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Breast cancer covers a wide number of different types of tumour which have different patterns of disease progression and outcomes. Any breast cancer can recur, but the following features affect the likelihood of recurrence:

Tumour size and lymph node involvement Grade Biological features
  • The larger the size of the tumour, the higher the likelihood of relapse.

  • The greater the degree of lymph node involvement, the higher the likelihood of recurrence.  This is the biggest risk factor for recurrence.
The grade of the tumour describes the histological appearance. Higher grades are more likely to relapse.

  • Low grade/ grade 1 – well-differentiated
  • Intermediate grade/ grade 2 – moderately differentiated
  • High grade/ grade 3 – poorly differentiated cancers
 The biological features of the tumour are defined by the presence or absence of receptors for oestrogen, progesterone and HER2. The presence or absence of theses receptors affects treatment and prognosis. Triple-negative breast cancer
and HER2 positive breast cancer are more likely to recur.

Dr Sarah Taylor, GatewayC GP Lead, discusses the risk of recurrence with Dr Richard Simcock, Consultant Clinical Oncologist.


  • Key points

    Breast cancers most commonly recur in the first 2-3 years after primary diagnosis. However, breast cancer may recur many years afterwards. Primary care professionals need to be aware of the risk of recurrence in all patients as low risk does not mean no risk .
    Which cancers are most likely to recur?

    • Risk is based on various factors – see table above
    • Healthcare professionals and patients can use the NHS Predict website to understand the risk of recurrence of a particular tumour. This is used to help patients and professionals decide on treatment regimes

    When?

    • Triple negative breast cancers are more common in younger women and tend to relapse in the first 2-3 years. They are unlikely to recur after 5 years
    • Recurrence for oestrogen positive cancers, which form the majority, occurs mostly within 5 years. However, some do recur beyond 5 or even 10 years. This is why advice regarding endocrine therapy has changed to be recommended over 10 years.

    Age

    • Younger, pre-menopausal women are more vulnerable to early relapse
    • Older women are more likely to have an oestrogen receptor-positive (ER-positive) breast cancer

    Where?

    • Local recurrence is the most common type of recurrence and occurs in the affected breast or associated lymph nodes.
    • Distant recurrence most commonly occurs in the bone, lung, liver and brain, but can occur in any site
    • However, of note, patients who have had a diagnosis of invasive lobular breast cancer may experience recurrence in the GI tract, peritoneum and ovary

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Additional resources

Link: Facts and statistics 2021, Breast Cancer Now (2021)
Link: Invasive Lobular Cancer, The Oncologist (2021)

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