Evaluation of Breast Cancer at Recurrence

After first-line definitive treatment (whether breast conservation or mastectomy), approximately 5–15% of patients may experience recurrence which could be locoregional or distant. Locoregional recurrence could portend an increased risk of distant metastases and deaths. Most recurrences occur in the ipsilateral breast or chest wall, and they usually appear within 5 years of initial treatment. Recurrence after mastectomy usually occurs earlier than that after breast-conserving therapy. Recurrences are usually detected via physical examination, mammography (following breast-conserving therapy), or other imaging modalities. It is paramount to differentiate ipsilateral breast tumor recurrence from second primary as this guides treatment decisions and influences overall prognosis. At recurrence, a repeat biopsy should be done to confirm diagnosis and reevaluate the ER/PR (progesterone receptor) and HER2 status should be determined from a recurrent tumor or metastatic sites. Complete staging evaluation should include blood work, cross-sectional imaging, and radionuclide bone scan.