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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.



Recurrence is when breast cancer returns. It is not a new cancer.

Learning that breast cancer has returned can be devastating. It can even feel worse than the first diagnosis. You battled the disease once, but now you must face it again. 

To help cope with the emotions that are bound to appear:

  • Take some time to adjust to the news. Maybe even take a day off.
  • Use whatever mechanisms and relationships you used the first time around. You survived cancer at least once. You also have the advantage of everything you learned since then, including thoughts about what you would have done differently.
  • Keep in mind that  the fact of a recurrence by itself is not a cause for guilt or for undue alarm. Rather than focus on the fact that breast cancer came back, it is better to think about what to do about the situation. (To learn how to get past recurrence guilt, click here.)
  • It may help if you think of cancer as a chronic condition like diabetes which sometimes has acute phases.
  • At least one person survives every illness. There is no reason that person isn't you.


A recurrence presents challenges for your medical team. Even if the range of treatments is the same as during your first encounter with cancer, the specifics may be different. Treatment decisions are based on the type of disease, timing of recurrence, location of the recurrence, extent of spread, your overall health, and your personal wishes.

  • If you received chemotherapy, your cancer doctor may recommend a different chemotherapy. 
  • If you received radiation, you cannot generally receive additional radiation in the same area. You can receive it in a different area.
  • There may be newly approved treatments. There may also be cutting edge treatments that are being scientifically investigated which you can access through a controlled process known as a clinical trial.

Before deciding on a treatment:

  • Ask your cancer doctor about:
    • The pros and cons of each potential treatment
    • His or her suggestion 
    • The reasoning behind the suggestion
    • How long you have to make a decision. It is not likely that a decision must be made right away. 
  • With a time frame in mind, get a second opinion from a reputable source such as a doctor at an NCI Comprehensive Cancer Center both as to your diagnosis and your treatment. You can find an NCI center by clicking here offsite link.
    • Preferably the opinion should be from a cancer doctor who has a different specialty from the one who initially recommended a treatment. For instance, if you saw a medical oncologist (a doctor who specializes in the use of drugs to treat cancer), see a radiation oncologist (a cancer doctor who specializes in the use of radiation for the treatment of cancer). This is so even if you already had surgery or chemotherapy.  
    • Second opinions are usually covered by insurance.
  • Free transportation to and from medical appointments is available if needed.

If needed, learn how to do medical research by clicking here. There are services you can hire that will research treatments, vet the pros and cons, and make a recommendation. To learn how to find one, click here.

If there are no treatments in the U.S. that can reasonably be said to work for you, it may be worth exploring what is happening in other countries. If you use this option, (known as "medical tourism") be cautious. There are signs to look for to help spot phony treatments. Also see: What Happens If Cancer Treatment Is No Longer Working?

Use the practical experience you have gained to help avoid unwanted side effects and to deal with those you can't avoid. Keep in mind that with time, treatments keep getting smarter with fewer side effects. Plus, the ability to control side effects gets better.

Consider reading Breast Cancer: Newly Diagnosed, Medical for tips about the decision making process and treatments.

Health Insurance/Uninsured

  • If you have health insurance:
    • Do what you have to in order to keep your insurance in force
    • Learn how to maximize your coverage. For information, click here.
  • If you do not have health insurance
    • You can still obtain it, despite your health history. To learn how, click here.
    • In the meantime, our information about Uninsured provides information about alternatives for getting the health care you need without insurance.


If paying for cancer treatment is an issue, or if finances of any type are an issue, see Uninsured and How To Deal With A Financial Crunch Or Crisis.

If your recurrence throws you off balance financially, when things settle, take a few moments to do financial planning that takes account of your health condition. A bit of planning will help maximize your resources. We even have tips about dealing with credit cared debt and negotiating with creditors if that is problem. (If financial planning is difficult for you, ask a trusted family member or friend to do it for you. Planning will help you feel in control.)

Work Issues

Day To Day 

This is not a time to beat yourself up if you haven't been living a cancer preventive diet and lifestyle, or if you have, thinking that you could have done more. As the American Cancer Society says: "Although eating right, exercising, and seeing your doctor for follow-up visits are important, please understand that there probably was nothing you could do to keep your cancer from coming back… Even if you do everything just right, you can't change the possibility that cancer will come back."

