Treatments and drugsBy Mayo Clinic staff
To plan treatment for recurrent breast cancer, your doctor considers many factors, including the extent of the disease, its hormone receptor status and the type of treatment you received for your first breast cancer. Most women receive a combination of treatments for recurrent breast cancer that may include surgery, radiation, medications to destroy cancer cells (chemotherapy) and hormone therapy. Breast cancers that make extra amounts of the HER2 protein may be treated with a targeted therapy such as trastuzumab (Herceptin).
Treatment decisions for recurrent breast cancer are complex and individualized. Talk with your health care team to learn about your treatment options.
Treating a local recurrence
Treatment for a local recurrence typically starts with an operation and may include radiation if you haven't had it before, chemotherapy and hormone therapy.
Surgery. For recurrent breast cancer that's confined to the breast, the usual treatment is mastectomy. During a mastectomy, your surgeon removes all your breast tissue — lobules, ducts, fatty tissue, skin and nipple. If your first breast cancer was treated with mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.
A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the lymph nodes under your arm (axillary dissection) during surgery if they weren't removed during your initial treatment.
- Radiation therapy. Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. If you did not have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects.
- Drug therapy (chemotherapy). If your recurrent breast cancer is the inflammatory type or involves the skin, your doctor may recommend chemotherapy before surgery. Chemotherapy may also be recommended if your recurrent cancer is so extensive that surgery isn't an option or if you have previously received hormone therapy.
- Hormone therapy. Medications that block the growth-promoting effects of estrogen and progesterone may be recommended if your cancer is hormone receptor positive. Hormone therapy may shrink and control recurrent breast cancer. Hormone therapy may include tamoxifen or an aromatase inhibitor, such as anastrozole (Arimidex), letrozole (Femara) or exemestane (Aromasin).
Treating a regional recurrence
If it's possible, surgery to remove the cancer is the recommended treatment for a regional recurrence. Your surgeon may also remove the lymph nodes under your arm (axillary dissection) if they're still present. Sometimes radiation therapy may be used after surgery.
If surgical removal isn't possible, radiation therapy may be used as the main treatment. Chemotherapy or hormone therapy also may be recommended as the main treatment or may follow surgery or radiation.
Treating a metastatic recurrence
Treatment for recurrent breast cancer that's spread beyond the breast region involves many different options. It's important to work with your doctor to understand what's most appropriate for your particular situation. If one treatment doesn't work or stops working, you may be able to try other treatments.
In general, the goal of treatment for a metastatic recurrence isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor will try to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.
If the cancer has spread to other parts of the body, treatment for a metastatic recurrence usually involves whole body (systemic) therapy rather than local therapy such as surgery or radiation. Options for systemic therapy include hormone therapy, chemotherapy or targeted therapy. Because hormone therapy is less toxic than chemotherapy, your doctor might start with tamoxifen or an aromatase inhibitor. But if your cancer is fast-growing or has already spread to other organs such as the lungs and liver or if you have previously received hormone therapy, your doctor might recommend starting with chemotherapy.
If your cancer is HER2 positive, you may also be given a targeted therapy to attack the protein that's overproduced in these cancers. Targeted therapies include trastuzumab (Herceptin) or lapatinib (Tykerb).
Depending on where the cancer has spread and what symptoms it's causing, you may also have localized treatments, such as medications or radiation.
Your doctor will likely let you know if you're eligible for any clinical trials of newer medications or treatments. If he or she hasn't suggested a clinical trial and you'd be interested in participating in one, let your doctor know.
- Hurria A. Follow-up for breast cancer survivors: Patterns of relapse and long-term complications of therapy. http://www.uptodateonline.com/home/index.html. Accessed March 19, 2011.
- Breast cancer. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed March 17, 2011.
- Punglia RS, et al. Local therapy and survival in breast cancer. New England Journal of Medicine. 2007;356:2399.
- Hayes DF. Overview of treatment for locally advanced, recurrent, and metastatic breast cancer. http://uptodateonline.com/index. Accessed March 19, 2011.
- What you need to know about breast cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/breast/AllPages/Print. Accessed March 19, 2011.
- Living with uncertainty: The fear of cancer recurrence. American Cancer Society http://www.cancer.org/docroot/MLT/content/MLT_4_1x_Living_With_Uncertainty_-_The_Fear_of_Cancer_Recurrence.asp. Accessed March 19, 2011.
- Hirsch A, et al. Management of locoregional recurrence of breast cancer after mastectomy. http://www.uptodateonline.com/home/index.html. Accessed March 19, 2011.
- Debled M et al.Prognostic factors of early distant recurrence in hormone receptor-positive, postmenopausal breast cancer patients receiving adjuvant tamoxifen therapy: Results of a retrospective analysis. Cancer. 2007;109:2197.
- Rausch SM, et al. Complementary and alternative medicine: Use and disclosure in radiation oncology community practice. Supportive Care Cancer. 2011;19:521.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. April 11, 2011.