Tests for Breast Cancer Recurrence

When you’ve been treated for breast cancer, it’s normal to worry the cancer may come back. Your breast cancer recurrence risk depends on various factors, including your breast cancer size and type. Even if you’ve received treatment to reduce your risk of cancer recurrence—like radiation, chemotherapy, or hormone therapy—it can still be hard to shake that fear. But two main types of tests can help you monitor for recurrence and understand your risk. Surveillance tests can improve your chances of catching the cancer early if it returns. And genomic tests can estimate your chances of the cancer coming back (recurrence risk). 

Physical exams of your breasts by a doctor are a key part of surveillance after breast cancer treatment to monitor for recurrence. Physical checks are recommended every three to six months in the first three years after breast cancer treatment. Then you'll have these exams every six to 12 months for the next two years, and then every year. 

After a mastectomy, your doctor will recommend a mammogram every year for your remaining breast. After a lumpectomy, you need a yearly mammogram of both breasts. 

Magnetic Resonance Imaging (MRI) is usually recommended if you're at high risk for breast cancer recurrence. That's if you have factors such as a strong family history of breast cancer or you're genetically predisposed to it. Talk to your doctor about whether you need this imaging, and how often.

If you have dense breasts, your doctor may recommend ultrasound screening. This tool can help your doctor detect cancer that may be hard to see on mammograms.

Your breast cancer recurrence risk depends on various factors, including your breast cancer size and type. There are tests that can help predict your recurrence risk, and help your doctor create your ongoing treatment plan. 

This is one of several genomic tests that can determine your risk of recurrence by testing the genes in your breast cancer tumor.

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 12 genes in your breast cancer cells to predict if the cancer will show up in another part of your body within 10 years of your diagnosis. You can use it if you're recently diagnosed with early-stage estrogen-receptor-positive, HER2-negative breast cancer, and there's no cancer in your lymph nodes or it's in one to three lymph nodes.

What it means: You'll get an EPclin Risk Score between 1.1 and 6.2. Scores below 3.3287 show a low risk of recurrence. Scores higher than that show a high risk of recurrence. Your doctor can use this score to decide whether you’ll benefit from chemotherapy.

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

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.

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.