Consider using the recurrence as a wake-up call to think about what is important in your life.

Look around you. Is your home environment peaceful and conducive to healing and to a healthy life? If not, do what you can to change it. For instance, repaint walls to restful colors.

Look for humor. It helps. Consider getting a pet. A pet doesn't have to be a cat or a dog to have positive effects and you don't have to sign on for life. For example, you can be a foster parent until the effects of treatment are over.

Planning Ahead

If you haven't before, now is the time to get your legal affairs in order. If you have, check what you did to be sure it still reflects your wishes.

  • For instance, everyone needs an up-to-date will. In fact, we all have one because each state has laws which provide what happens if a person dies without a valid will. But is the state law the way you want your estate to go? NOTE: We are not recommending that you write a will because you had a recurrence. Rather, this is advice we give to everyone all the time, including people who have not been diagnosed with a serious health condition. As we all know, life is fragile.
  • Revisit your Living Will and other advance healthcare directives. Your thoughts may have changed. In any event, it is good to constantly update advance directives by at least adding your initials and the current date. If the documents are updated, expensive delays won't happen while people question whether you still feel this way.
  • Consider preplanning a funeral. Bring the family in on the discussion so you can make it about what everyone wants for themselves instead of focusing on you.

If you have a DNR, remind people you live with not to call 911 in an emergency.


  • Continue to think of non-traditional therapies as complementary to medical treatment rather than instead of medical treatment. To learn about complementary therapies, click here.
  • If getting medical care is difficult because money is the problem, there are alternatives for obtaining free or low cost care described in our information for people who are uninsured.
  • Let your doctor know about everything you put into your body and all treatments you receive. Herbs, supplements and high dose vitamins can cause a drug interaction that interferes with treatments.



What Is A Breast Cancer Recurrence?

In General

Breast cancer recurrence is the return of cancer after treatment and after a period of time during which the cancer cannot be detected. A recurrence may be in the same breast where it started or it could have spread beyond the breast. Even if it shows up in other parts of the body, it is still known as breast cancer because the cells are breast cancer cells. When the original cancer spreads to a new place, it is called a metastasis. (meh-TAS-tuh-sis).

A recurrence may be at the same stage as originally, or it may be more advanced. Even if it is an advanced stage, keep in mind that at least one person survives every cancer - and that person could be you. Even a 1% chance of long term survival means that one in one hundred people will survive.

A recurrent cancer starts with cancer cells that the first treatment did not fully remove or destroy. Some may have been too small to be seen in follow-up. This does not mean that the treatment you received was wrong. And it does not mean that you did anything wrong either. It just means that a small number of cancer cells survived the treatment. These cells grew over time into tumors or cancer that your doctor can now detect.

It is possible to develop a completely new cancer that has nothing to do with your original cancer. This doesn't happen very often. Recurrences are more common. If the cancer is not related to your first cancer, it is called a Secondary Primary Cancer.

Types of Recurrence

There are three different types of cancer recurrence. The different types are defined by where in your body the cancer appears.

  • Local recurrence: The cancer appears in the same place where it was first found, or very close by.
  • Regional recurrence: The cancer appears in the lymph nodes and tissue near where it started.
  • Distant recurrence: The cancer appears in another part of the body which is further away from where it started. This is known as "metastasized" or advanced cancer.

Local and regional breast cancer is considered to be treatable and potentially curable.

A distant recurrence of breast cancer is not curable, but it is treatable. While that may sound frightening, keep in mind that a disease like diabetes is also treatable but not curable.

Recurrence Or Progression: What Is The Difference?

Progression is when cancer spreads or gets worse. Sometimes it is hard to tell the difference between recurrence and progression.

There is no standard period of time that defines recurrence versus progression. Most doctors consider a cancer to be a recurrence if you had no signs of cancer for at least a year. If your cancer has been gone for only 3 months, this would most likely be a progression of your disease. With a short period of time, the medical community would assume that the cancer never totally went away even though it could not be found by any existing tests.

Your doctor will tell you whether your cancer is a recurrence or a progression and what that means to you.

