September 8, 2012 2:26:19 PM WATime
Yes Jo - this is a very important issue that I know can play on the back of the mind ..
I do also appreciate that reading about this may not be easy, and some may find unsettling .. please only read on if you feel okay to read about return of cancer ..
After undergoing recommended treatments for early breast cancer, risk of the return of cancer is aimed to be as low as possible. The chance of this occurring will depend on the features of the cancer and any other factors that may influence the risk (e.g. lifestyle factors, genetics, risk-reduction treatments, etc).
If cancer does return, this may happen at the site of previous cancer in the breast (local recurrence), a separate location in the same breast or the other breast (new primary breast cancer), or elsewhere in the body (secondary cancer). These events do not have to happen in any order. Of course not every problem that may occur in the future will necessarily be cancer-related. Other health problems can still happen to any of us!
When may cancer recur? It's possible the previous breast cancer may return as a local recurrence in the breast or as a secondary cancer. The most common sites for secondary breast cancer are the bones, liver and lungs. Tests may be carried out around diagnosis to assess if secondary cancer is present, and usually include blood tests, CT scan of the chest/abdomen & bone scan.
If no secondary cancer is present at diagnosis, this is very unlikely to occur in the first year after surgery and treatments. However the risk of recurrence (local or secondary) is then highest over the next 3 to 5 years (treatments such as hormone therapies are given over this time to reduce this risk).
From 5 to 10 years the risk gradually declines to a low level.
After 10 years the risk reaches a 'minimal' level - and is considered unlikely the original cancer will return. This is why many statistics relating to breast cancer and treatments refer to a '10 year' time-frame - as the cancer is unlikely to recur after this.
A new primary cancer in the breast is also not likely to occur during or soon after treatments, however then the risk (though usually low) is constant unless other risk-reducing measures are taken.
The symptoms to indicate a possible return of cancer will depend on where the cancer has occurred.
- A return in the breast (local) may be felt as a new lump or thickening, usually around or on the scar area, but may also cause other symptoms such as nipple discharge or inversion, or skin changes. ANY changes to the breast should be checked by your GP or team (**PLEASE NOTE: Many of these changes WILL NOT be due to cancer, and often are caused by scar tissue or changes from radiation & other treatments – however should always be checked).
- Any lumps or swelling in the armpit or neck/collar-bone area of the affected side may indicate a return of cancer in the ‘local’ lymph nodes (loco-regional recurrence). Other non-cancerous factors may cause lymph nodes to enlarge – again this should always be reported and checked.
- Lumps or changes in the other breast or armpit area – report.
- Symptoms of secondary cancer may not be easy to determine as many other non-cancer changes may cause similar symptoms. Any unusual, persistent unexplained aches, pains or changes in the body should be checked (e.g. persistent cough, bone aches, increasing loss of appetite or fatigue). NB: Many of these problems may occur as consequences of treatments or other illnesses (cold & flu), natural aging (back/hip aches) and other health problems. Having them checked by your GP or team is always important to determine cause.
It can be very easy to become focussed on cancer return and live in fear and dread of this happening. Looking at ways to manage this and keep things in perspective so we are able to relax and enjoy life is critical. Seeking supportive guidance from a counsellor, psychologist, other health professional or understanding family & friends (and the Click website ‘family’!) are powerful tools in achieving this.
Hope this has addressed the queries for you Jo. Please let me know if any other aspects to discuss. Our wonderful chat sessions on supportive measures and our posts in Forum have provided useful hints on sharing and dealing with concerns.
Loads of love & hugs, Glenys xx
The Click Breast Care Nurse 
