How the Right Treatment Plan May Lower Your Risk of HR+ Breast Cancer Recurrence

Written by Kendall K. Morgan
Medically Reviewed by Jabeen Begum, MD on September 19, 2025
8 min read

When you have a hormone receptor-positive (HR+) breast cancer, the goal of your treatment is to get rid of the cancer completely and for good.

Your treatment will likely include surgery to remove the cancer. You may also have radiation, chemotherapy, or both. Additional treatments, including hormone therapy, may help lower the risk of your cancer coming back (recurrence).

Generally speaking, the more your breast cancer has grown and spread before your diagnosis, the more aggressive the treatment needs to be to keep it from coming back. As treatments have continued to expand and improve over time, more women with breast cancer are living for many years or decades beyond their diagnosis.

But those choices mean that you may have some tough decisions to make. Your options depend on your:

  • Cancer’s features
  • Age
  • Menopausal status
  • Personal choices

HR+ breast cancer is the most common subtype by far. It makes up about 70% of all breast cancers.

When your breast cancer is HR+, that means it carries receptors that respond to estrogen or progesterone hormones your body makes. Those hormones encourage your cancer to grow. It may reassure you to know the five-year relative survival for HR+ breast cancer is 95.6%. Your odds of a good outcome with treatment are exceedingly good.

Even so, you may worry about the possibility of your cancer coming back, or recurring, after treatment ends. You may wonder about your specific risk of a recurrence, and whether you’re doing everything possible to make sure it doesn’t happen. These are important conversations to have with your oncologist. To determine your personal risk and treatment options, many factors will come into play. Among the first is your breast cancer subtype.

“If it’s hormone receptor-positive, HER2-negative versus HER2-positive or triple negative, we know it’s a good prognosis,” says Arya Roy, MD, a breast medical oncologist at The Ohio State University in Columbus, Ohio. “The recurrence rate is lower in that [breast cancer subtype]. But there also are high-risk features [to consider].”

These may affect the risk of your cancer coming back:

  • The size of your tumor
  • Whether your tumor had spread to the lymph nodes
  • How many lymph nodes are involved
  • The location of any involved lymph nodes

“If the size of the tumor is more than 5 centimeters, the risk of the recurrence is higher,” Roy says. “If you have lymph node involvement, the recurrence risk is higher when compared to someone without lymph node involvement. But the number of lymph nodes also is a factor. High risk is usually defined as having more than or equal to four lymph nodes [involved].”

The site of the involved lymph nodes is also a key factor. If the only lymph nodes positive for breast cancer are near your armpit (axillary) area, the risk of recurrence may be lower than if the cancer spreads to lymph nodes near the collarbones. Your age and menopausal status also matter. Breast cancers diagnosed at an earlier age, and before menopause, tend to grow more aggressively than those that come up later in life.

To learn even more about your cancer’s underlying biology and recurrence risk, your doctor may send your tumor sample off for one or more genetic tests.

For example, Oncotype DX looks at 21 genes in your cancer to give you a recurrence score from 0 to 100. A recurrence score of 15 or less means your cancer has a low risk of recurrence. Scores over 25 come with a high risk of recurrence. Scores from 15 to 25 come with a medium risk of recurrence when you’re aged 50 or younger. If you’re over 50, a recurrence score up to 25 still has a low risk of recurrence.

How Treatments May Reduce Your HR+ Breast Cancer Recurrence Risk

While it’s scary to hear your breast cancer has a high risk of coming back based on its features, your age, or other factors, there’s a lot you can do. Work with your oncologist to come up with a treatment plan designed to lower your recurrence risk as much as you can. Be sure to ask any questions you have, so you’ll have all the information you need.

Based on your breast cancer features and any genetic test results, your doctor can help you figure out the risk of your cancer coming back if you have hormone therapy only, Roy says. You may or may not need chemotherapy to treat your breast cancer. Radiation may be an option to think about, too, depending on your risk for recurrence.

“For hormone receptor-positive breast cancer, we give chemotherapy only if there is a high risk of recurrence,” Roy says. “Radiation is always in the picture to decrease the cancer’s risk of coming back, especially in the same area.”

You’re more likely to need chemotherapy in addition to hormone therapy if you're younger and premenopausal, than if you're older and in perimenopause or menopause. Your response to chemotherapy may depend on how many hormone receptors your breast cancer has. Roy says  cancers with a high amount of estrogen receptors don’t tend to respond well to chemotherapy. 

You may start chemotherapy after surgery to treat any residual or lingering cancer cells (adjuvant therapy). If your cancer is high risk, large, or spread to your lymph nodes, your doctor may suggest chemotherapy before surgery (neoadjuvant therapy). That's to shrink your tumor and gauge your treatment response. 

