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For those who have had breast cancer, a common fear is that it comes back. If it does, you might feel a range of emotions, including anger and confusion. It’s also natural to have questions.
Here’s what Sandhya Pruthi, M.D., a breast health specialist at Mayo Clinic and a professor of medicine at Mayo Clinic College of Medicine and Science, tells her patients when they ask about cancer recurrence.
What exactly does “cancer recurrence” mean?
A recurrence is when cancer comes back after a period of remission, whether that’s 6 months or 6 years later – sometimes it’s even longer.
It happens when, despite efforts to clear your body of cancer, some cancer cells remained. Even though they were dormant for some time, they eventually continued to multiply, resulting in the reappearance of cancer. The recurrence could be in the same location as your original cancer, or it could be in another part of your body.
How common is cancer recurrence?
When it comes to breast cancer, recurrence is far less common than it was in the past. Thanks to regular screenings and education, healthcare professionals are increasingly diagnosing cancers at an earlier stage. That itself reduces the risk of recurrence.
Recurrence is largely dependent on the stage and the biology of the tumor. If you have earlier stages of breast cancer (stages 0, I, II), chances of disease-free survival in the next 5 years are as high as 95%. This means with treatment, there is up to a 95% chance the cancer will not come back or recur.
If you have later-stage breast cancer (stage III), the risk of recurrence is higher. The disease-free survival rate is around 60%.
Which breast cancers have the lowest and highest recurrence rates?
Noninvasive breast cancer (stage 0) has the lowest recurrence rate because it’s confined within the milk duct. With noninvasive ductal carcinoma in situ, you have a 99% chance of being disease-free at 5 years.
Stage IV breast cancer, which makes up only 5% to 10% of all breast cancers, often does not go into a complete remission. When it does, it usually recurs months or years later.
Are the treatments for recurrence the same as for a first diagnosis?
The treatment plan for recurrent breast cancer won’t necessarily look the same as it did the first time around. It depends on the type and location of your cancer, how much time has passed since your original diagnosis, your previous treatments, and your health.
It also depends on how much time passed since your first diagnosis. The treatments available are expanding and researchers may have a better understanding of a particular cancer or discovered new, targeted therapies. As a result, doctors are often able to better manage recurrence because of better treatments.
Biopsy of the new recurrence is often recommended to learn more about the biology or type of cancer, as this can help with targeted therapies.
Is there anything I can do to lower the risk of recurrence?
Yes. There are several cancer risk factors that you have control over. They include healthy habits like getting regular exercise, maintaining a healthy weight, eating a diet rich in fruits and vegetables, and avoidance of alcohol and smoking.
But I’ve done everything right. Why did my cancer recur?
Unfortunately, even when you do all the “right” things, sometimes cancer still comes back. And it’s certainly not your fault.
This really has to do with the biology of the cancer. There is much that researchers still have to understand about cancer. Especially in certain cancers, researchers are still trying to learn how to better target the tumor and prevent recurrence.
Genetics also may play a role. If you’re someone who has a hereditary predisposition to breast cancer, you may be more likely to develop a second new cancer rather than a recurrence of your original cancer.
If your genetic testing was done over 5 years ago, you may be asked to have repeat genetic testing. New genetic mutations are being identified and could impact the treatment options if you have a cancer recurrence.
How can I maintain positivity in the face of a recurrence?
There are so many emotions that come along with cancer recurrence. You may feel anger, fear or defeat. You might want to blame yourself or your care team. You may worry about whether you can handle going through treatment again.
Adding to the emotions is the fact that your experience might be different this time. The recurrence may not have the same biology as the original tumor. You may need another biopsy to evaluate a new growth. New treatments might also be available.
Surrounding yourself with people who “get it” can help your mindset. Lean on loved ones. Join a support group or reputable online community such as Mayo Clinic Connect. Talk with a mental health care provider. Some therapists are trained to work specifically with people with cancer and will understand your fears around recurrence.
Dr. Pruthi’s tips for handling ‘scanxiety’
When you’ve had cancer, it’s normal to feel nervous, afraid, stressed or anxious when it’s time for follow-up scans. In fact, these feelings are so common that they’ve inspired the term: “scanxiety.”
As you face diagnostic tests, it may be helpful to remind yourself that scans are an important and helpful tool for your health.
“If the results come back as you’d hoped, the scans will be reassuring,” says Dr. Pruthi. “And if a scan reveals a concern or new change from normal, or confirms a cancer diagnosis, there is power in knowing. You can address it and seek care promptly.”
Here are some tips for coping with your anxiety.
- Share your worries with your healthcare team. They can answer your questions and help you understand what to expect.
- Get up and move. “Don’t just sit and wait for your result,” says Dr. Pruthi. “Exercise, go for a walk, take that class at your gym. Doing something physical lets you control your body and distracts your mind.”
- Lean on loved ones. Ask a friend or family member to come to your appointment for support. And surround yourself with positive, supportive people who “get it” while you wait for your results.
- Work with the calendar. Schedule your test early in the day. This will give you less time to worry in the morning.
- Understand the process. Ask your doctor when you can expect your results and how you’ll get them. Will someone from your care team call you? Will you get a message in a patient portal?
“Doctors who work in the cancer space know how important this call is and are dependable when it comes to getting back to patients when they say they will,” says Dr. Pruthi.
- Practice stress management techniques. “It’s important to find ways to reduce your stress,” says Dr. Pruthi. “You may benefit from yoga, deep breathing, or other stress relievers.”
- Get help with sleep. “Sleep is often disturbed first,” says Dr. Pruthi. “When you’re worried about results, the mind is constantly going all night.” She adds that lack of sleep can lead to fatigue and irritability, which escalates scanxiety.
If you’re having trouble sleeping, meet with your doctor to discuss what other factors may contribute to sleep disturbance and whether they may be able to offer something that can help.
- Seek counseling. Some therapists are trained to work specifically with people who have cancer. Ask your doctor for recommendations.
- Be cautious when using the internet. “Avoid internet chat rooms, especially if there’s no moderator,” says Dr. Pruthi. “You might read something that makes you worry even more — but remember that every individual’s situation is different, and it won’t be your experience.”
If you do go online, visit reputable websites. When it comes to online sources of health information, stick to respected nonprofit institutions, professional organizations, and government agencies.
Some examples are MayoClinic.org, the American Cancer Society, and the Centers for Disease Control and Prevention. Mayo Clinic Connect is another helpful community site for people who have questions about various health conditions.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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