Even years after the initial treatment, breast cancer can reappear either locally or in other regions of the body.    

If cancer is detected in the same location as a previous cancer, pathologists can examine some cells from it, compare them with samples from the original cancer, and decide if this is a new cancer or a recurrence of the original. Recurrence means the cancer is not a new cancer; it is the same cancer the person originally had. 

The original cancer can also reappear in a new location. Any cancer can spread and invade other organs and body parts. This is called "metastatic cancer."  "Metastasize" means to spread; cancer that has "metastasized" has spread to other parts of the body.  For example, if breast cancer cells invade the liver, the disease in the liver is not called "liver cancer," but "metastasized breast cancer." 

Therefore, breast cancer recurrence can be:

• Local: the cancer returns to the breast where it started, or to the skin and tissues where the breast was.
• Regional: the cancer returns to lymph nodes near the breast.
• Metastatic or distant: the cancer returns to some other part of the body which may not be near the breast, such as bones, the brain, liver, or lungs.

When a woman first has breast cancer, the doctors can look for certain things that increase or decrease the risk of recurrence, such as: 

• Stage and grade.  Stage denotes size.  The larger the original cancer, the greater the risk of recurrence.  The grade denotes how aggressive the cancer is; that is, how fast it is likely to grow and spread in the future. 
• Histologic grade refers to how similar the cancer cells are to normal cells. The more the cancer cells resemble normal cells, the lower the grade, and the lower the risk of recurrence. 
• Nuclear grade refers to how fast the cancer cells divide to form more cells.  The slower the rate, the lower the grade, and the lower the risk of recurrence.
• Cancer in the lymph node.  The risk of recurrence is greater if the original cancer spread to nearby lymph nodes.
• How well the patient responded to treatment for the original cancer.
• Hereditary mutations in BRCA1 and BRCA2 tumor suppressor genes.
• Acquired mutations in certain genes:
• Genes responsible for the division process of the cells are called proto-oncogenes.  When a proto-oncogene mutates it's called an oncogene. 
• Genes that decrease the cell division process or cause cells to die are called tumor suppressor genes.
  When either type of gene does not function properly, cells can grow out of control, which can lead to cancer.
• ER+ (estrogen receptor positive):  ER+ means the cancer contains (is positive for) receptors for the hormone estrogen. ER+ cancers generally are more receptive to treatment with hormones and grow more slowly; therefore the risk of recurrence is reduced.

The symptoms of a local recurrence are somewhat similar to those of breast cancer in general:

• A lump in the breast that persists and seems to grow
• A lump on or under the skin that seems irregular in shape, pink to red in color, firm or hard to the touch
• A thickening in or near the breast or in the underarm
• A part of the breast that seems unusual or different from any other part of either breast
• A change in the breast's shape, contour, or size
• Redness or a rash on the skin of the breast or nipple
• Other changes in the look or feel of the skin of the breast or nipple
• Fluid coming from the nipples

However, some of these symptoms can also result from harmless causes.  The important thing is to continue your regularly scheduled follow-up appointments with your doctor and to be extra vigilant in performing monthly breast self-exams.  Note that:

• Breast self-exam or a doctor's physical exam detects about one third of local breast cancer recurrences
• Mammography alone detects another third of local breast cancer recurrences
• Mammography and physical exam together detect the final third of local breast cancer recurrences

About forty percent of cases of recurrence are regional; they have spread to the lymph nodes in one or more of these places:

• Under the arm next to the breast that had the original cancer
• Under the other arm
• At the base of the neck
• Below the collarbone
• Under the chest wall
• Along the breastbone

The basic symptom for this is the presence of hard, round lumps in any of these areas. But again, there are harmless causes for this as well.  Be sure to report any concerns to your doctor.

In cases of distant or metastatic recurrence, the cancer spreads most often to the bones, brain, liver, or lungs.  Naturally, the symptoms depend on the area affected.  You can find a detailed description of them at Breastcancer.org.

Learn more about Breast Cancer Recurrence:
 
Key Point 2: Breast cancer recurrence is a chronic disease that has to be managed. The goal of treatment is control, not necessarily cure.  Many people live full, long lives with breast cancer.