Emotions That Surface With A Recurrence And How To Cope With Them

The emotions

A recurrence is likely to bring up all the emotions that you experienced when you were first diagnosed with cancer. It is not unusual to also feel any of the following:

  • Anger -- especially if you have been following a cancer prevention lifestyle.
  • Distress at realizing that your cancer was not gone despite suffering through treatment.
  • Doubt about whether you made the right treatment decision originally, or had the right doctor(s).
  • Guilt over the feeling that you did something to make your breast cancer recur.
  • Fear that was greater than before because of a feeling that you are closer to death - whether it is true or not.
  • "I know what this is like. I can't go through this again." 

How to cope

Focus on what got you through your first bout with breast cancer. You made it through once. You can do it again. In fact, it may be a bit easier this time because you have a relationship with your doctor and his or her staff. You likely also know your way around the treatment facility. Plus there are continuing advances in treatments and dealing with side effects.

If you didn't before, consider speaking with a breast cancer buddy - another woman who is living through a recurrence of breast cancer.  To help find a buddy, contact your cancer center. It may have a survivors program. You can also contact the American Cancer Society's Reach To Recovery program. See offsite link or call 800.ACS.2345.

Also consider joining a support group of other women living through breast cancer recurrence. In addition to the support, you are likely to learn practical information. You can attend support group meetings in person, on line or on the telephone. See the document in "To Learn More" which lists organizations which sponsor or know about breast cancer support groups.

When fear comes in, keep in mind that it is a projection, a thought. You can change the thought. It takes practice and time, but you can do it. The more you practice it, the easier it becomes. Plus there are techniques to help deal with stress.

When it comes to doubt, keep in mind that you made the best decision you could with the facts you had at the time. There never was a guarantee that your cancer wouldn't return. All we can ever do is our best.

Stay hopeful. Breast cancer is becoming a disease that doctors can manage. To help build your sense of hope:

  • Plan your days as you have always planned your days.
  • Don't limit the things you like to do just because you have cancer.
  • Look for your own reasons to have hope.

Look for humor. It helps. Art Linkletter got it right when he said that "laughter is the best medicine."

You can help assure your comfort with the treatment decision you have to make now by doing the following:

  • Tell your doctor about the emotions the recurrence has brought up just as you tell him or her about your other concerns. If you don't like the way decisions were made the first time, discuss making a change. If you are no longer comfortable with the doctor, consider changing doctors. This is not something to do lightly, but your health is the issue. You may find that a fresh start with a new health care team will help you improve your attitude and feel better about your current situation. Survivorship A to Z provides suggestions about working through issues with your doctor, and changing doctors if things don't work out. See "To Learn More."
  • Get a second opinion - particularly from an NCI designated Comprehensive Cancer Center. offsite link Second opinions are generally covered by insurance. Our treatment evaluator can help you compare treatments.

It can help to set goals. Planning something takes your mind off the disease each day. Aim for small goals each day, such as:

  • Exercising.
  • Completing tasks you have been wanting to do.
  • Making phone calls.
  • Having lunch with a friend.
  • Reading one chapter of a book or doing a puzzle.
  • Listening to music or a relaxation tape.

Many people also set longer-term goals. They say that they do much better if they set goals or look forward to something special. It could be an anniversary, the birth of a child or grandchild, a wedding, a graduation, or a vacation. If you set a long-term goal, make sure you are realistic about how you will achieve it.

Remember that being flexible is important. You may have to change your plans if your energy level drops. You may have to adjust your goals if the cancer causes new challenges. Whatever your goals, try to spend your time in a way that you enjoy.

Review the tips we provide in "To Learn More" about coping with specific emotions if they appear.

NOTE: According to the American Cancer Society: Improving your physical symptoms and taking action will probably make your mood better.

A Wake-up Call To Life And To Meaning

For some people, recurrence is a wake-up call. For some people, a recurrence becomes a trigger to look for meaning in their lives.

Wake-up call

What a wake-up call means is different for each of us. For example, it could be:

  • Enjoying the little things in life.
  • Traveling somewhere you always wanted to go.
  • Spending more time with loved ones.
  • Looking for a sense of peace.

