Dr. Susan Love Research Foundation | Breast Cancer

Local Recurrence After breast conservation (Lumpectomy)
If the tests are normal (only 5–10 percent of women with local recurrences will have signs of disease elsewhere in their bodies), then the next step is to determine how to eradicate the tumor from the breast. This usually means having a mastectomy. The research still isn't clear on whether chemotherapy is required after a local recurrence in the breast, but it is often considered in high-risk women. If your tumor is hormone-sensitive and you were on tamoxifen, it is reasonable to switch to an aromatase inhibitor, or vice versa.

New Primary Tumor
Most often the local treatment will be a mastectomy, since you can receive radiation therapy only once to a particular area. However, the newer approaches to partial radiation may change this. The addition of chemotherapy and/or hormone therapy will depend on the size and type of tumor you have. You can learn more about the different drugs used for chemotherapy to treat breast cancer here.

Local Recurrence After Mastectomy
Approximately 20–30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease and another 20–30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease. These tests may include a bone scan, chest X-ray, CT scan, MRI, or PET scan. They may also incorporate some blood tests, among which are tests for tumor markers. Local recurrence after mastectomy usually shows up as one or more nodules on or under the skin in or near the scar. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself (tissue from the abdomen) but along the edge of the old breast skin.

Most commonly the lesion will be removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation. Occasionally, even larger lesions will be surgically removed, including sections of rib and breastbone. Although this approach has not been shown to increase survival, it can improve the quality of life by preventing further local spread, which can be difficult to manage.

Despite aggressive local treatment, up to 80–85 percent of women with an isolated local recurrence following mastectomy will eventually develop distant metastases. For this reason, systemic therapy is sometimes used in this group as well. There are, however, no randomized controlled studies showing an advantage to restarting systemic therapy at this time rather than waiting and using it if and when metastatic disease appears. The biggest predictor of overall survival is the length of time between the original therapy and the recurrence or the length of the disease-free interval. The later the recurrence, the better.

Regional Recurrence
Further treatment to this area with either surgery or radiation often takes care of the problem, although systemic therapy may also be used. Regional recurrence in lymph nodes elsewhere, such as the neck or above the collarbone, has a more serious implication, since it is more likely to reflect spread of the tumor through the bloodstream. Akin to local recurrence following mastectomy, it usually warrants a more aggressive approach. You can learn more about the different drugs used for chemotherapy to treat breast cancer here.