What is the rate of breast cancer recurrence?

Breast Cancer Recurrence Rates

Breast cancer recurrence rates vary significantly by stage, with 10-30% of stage I cancers recurring within 10 years and 40-50% of stage II cancers recurring within 5 years. 1

Recurrence Rates by Stage and Time Period

Early Stage Disease

• Stage I (T1N0M0):
  • 10-30% recurrence rate within 10 years 1
  • For tumors ≤1.0 cm: 7% recurrence rate over 10 years 2
  • For tumors 1.1-2.0 cm: 21% recurrence rate over 10 years 2
  • T1N0 disease: 13% risk of distant recurrence between 5-20 years after stopping endocrine therapy 3

More Advanced Disease

• Stage II: 40-50% recurrence within 5 years 1
• Node-positive disease: Higher recurrence rates based on nodal status 3
  • T1N1-3 (1-3 positive nodes): 20% distant recurrence risk
  • T1N4-9 (4-9 positive nodes): 34% distant recurrence risk
  • T2N0: 19% distant recurrence risk
  • T2N1-3: 26% distant recurrence risk
  • T2N4-9: 41% distant recurrence risk

Timing of Recurrences

• Up to 85% of recurrences occur within the first 5 years after diagnosis 1
• After postoperative radiotherapy, local-regional recurrences occur in <10% of cases 1
• For hormone receptor-positive cancers, recurrences continue to occur steadily from 5-20 years after diagnosis 3
• Breast cancer subtypes show different recurrence patterns over time 4:
  • HER2-positive and triple-negative: highest recurrence rates in the second year
  • Luminal A and B: more continuous pattern over time

Recurrence by Breast Cancer Subtype

• Luminal A (ER+/PR+/HER2-/low grade): Lowest recurrence rates

  • 3.7% local recurrence
  • 1.7% regional recurrence
  • 9.5% distant metastases 4

• HER2-positive: Highest overall recurrence rates

  • 7.5% local recurrence
  • 25.6% distant metastases 4

• Triple-negative: Highest regional recurrence rates

  • 5.2% regional recurrence 4

Risk Factors for Late Recurrence

For recurrences occurring after 10 years:

• Progesterone receptor positivity
• Positive lymph nodes 5
• These factors differ from those associated with early recurrence (ER/PR status, Ki-67 index, p53 overexpression) 5

Surveillance Recommendations

• Annual mammography is the only imaging test routinely recommended for detection of local recurrence 1
• No evidence supports routine screening for brain metastases in asymptomatic patients, even in HER2+ disease 1
• Early detection of recurrence before clinical symptoms improves long-term survival by 17-28% 1

Prognostic Factors

Tumor grade significantly impacts recurrence risk:

• T1N0 breast cancer with low-grade: 10% distant recurrence risk (5-20 years)
• T1N0 breast cancer with moderate-grade: 13% distant recurrence risk
• T1N0 breast cancer with high-grade: 17% distant recurrence risk 3

The presence of tumor emboli in lymphatics significantly increases recurrence risk, particularly for tumors >1 cm (43% mortality rate) 2

Understanding these recurrence patterns is essential for developing appropriate surveillance strategies and determining the optimal duration of adjuvant therapies, particularly for hormone receptor-positive disease where late recurrences are common.