“If you still have cancer cells in the surgical specimen, that means these patients are still at high risk for recurrence,” Roy says. “If the tumor is completely gone, that’s what we call a pathological complete response (PCR). PCR means the chance of this cancer coming back will be less.”

All women with HR+ breast cancer can benefit from hormone therapy. These treatments will block your hormones to discourage any lingering breast cancer cells from growing. Your oncologist might recommend starting hormone therapy before or after surgery. The specific therapy varies depending on your age and menopausal status. Hormone therapy falls into a few classes:

Selective estrogen receptor modulators (SERMs)

Drugs in this class work by blocking estrogen receptors to keep estrogen from reaching your cancer cells. A common one is called tamoxifen. If you have HR+ invasive breast cancer that’s been surgically removed, this medicine can help keep it from coming back. Another option that’s used less often is called toremifene.

Selective estrogen receptor degraders (SERDs)

These drugs target estrogen receptors, too. However, they bind to receptors more tightly than SERMS, causing them to break down. You’re more likely to use a SERD when other hormone therapies stop working.

Aromatase inhibitors

If you’ve gone through menopause already, aromatase inhibitors can keep your body from turning other hormones into estrogen. You might also use an aromatase inhibitor if you’re premenopausal and taking other medicines to shut down your ovaries. Aromatase inhibitors include: 

  • Anastrozole (Arimidex)
  • Exemestane (Aromasin)
  • Letrozole (Femara)

Ovarian suppression

If you haven’t entered menopause yet and have a high risk for recurrence, your oncologist might suggest treatment to shut down or remove your ovaries. You might take an aromatase inhibitor, too. Treatments to suppress your ovaries may include:

  • Surgery to remove your ovaries (oophorectomy)
  • Drugs that stop your ovaries from making estrogen, called luteinizing hormone-releasing hormone agonists, such as leuprolide (Lupron)
  • Chemotherapy

How long does hormone therapy last?

Hormone therapy usually lasts 5-10 years. Talk to your doctor about how long they recommend hormone therapy to lessen your recurrence risk. Ask if you should have a test, such as the Breast Cancer Index, to help you decide.

“There are some calculators or online models we can use to see what is the risk of this patient’s recurrence, and what is the benefit of extending endocrine therapy for more than five years,” Roy says. “So it’s at least five years, and then extending it to beyond five years is a discussion between the patient and the provider based on the patient’s risk of recurrence.”

If your HR+, stage II or III breast cancer has a high risk of recurrence, you will have more treatment options to consider today. Based on clinical trial results showing an advantage, some treatments previously used for stage IV metastatic breast cancer can help lower your risk. These treatments are known as CDK4/6 inhibitors. They include:

  • Abemaciclib (Verzenio)
  • Ribociclib (Kisqali)

CDK4/6 inhibitors to lower breast cancer recurrence

CDK4/6 inhibitors target CDK4/6 proteins that make your breast cancer cells grow faster. By blocking the proteins, they can slow it down. Clinical trial results show that taking abemaciclib with hormone therapy for high-risk, early breast cancer not only slows the cancer but also improves survival.

Bisphosphonates for breast cancer

Bisphosphonates are another treatment that can lower the risk for recurrence. They’re medicines used to keep your bones from thinning too much with age. They’re also used to treat osteoporosis. You can take them by mouth or IV. Bisphosphonates include:

  • Alendronate (Fosomax)
  • Ibandronate (Boniva)
  • Pamidronate (Aredia)
  • Risedronate (Actonel)
  • Zoledronic acid (Reclast, Zometa)

The discovery that bisphosphonates might lower breast cancer recurrence came from studies of many postmenopausal women. Those studies found fewer cases of invasive breast cancer in women taking bisphosphonates. Roy says bisphosphonates may be an option if you’re in menopause or you’re getting ovarian suppression. Ask your doctor if you should consider adding bisphosphonates to your treatment plan.

Roy suggests talking openly with your care team about your treatment options and ways to lower your risk of a recurrence. Many of these treatments should be offered as part of standard practice, she says. But some doctors may be less aware of the latest findings, including the survival benefits of CDK4/6 inhibitors. 

Anytime you’re curious about a treatment or have concerns about recurrence, ask questions, such as:

  • What's my recurrence risk?
  • If my recurrence risk is high, how likely is my cancer to come back?
  • Do I need chemotherapy? Why or why not?
  • What about radiation?
  • What kind of hormone therapy would you recommend for me and why?
  • Would I benefit from any other medicines that could prevent my cancer from coming back?
  • How will we know if my cancer comes back?
  • How often should I be checked for a recurrence? 
  • Can I get a circulating tumor DNA (ctDNA) test done, and will insurance cover it?
  • What would treatment look like if my cancer comes back?