It may be hard at first, but you can find joy in your life. One way is to take note of what makes you smile and activities you do each day that you enjoy. The activities can be as simple as drinking your morning coffee, sitting with a pet, or talking to a friend. It could be playing gold or some other sport that you love. Small, day-to-day activities can give comfort and pleasure.


Many people with recurrent cancer find the search for meaning important. Meaning is individual, and depends on how we approach it. For example:

  • Try to understand their purpose in life by reflecting on what they have gone through.
  • Look for a bond with other people.
  • Seek to forgive themselves or others for past actions. 
  • Look for answers and strength through religion or spirituality.

For more thoughts about meaning, click here.

Cutting Edge Treatments: How To Find Clinical Trials/ Medical Tourism Outside The U.S.

Clinical Trials

  • A clinical trial is a controlled test to learn about cutting edge treatments.
  • When looking for a clinical trial that works for you, search through the available databases. There is no one source which lists every clinical trial in the United States. To learn how to find a clinical trial, see: How To Locate A Clinical Trial 
  • Before starting your search, pull together the information needed to determine eligibility.  
  • You do not need a doctor's referral to enter most trials.
  • Before entering a clinical trial, be an informed consumer. 
    • Learn the questions to ask. For instance:  The drugs in a clinical trial are free for participants but you may have to pay some costs such as for check ups. Learn how much participating in a trial will cost you. Costs you have to pay may be covered by health insurance.  
    • Ask your doctor for his or her opinion before joining a trial.
    • For information about clinical trial cost considerations, click here.

If no treatments or clinical trials are available for your situation in the U.S.

It is worthwhile to at least explore what may be available outside the United States.

Be sure to study any out-of-the mainstream treatment carefully before pursuing it - particularly if it means not taking a mainstream treatment that could be helpful.

Keep in mind the difference between drugs and treatments which have been scientifically studied or are being scientifically studied, and treatments which have not been subjected to scientific scrutiny.

Watch for phony treatments that have no scientific credibility. For example, if you are asked to pay to be in the trial, there is something likely fishy with the trial. To learn more, click here.

Out of the mainstream treatments are not covered by health insurance.

What Are The Chances The Treatment Will Work?

As you may suspect from your previous experience, the answer depends entirely on your situation. Factors that influence the answer include:

  • The type of breast cancer you have.
  • The length of time between the original diagnosis and recurrence.
  • The aggressiveness of the cancer cell type.
  • Your age.
  • Your overall health status.
  • How well you tolerate treatment.
  • The length of time you are able to take treatment.
  • The types of treatment you get.

Ask your doctor about your specific situation.

NOTE: If the treatment doesn't work, read the document in "To Learn More."

What If I Don't Want To Go Through Treatment Again?

Recurrences can become exhausting and discouraging.

It is up to you to decide whether to go through treatment again. There is no right or wrong. It is your life and you are in charge.

Before you decide not to take a treatment, consider the following:

  • Check for depression. It may be the depression, rather than you, that is evaluating the situation. Survivorship A to Z provides a list of symptoms to look for, as well as suggestions for treating depression. (See "To Learn More.")
  • Speak with your religious or spiritual advisor.
  • Speak with your closest loved ones.

Keep in mind that even if there is no cure for your breast cancer, treatments can help prolong life and possibly turn your cancer into a chronic condition like diabetes.


  • No matter what your decision, there is no reason to be in pain. Pain can be controlled and possibly eliminated. This is known as Palliative Care. If your doctor cannot control your pain, there are Palliative Care specialists with whom you can consult.
  • Other side effects of your cancer can also likely be reduced or eliminated with the use of traditional medicine or complementary therapies. Speak with your doctor.

Spouses and Partners

  • Try as much as you can to keep your relationship as it was before you were diagnosed.
  • Talk things over. This may be hard for you or your spouse or partner. If so, ask a counselor or social worker to talk with both of you together.
  • Be realistic about demands. Your spouse or partner may feel guilty about your illness or about any time spent away from you. He or she also may be under stress due to changing family roles.
  • Spend some time apart. Your spouse or partner needs time to address his or her own needs. If these needs are neglected, your loved one may have less energy and support to give. Keep in mind that you didn't spend 24 hours a day together before you got sick.
  • Body changes and emotional concerns may affect your sex life. Talking openly and honestly is key. If you can't talk about these issues, consider talking with a professional. Don't be afraid to seek help or advice if you need it.

