Signs and symptoms of recurrent breast cancer vary depending on where the cancer comes back.

Local recurrence

In a local recurrence, cancer reappears in the same area as your original cancer.

If you've undergone a lumpectomy, the cancer could recur in the remaining breast tissue. If you've undergone a mastectomy, the cancer could recur in the tissue that lines the chest wall or in the skin.

Signs and symptoms of local recurrence within the same breast may include:

• A new lump in your breast or irregular area of firmness
• Changes to the skin of your breast
• Skin inflammation or area of redness
• Nipple discharge

Signs and symptoms of local recurrence on the chest wall after a mastectomy may include:

• One or more painless nodules on or under the skin of your chest wall
• A new area of thickening along or near the mastectomy scar

Regional recurrence

A regional breast cancer recurrence means the cancer has come back in the nearby lymph nodes.

Signs and symptoms of regional recurrence may include a lump or swelling in the lymph nodes located:

• Under your arm
• Near your collarbone
• In the groove above your collarbone
• In your neck

Distant recurrence

A distant (metastatic) recurrence means the cancer has traveled to distant parts of the body, most commonly the bones, liver and lungs.

Signs and symptoms include:

• Persistent and worsening pain, such as chest or bone pain
• Persistent cough
• Difficulty breathing
• Loss of appetite
• Weight loss
• Severe headaches
• Seizures

Recurrent breast cancer occurs when cells that were part of your original breast cancer break away from the original tumor and hide nearby in the breast or in another part of your body. Later, these cells begin growing again.

The chemotherapy, radiation, hormone therapy or other treatment you may have received after your first breast cancer diagnosis was intended to kill any cancer cells that may have remained after surgery. But sometimes these treatments aren't able to kill all of the cancer cells.

Sometimes cancer cells may be dormant for years without causing harm. Then something happens that activates the cells, so they grow and spread to other parts of the body. It's not clear why this occurs.

For breast cancer survivors, factors that increase the risk of a recurrence include:

• Lymph node involvement. Finding cancer in nearby lymph nodes at the time of your original diagnosis increases your risk of the cancer coming back.
• Larger tumor size. Women with larger tumors have a greater risk of recurrent breast cancer.
• Positive or close tumor margins. During breast cancer surgery, the surgeon tries to remove the cancer along with a small amount of the normal tissue that surrounds it. A pathologist examines the edges of the tissue to look for cancer cells.

If the borders are free of cancer when examined under a microscope, that's considered a negative margin. If any part of the border has cancer cells (positive margin), or the margin between the tumor and normal tissue is close, the risk of breast cancer recurrence is increased.

• Lack of radiation treatment following a lumpectomy. Most women who choose a lumpectomy (wide local excision) for breast cancer undergo breast radiation therapy to reduce the risk of recurrence. Women who don't undergo the radiation therapy have an increased risk of local breast cancer recurrence.
• Younger age. Younger women, particularly those under age 35 at the time of their original breast cancer diagnosis, face a higher risk of recurrent breast cancer.
• Inflammatory breast cancer. Women with inflammatory breast cancer have a higher risk of local recurrence.
• Cancer cells with certain characteristics. If your breast cancer wasn't responsive to hormone therapy or treatments directed at the HER2 gene (triple negative breast cancer), you may have an increased risk of breast cancer recurrence.