Tests for Breast Cancer Recurrence

When you’ve been treated for breast cancer, it’s normal to worry the cancer may come back. That includes stage 2 or 3 HR+/HER2-  breast cancer. Your concerns may be especially difficult to shake if your cancer has a higher risk of recurrence. But two main types of tests can either estimate the chances of that happening or help catch the cancer early if it does return. These tests also offer valuable information about your best treatment options. 

What it does: Looks at 21 genes in your tumor known to affect the way breast cancer acts and how it responds to treatment. It’s often used when breast cancer is early-stage, HR-positive, and negative for HER2 to measure recurrence risk. You’ll get a score from 0 to 100.

What it means: A score of 26 or greater means you have a higher risk of recurrence. Scores less than 26 mean you have a low to medium risk of recurrence. Your doctor can use this score to decide whether you’ll benefit from chemotherapy.

When you may need it: Your doctor may order this test if you both agree the results could help make decisions about your treatment plan. They’ll send a sample of your tumor to a lab after surgery.

What it does: Looks at 11 genes in your tumor that predict whether your breast cancer is likely to come back. You can use it if your breast cancer is early-stage and HR-positive. 

What it means: You’ll get a percentage that tells you how likely your cancer is to come back after five or 10 years. You’ll also get a “yes” or “no” result that tells you whether you’ll benefit from more hormone therapy to prevent a recurrence.

When you may need it: Your doctor can order this test anytime after surgery to decide how long you’ll need hormone therapy. You may want this test after taking hormone therapy for four to five years to decide whether to keep taking it for longer.

What it does: Looks at 70 genes to give you a recurrence score. You can use this test if you have early-stage, HR-positive, or HR-negative breast cancer that’s small but invasive. 

What it means: Your score tells you if your cancer has a high or low recurrence risk based on its gene activity.

When you may need it: You may use this test after surgery anytime you want to make a treatment decision and want to know more about your recurrence risk.

What it does: Looks at 50 genes to give you a recurrence score. You may use this test if you have early-stage, HR-positive, HER2-negative breast cancer that’s small but invasive. 

What it means: Your score tells you if your cancer has a high or low recurrence risk after five years of hormone therapy. A score of 40 or less means there’s a low risk.

When you may need it: You may use this test after surgery anytime you want to make a treatment decision and want to know more about your recurrence risk.

What it does: Looks at a sample of your blood to see if it has DNA fragments from cancer cells in it. Some ctDNA tests look for changes that were present in your original cancer, while others look for changes present in many cancers.

What it means: If the test comes back positive, it means you have some residual cancer in your body, making a recurrence more likely. You may have cancer cells growing in a place your doctor can’t yet see on a scan. 

When you may need it: Insurance may not cover these tests, but you may ask about having one done any time you’re worried about a recurrence.

Your recurrence risk depends on lots of factors your doctor will measure during your diagnosis, such as your breast cancer size and type. Additional tests can look deeper into your cancer to predict recurrence risk after surgery and help you decide on an ongoing treatment plan. Tests to look for signs your cancer is coming back including regular monitoring can help you catch a recurrence sooner, when it’s easier to treat. If you have concerns, ask if there are other tests you can get to understand your recurrence risk better or look for a recurrence.

Talk to your doctor about what your monitoring should look like. You’ll likely continue to see your care team every three to six months for the first five years after your primary cancer treatment ends. After that, you may start to see them once a year. Your doctor will use mammograms to look for signs of a recurrence in your affected breast and to check your other breast. Ask about your risk for recurrence and any steps you can take to make it less likely or catch it earlier. 

Beyond mammograms, your doctor may recommend a MRI, CT, X-ray, bone, or PET scan to see if your breast cancer has spread to other parts of your body. Ask your doctor what signs to watch for between your regular visits and when you may need extra scans to look for a recurrence.

It’s common to feel nervous when you go in for a test, biopsy, or scan. It’s called scanxiety. Stress and worry during testing and while waiting for testing results is normal. Look for ways to keep yourself relaxed, distracted, and connected to others who understand and support you. If your scanxiety isn’t manageable and interferes with your life, ask your doctor for advice or a referral to someone who can give you tools to help.