For more information, see: Couples

Family And Friends

Your loved ones may need time to adjust to the news that breast cancer has returned. They need to come to terms with their own feelings. These may include confusion, shock, helplessness, anger, and other feelings.

Let family members and friends know that they can offer comfort just by:

  • Being themselves.
  • Listening and not trying to solve problems.
  • Being at ease with you.

Being able to comfort you can help them cope with their feelings.

Bear in mind that not everyone can handle the return of cancer. Sometimes a friend or family member can't face the idea that you might not get better. Some people may not know what to say or do for you. As a result, relationships may change, but not because of you. They may change because others can't cope with their own feelings and pain. If you can, remind your loved ones that you are still the same person you always were. Let them know if it is all right to ask questions or tell you how they feel. Sometimes just reminding them to be there for you is enough.

It is also okay if you don't feel comfortable talking about your cancer. Some topics are hard to talk about with people you are close to. In this case, you may want to talk with a member of your health care team or a trained counselor. You might want to attend a breast support group where people meet to share common concerns. (Survivorship A to Z has a list of organizations that sponsor breast cancer support groups in the document in "To Learn More.")

Family Meetings

Some families have trouble expressing their needs to each other. Other families simply do not get along. If you don't feel comfortable talking with family members, ask a member of your health care team to help. You could also ask a social worker or other professional to hold a family meeting. This may help family members feel that they can safely express their feelings. It can also be a time for you and your family to meet with your entire health care team to solve problems and set goals.

Although it can be very hard to talk about these things, studies show that cancer care is a smoother process when everyone remains open and talks about the issues.

Children (Underage and Adult)

Keeping your children's trust is very important at this time. Children can sense when things are wrong. So it is best to be as open as you can about your breast cancer.

Children may worry that they did something to cause the cancer. They may be afraid that no one will take care of them. They may also feel that you are not spending as much time with them as you used to. Although you can't protect them from what they might feel, you can prepare them for these feelings.

Children: Telling The News provides general guidelines for telling underage children and tips for different age groups.  Also see:  Children: Care Of If You Are Unable To

Children 101 

Adult Children

Your relationship with your adult children may change now that you have cancer again. You may have to rely on them more. And it may be hard for you to ask for support. After all, you may be used to giving support rather than getting it.

Adult children have their concerns, too. They may start to think about their own mortality. They may feel guilt, because of the many demands on them as parents, children, and employees. Some may live far away or have other duties. They may feel bad that they can't spend as much time with you as they would like. Often it helps to:

  • Share decision-making with your children.
  • Involve them in issues that are important to you. These may include treatment choices, plans for the future, or activities that you want to continue.
  • If they aren't able to be there with you, keep them updated on your progress.
  • Make the most of the time you have. Share your feelings with them.
  • Try to reach out to your adult children. Openly sharing your feelings, goals, and wishes will help them adjust. It will also help prevent problems in the future.

Remember, just as parents want the best for their children, children want the best for their parents. They want to see your needs met effectively and with compassion. Your children don't want to see you suffer.

