After breast cancer, your thoughts may turn to whether you’ll face it again, and how to keep that from happening. Fear of cancer coming back can be one of the hardest, yet most common, challenges among survivors.
Although some of your risk factors may be out of your control, you can take steps to be as healthy as you can and lower your risk.
“Focus on what you can control -- taking your medicines, staying active, eating well. And remember that treatments today are more effective than ever, and many women go on to live long, healthy lives after breast cancer,” says Steven Quay, MD, PhD, pathologist and scientist whose work mainly focuses on breast cancer prevention.
Your doctor will guide you through any ongoing treatments required to control certain factors in your body that can add to the risk of your cancer coming back. Also, you can focus on your daily habits — some may add to your overall health, while others may be harmful.
“Lifestyle choices add up,” says Quay. “Not smoking, getting seven to eight hours of good sleep, and finding healthy ways to manage stress all help. None of these things are dramatic, but together they tilt the odds in your favor.”
Maintenance Medications
Getting past surgery, chemotherapy, and radiation is a huge milestone, but often treatment doesn’t end there. Typically, you continue with long-term medicines to keep your cancer from coming back.
“For most women with hormone-sensitive breast cancer, that means taking hormone-blocking pills such as tamoxifen or aromatase inhibitors for 5-10 years," says Quay. "If the tumor was HER2-positive, there may be ongoing targeted therapy, and some women also benefit from bone-strengthening drugs to reduce recurrence in the bones.”
Depending on your cancer type and other factors, you might take a medication known as a chemopreventative, or preventative therapy. These include:
Tamoxifen. This is a pill you take by mouth once a day. It’s a selective estrogen receptor modulator (SERM), which means it reduces the effects of estrogen on your body (except in your uterus). Typically, you take it for five years, but its effects last another five years after that, giving a total benefit of about 10 years.
After Autumn Ginn, 45, was diagnosed with HR-positive stage II invasive ductal carcinoma in one of her breasts in 2023, she went through chemotherapy, immunotherapy, radiation, and also had a lumpectomy. Now in remission, she’s on daily tamoxifen. Although the pill's estrogen-suppressing effects sent her into early menopause, she says overall she’s tolerated the medication well.
“I have friends who haven't been able to tolerate tamoxifen or who've had some really bad effects, like blood clots in their legs. So they’ve had to switch to aromatase inhibitors,” she says. “But I know that it’s really the best way to lower my recurrence risk because I had HR-positive cancer.”
Raloxifene (Evista). Raloxifene is very similar to tamoxifen. It’s also a SERM, and lowers estrogen effects in your body — including your uterus. You take it as a pill by mouth once a day for five years.
Aromatase inhibitors. These are drugs doctors sometimes prescribe to treat hormone-positive breast cancers, but you can also take them as preventative maintenance medications if you are done having your periods. They lower the amount of estrogen in your body so that if you have cells that feed off of that hormone, they won’t be able to flourish.
Options include:
- Anastrozole (Arimidex)
- Exemestane (Aromasin)
- Letrozole (Femara)
These medications are pills you take by mouth once a day for five years.
Food and Movement: Give Your Body What It Needs
Diet and exercise are two things you do have some control over. If you’re not sure where to start with changes, try these tips.
Choose your foods with prevention in mind
Some research suggests that the risk of breast cancer recurrence — especially hormone-driven cancers — might be higher in people who carry excess weight since it’s linked to higher estrogen levels. Losing some of that weight may lower that risk.
Quay suggests a “plant-forward” diet with vegetables, fruits, beans, and whole grains, as this can help ease inflammation, maintain a healthy weight, and create an internal environment that makes it harder for cancer to return.
The recommendations experts make for helping to prevent breast cancer recurrence are the same as they are for preventing cancer in the first place:
- Load your plate with a variety of fruits and vegetables in dark greens, reds, and oranges.
- Get plenty of fiber through sources such as beans and peas.
- Eat nutrient-dense foods that will keep you full longer.
- Limit red and processed meats such as beef, hot dogs, and lunch meat.
- Choose whole-grain options over refined grains.
- Cut out sugary drinks and avoid alcohol.
“Diet is not a substitute for medicine, but it can support your body’s defenses,” says Quay.
Two-time breast cancer survivor Renee Chirico, 67, says she turned into a vegetarian after reading about how nutrition affects breast cancer risk.
“Having cancer changes the way you look at absolutely everything, including everything you put in your body,” says Chirico. “You want it to be nutritional. I'm not saying I don't eat sugar and cake and have good things, but I don't have processed food. I don't think I've eaten in a fast food restaurant in 15 years.”
Move your body consistently
The American Cancer Society recommends cancer survivors get at least 150-300 minutes of “moderate-intensity” activity (or 75-100 “very active” minutes) along with at least two days of strength training.
Ginn says it was breast cancer treatment that got her into weight lifting.
“I started because they were concerned about me having osteoporosis,” she says. “My oncologist emphasized how good this is for women my age and at this stage.”
“Even something as simple as walking 30 minutes a day makes a measurable difference,” he says. “Physical activity is one of the most powerful tools you have to lower your risk. Regular exercise lowers estrogen levels, boosts the immune system, and helps control weight — all factors that reduce recurrence.”
Dealing With the Worry of "What if?"
The thought that you could face cancer again is very real and often haunts people who have lived through the experience. Quay’s advice: Don’t carry your worries alone.
When Ginn opened up to her oncologist about her anxiety, she found not only relief in knowing she was not alone in her fear but also another tool to help improve her overall mental health.
“She said, ‘Oh, 75% of my patients are on an anxiety medicine,” says Ginn. This opened up a new avenue, and after some trial and error, Ginn found an anxiety medicine that made a big difference in how she was able to manage her emotional wellness.
“I finally stabilized to a point where I wasn’t cycling through thoughts of ‘What if? What if? What if?’” she says.
Ginn also encourages therapy, which she had during her cancer treatment and continues today. She says having a place to name her emotions and explore them can be a lifeline.
“People think I did a great job and tell me I'm a hero, but it was really hard and I really have to process how I feel about it,” says Ginn.
Connecting to other people who have been through breast cancer can also be a reassuring and safe space to release your worries. Lean on support groups you’ve been part of, or seek out new ones focused on survivorship.
“Talk with your care team, connect with support groups, or work with a therapist,” says Quay. “Fear shrinks when it’s shared.”
