> Survival and Risk of Having Cancer Return after Treatment (Recurrence, Relapse)
Treatment type and breast cancer survival
One major decision you may face with early breast cancer is whether to have mastectomy or lumpectomy (also called breast conserving surgery) plus radiation therapy. Both surgeries are effective in treating early breast cancer.
Overall survival is the same for mastectomy and lumpectomy plus radiation therapy. This means both treatments lower the risk of dying (from breast cancer or other cause) by the same amount.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy in the treatment of early breast cancer, visit Breast Cancer Research.
Risk of breast cancer recurrence
Although the choice between mastectomy and lumpectomy plus radiation therapy will not affect your survival, it may affect your risk of breast cancer recurrence (the return of cancer, relapse).
Local recurrence is the return of cancer to the breast, chest wall or lymph nodes after treatment. Most local recurrences occur within the first five years after diagnosis . If you have a recurrence, you will need more treatment.
Learn more about treatment for local recurrence.
Distant recurrence (metastasis)
Distant recurrence (metastasis) occurs when cancer spreads beyond the breast to other organs such as the bones, liver, lungs or brain. It is the main cause of breast cancer death.
The risk of distant recurrence is the same for people who have mastectomy and those who have lumpectomy plus radiation therapy .
Learn about treatment for distant recurrence (metastatic or advanced breast cancer).
Lumpectomy plus radiation and local recurrence
With current treatment, women who have lumpectomy plus radiation therapy have a 0.5 percent chance (that is, 5 in 1,000 or 1 in 200) of a local recurrence each year after diagnosis .
The best predictor of local recurrence is whether the tumor margins contain cancer cells.
- Positive (also called “involved”) margins contain cancer cells.
- Negative (also called "not involved," "clear" or "clean") margins do not contain cancer cells.
The chance of local recurrence is lower when the tumor margins are negative .
The risk of recurrence also depends on the status of the lymph nodes. If the lymph nodes are negative (do not contain cancer cells), the chance of local recurrence in five years is 6.7 percent . If the lymph nodes are positive (contain cancer), the chance is 11 percent .
With lumpectomy, the tumor should be fully removed with negative margins before radiation therapy begins. The risk of local recurrence with lumpectomy plus radiation therapy can be lowered with chemotherapy, targeted therapy and/or hormone therapy after surgery .
Mastectomy and local recurrence
With mastectomy, the best predictor of local recurrence is how far the cancer has spread in the lymph nodes. The chance of local recurrence in five years is about six percent for women with negative lymph nodes (do not contain cancer) .
For those who have cancer in one to three nodes, the chance of local recurrence in five years is about 16 percent. Radiation therapy can reduce this risk to about two percent .
The chance of local recurrence increases to about 26 percent when cancer is in four or more lymph nodes . Radiation therapy to the chest wall after mastectomy is given routinely when there are four or more positive nodes. This reduces the risk of local recurrence in five years to about six percent for those with positive lymph nodes .
Learn more about recurrence.