Drugs, Vitamins and Supplements

  • Before agreeing to take any drug, learn about the risks as well as the benefits.
    • Survivorship A to Z provides questions to ask before agreeing to take any drug. 
  • Do what you can to avoid medical errors
    • Start by obtaining a readable doctor’s prescription. If you can't read it, neither can the pharmacist.
    • Check the drug you receive against the prescription and make sure it looks like you expect. 
  • Avoid overmedication
    • Overmedication is all too common. 
    • Ask your doctor if a lower dose will do the same job - particularly for drugs you continue to take over time.
  • Carry a list of your drugs all the time. Emergencies happen. Plus the list will be helpful each time you see a doctor or fill a prescription. In case it helps, we provide a form List Of Medications.
  • Have each newly prescribed drug checked for negative interaction with other drugs you are taking. Do not assume that this will happen automatically. 
  • Over-the-counter medications, supplements and vitamins need to be treated as if they are drugs.
    • Just because they are sold without a prescription does not mean that there is no risk.
  • Take care if you use herbs, vitamins or other supplements.
    • They are not subject to FDA approval. Therefore, there is no guarantee about their safety or effectiveness. 
    • There is not even a guarantee that the same mix of ingredients will be in each bottle – even for bottles from the same manufacturer.
    • It may feel like insurance company money is other people’s money, but expenses show up in your increased premiums.
  • Do not let price be the sole factor in determining what drugs to tak or where to obtain them. 
    • Free or low cost drugs may be available.
    • The drug manufacturer likely has a patient assistance program that is not just for poor people.
    • When choosing where to buy drugs, think about what  happens if you need a refill in an emergency.? 
    • Keep in mind that a pharmacist can be a very important part of your health care team.  If necessary, you may be able to obtain drugs for free or very low cost.
  • If the drugs currently on the market don’t satisfy your needs, there may be newer drugs to consider that are still being tested for safety. Access to these drugs is through clinical trials – controlled tests where use of the drug is medically monitored. It is essential that you be fully informed before entering a clinical trial.
  • Live with drugs wisely.
    • Comply with prescribed orders. Non-compliance can be harmful. Time tested tips help if you have difficulty complying.
    • Do not share drugs.
    • Store drugs correctly (not in a medicine cabinet in the bathroom).
    • Travel well with your drugs. Carry a copy of your prescription. Carry an extra supply in case you get delayed.
    • Drugs: How To Save Money When Buying Or Using
    • Drugs: How To Choose Which To Take
  • Stay open. The decisions you make regarding medical care and treatment may change over time.

For more information, see: Drugs 101 (An overview), Health Supplements

How To Get Your Legal Affairs In Order

If you haven't before, now is the time to get your legal affairs in order. As you read this, keep in mind that this is advice we give to everyone, including people who are at the top of physical fitness. Life is fragile. No one knows what will happen in the next minute. We could all get hit by the proverbial bus.

If you have tended to these matters, revisit what you did to be sure it still reflects your current wishes. What we want can change over time.

At least,

  • Make arrangements for your children in case you become unable to care for them or die.See Children 101
  • Consider what you want to happen medically if you become unconscious or otherwise unable to speak for yourself. The documents to write are called Advance Healthcare Directives.
  • Write a will.  If you are on pain medications or other drugs that could be said to affect your thinking, it is important to to Protect Your Will Against Challenges
  • Consider preplanning a funeral. Bring the family in on the discussion so you can make it about what everyone wants for themselves instead of focusing on you.

If you execute a DNR (a do not resuscitate order), remind people you live with not to call 911 in an emergency.

NOTE:  Check all documents, securities accounts and banks accounts with beneficiaries on them to be sure:

  • The beneficiary you want is listed. 
  • If there is more than one beneficiary, the split between them is clear.

To Learn More

More Information

Planning Ahead

When You Have Contact With An Employer, Insurer Or Government Agency

  • Keep in mind that honey is the best approach. 
    • Always keep in mind you are talking with another human being.
    • Try to be understanding of the person's personal situation. 
    • In short hand: Make a friend.
  • Always get the name and/or i.d. number of the person with whom you speak.
  • Make notes.
    • Note the day and time and what was said.
    • Keep your notes in the file with whatever subject you’re calling about.
  • Keep a photocopy of all forms you complete.
  • If you mail anything that seems important:
    • Include a cover letter with a date. 
    • Keep a copy. Attach a copy of the cover letter to your copy of the form.
    • Send it by a delivery system that provides delivery receipts such as certified mail, return receipt requested or, by overnight.  Note on your copy of the letter the receipt number so there is proof what was included in the particular envelope. Keep the receipt with your copy of the letter or document.
  • When you are told things must be done by a deadline, note the deadline in your diary – and finish on time.
  • After each conversation, make sure you are in sync with the other person by repeating what is to be done, by whom, and by when. 
    • Make an alert to follow up to be sure the other person does what he or she agreed to do. 
    • Follow up on the day of your alert.

See: Talking With Your Insurance Company (Make A Friend)

To Learn More