What makes early breast cancer return or spread

Early breast cancer can be treated successfully. For most people, early breast cancer will not come back (‘recur’) after treatment.

Unfortunately, doctors cannot currently predict if, when, or where the cancer might return. No test can tell you for sure that the breast cancer won't return.

Tests on your tissue help doctors work out the likelihood breast cancer may come back. Sometimes breast cancer is found later in the same breast, and sometimes in other parts of the body.

Features that suggest breast cancer is more likely to come back

The main features that increase the chance of breast cancer coming back or spreading are:

• Size of cancer: the cancer removed from the breast was bigger than 2cm
• Location of cancer cells: cancer cells were found in the lymph nodes (‘lymph node positive’)
• Sub-type of cancer: 
  
  • the cancer is HER2-positive and hormone-receptor negative (i.e. no oestrogen or progesterone markers)
  • the cancer is triple negative (i.e. does not have oestrogen, progesterone or HER2 markers)

• Grade of cancer: the cancer is high grade (grade 3)
• Surgery margin: the tissue removed during surgery shows cancer cells on the edge of the tissue. This means the ‘margins’ were not clear and you may have more surgery to remove more tissue.
• Treatments: your treatments also affect the risk factors. For example, the standard treatment for HER2-positive early breast cancer is trastuzumab. This reduces the chance that this type of breast cancer will come back. People who have 12 months of trastuzumab for HER2-positive early stage breast cancer have a similar prognosis to other people, if not better.

Always talk to your doctor about your own situation.

Features that suggest breast cancer is less likely to come back

Cancers that are less likely to come back or spread have the following features:

• Size of cancer: the cancer was small – less than 2cm
• Location of cancer cells: cancer cells are only in the breast tissue, not in the lymph nodes
• Sub-type of cancer: 
  • the cancer is hormone-receptor positive and you have hormone-blocking therapy
  •  the cancer is HER2-negative
• Grade of cancer: the grade of cancer is low (grade 1)
• Surgery margin: the surgical margin is clear. This means all the cancer is removed during the surgery. The tissue around the cancer does not contain cancer cells when it is tested. 

Important: just because your cancer has these features, it does not mean the cancer may not come back or spread later on. You should follow the care plan your doctors set for you.

Resources to help with a fear of cancer recurrence

Our resources on fear of breast cancer recurrence include personal stories, podcasts and specialist advice:

• Fear of breast cancer recurrence: BCNA member Kym talks about dealing with her fears. Health professionals share their advice on coping with fear
• Video: Recognising and managing fear of recurrence: in our panel discussion, specialists provide techniques and strategies to help reduce fears around cancer coming back
• Podcast: Let’s be Upfront about the fear of recurrence: host Kellie Curtain talks to breast surgeon Professor Bruce Mann and psychologist Jane Fletcher about managing fears of cancer recurrence and when to seek further help and advice.
• Podcast: The iron fist: fear of cancer recurrence: clinical psychologist Dr Charlotte Tottman explains why it’s normal to experience anxiety about cancer coming back. She explores common triggers and common responses, including avoidance and reassurance-seeking.