater threat of death from the disease. Recurrence happens when a previously treated cancer returns locally or metastasizes to a new site. Recurrences can appear up to 20 years following surgery, though most occur within the first two years.

Statistics show that most women diagnosed with breast cancer survive the first five years after treatment, but only half survive the next 20 years cancer-free. “Up to 40% of women thought to be cancer-free following treatment still have tumor cells in their bodies in a dormant state,” says Lewis A. Chodosh, MD, PhD, director of Cancer Genetics at the Abramson Family Cancer Research Institute at the University of Pennsylvania School of Medicine, who is working on a model to prevent cancer recurrence.

The good news is that with new drug treatments, more women are surviving recurrence than ever before. What "StudioCheetah" and experts alike recognize is that you can move past the fear and fact of breast cancer recurrence and do something positive to affect your health—even when fighting a second battle with cancer. For example, a woman who knows that her risk of osteoporosis is increased because of cancer treatment can strengthen her bones through exercise.


The link between recurrent breast cancer and its cause is not as obvious as smoking and lung cancer. But experts have identified possible factors that may reduce women’s risk of breast cancer, such as avoiding long-term hormone therapy, having children before age 30, breastfeeding, maintaining a healthy weight, eating a low-fat diet, and limiting alcohol consumption. For women at high-risk for developing breast cancer, Tamoxifen can cut the risk in half, if taken for five years. And evidence proves that smoking hinders your ability to survive breast cancer.

Last May, researchers from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center demonstrated that a low-fat diet could have favorable effects on breast cancer outcomes. This grew out of the idea that fat intake might affect breast cancer because fat affects estrogen production, and estrogen fuels breast cancer.

But the low-fat diet only seemed to impact women with estrogen-negative tumors, suggesting other mechanisms play a role. “We’ve been hearing about the potential of low-fat diets to affect cancer for decades,” said Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society. “Now we have evidence that, at least for post-menopausal women whose tumors are not hormonally sensitive, a low-fat diet may decrease breast cancer recurrence.”

Limited evidence also shows that vitamins A, E, and C can protect against breast cancer. Phytoestrogens, naturally occurring estrogens that are in high numbers in soy, might also prove protective. Discuss these foods with your nurse, as their effects vary for different tumors.

While breast cancer recurrence is disappointing and stressful, it can be dealt with and managed. With treament, life can go on and you can survive.

Breast cancer can return in one of three ways after initial treatment:

Locally: Cancerous cells remain in the original site; this is seen as a failure of primary treatment by some experts, not necessarily a recurrence.

Regionally: Cancerous cells from the first site spread to the lymph nodes and may then affect the chest or neck.

Distant: This is called a metastasis and is the most dangerous recurrence—one in four distant recurrences is from the breast to
the bone or lymph nodes; other common sites are marrow, lungs, liver and brain.


Experts at the National Cancer Institute recommend different strategies for treating recurrent breast cancer, including hormone therapy with drugs such as tamoxifen, surgery with or without radiation, chemotherapy (if recurrence is localized), and the estrogen blockers known as aromatase inhibitors, including anastrozole, letrozole, or vorozole.

Trastuzumab can be used to stop cancer growth in cells with too much of the growth-promoting protein HER2/neu. This medication is often added to chemotherapy to reduce recurrence and mortality rates as compared to chemotherapy alone.

Bisphosphonates can also be used to strengthen bones, particularly when the cancer has spread there. Breast cancer often spreads through the lymph nodes in the arm pits (so-called axillary lymph nodes), and whether these lymph nodes are tumor-free or contain small metastases is an important factor in the decision of how aggressively to treat the cancer.

About the Author: Kathleen Furniss RNC, MSN, DMH, is coordinator of Women’s Imaging at Mountainside Hospital in Montclair, New Jersey, and a nurse practitioner in women’s health at Drew University, Madison, New Jersey.