What Is Breast Cancer Surveillance?

In 2022, there are 3.8 million people who are being treated or have completed treatment for breast cancer in the US.1 After treatment, many people who no longer have evidence of breast cancer will receive follow up care and monitoring for potential recurrence.

Many people with breast cancer are counseled that an estimated 30% of people will experience a recurrence.2 In this post, we’ll share key information about breast cancer surveillance and recurrence. We’ll also discuss the Signatera™ Residual Disease Test, which can help people treated for breast cancer and their doctors stay on the lookout for recurrence.

Breast cancer surveillance refers to the follow up period after you have finished treatment for breast cancer. Your treatment will depend on the stage and type of your breast cancer and can include surgery, chemotherapy, radiation, hormone therapy, or a combination of these treatments.

After treatment, your oncologist will set you up with follow up care to address any ongoing health concerns and monitor you for any signs that the cancer may be returning.

This period of active surveillance following breast cancer treatment usually lasts about 5 years. However, you can remain in surveillance for the rest of your life as long as you continue to receive cancer monitoring tests.

Your surveillance plan may include physical exams, mammograms, pelvic exams, bone density tests, and/or other imaging or blood tests.3 Your oncologist will determine which of these options is best for you, and how often you should receive them.

Typically, you will have more frequent exams and tests during the first year of your breast cancer surveillance. After that, these appointments become less frequent if you continue to remain free of evidence of cancer.

Find more information about surveillance and follow up care after breast cancer treatment here. The American Cancer Society also provides helpful printable forms to help you keep track of your follow up care.

During surveillance, you may wonder if your cancer is coming back. About half of breast cancer survivors live with a moderate to severe fear of recurrence.4 This concern can sometimes affect their quality of life.

The experience of tapering off care team visits and interactions can also contribute to anxiety about recurrence. Your care team visits may feel few and far between compared to the period during treatment. If you have any concerns about your surveillance plan, it’s crucial to talk to your care team to ensure you have the information you need to feel confident.

Sometimes, despite receiving the best available treatment, a person may experience a recurrence of their breast cancer. This happens because a small number of cancer cells survived the initial treatment and grew into a tumor.5 Your risk of recurrence depends on the stage and type of breast cancer you had and how it was treated, as well as other factors such as your age at diagnosis.6

Breast cancer recurrence is detected through imaging and/or signs and symptoms. During your surveillance period, if you notice changes in your breast tissue, pain, swollen lymph nodes, or other concerning symptoms, contact your care team. Some people will have a recurrence detected on routine surveillance imaging such as mammography, even if they are not experiencing any symptoms.

These standard detection methods are the most sensitive when the recurrent tumor is large enough to be visible on scans or to cause noticeable symptoms. They are not always able to detect molecular recurrence—the presence of small traces of cancer that can grow into a tumor.

The SignateraTM Residual Disease Test is a personalized blood test developed by Natera to help people with breast cancer and their doctors watch for recurrence. It works by testing your blood for microscopic pieces of tumor DNA called circulating tumor DNA (ctDNA). When used at regular intervals over time along with other tests recommended by your doctor, Signatera™ may detect traces of recurring breast cancer ahead of standard tools like imaging.

Each Signatera™ test is custom-built for your unique breast cancer using a sample of your original tumor tissue, usually taken from a block of tissue saved during a surgery or biopsy. After your Signatera™ test is designed, you only need to provide a blood sample each time your oncologist orders Signatera™.

Signatera™ can provide additional information to inform your surveillance period. Since it works by detecting tiny molecules of your cancer’s DNA, it can help your oncologist determine if traces of cancer are left after treatment or are coming back.

Each time you receive a Signatera™ test, your results will show whether ctDNA was detected in your blood. If you receive a positive result, your cancer may be more likely to come back, and you and your doctor can formulate a plan to optimize your care. If you receive a negative result, ctDNA was not detected. If you receive multiple negative results with repeated testing, you are more likely to remain recurrence-free. Signatera™ can be used on a repeated (or serial) basis at a frequency recommended by your doctor (every six months, for example), so it can show if your ctDNA levels change over time.

Ask your oncologist if Signatera™ can help you. Natera has developed a discussion guide that you can download and use to guide the conversation. The testing process is streamlined and convenient for patients and their clinicians. You can learn more about Signatera™ at natera.com/breastcancer.

“I can take a plan of action. My oncologist can set up a plan for me early on, before it develops into something that's too late to treat.”

– Rachelle, entrepreneur, advocate, and breast cancer survivor

“SignateraTM gave me a sense of calm and empowered me with knowledge regarding my potential risk for recurrence.” – Cynthia, advocate for early detection and breast cancer education, breast cancer survivor

Disclaimer

Signatera™ has been developed and its performance characteristics determined by the CLIA-certified laboratory performing the test. The test has not been cleared or approved by the US Food and Drug Administration (FDA). CAP accredited, ISO 13485 certified, and CLIA certified. © 2022 Natera, Inc. All Rights Reserved

References

1. Key statistics for breast cancer. American Cancer Society. Accessed September 19, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html

2. Colleoni M et al. Annual Hazard Rates of Recurrence for Breast Cancer During 24 Years of Follow-Up: Results From the International Breast Cancer Study Group Trials I to V. J Clin Oncol. 2016;34(9):927-935. doi:10.1200/JCO.2015.62.3504

3. Mammograms after breast cancer surgery. Accessed September 19, 2022. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/having-a-mammogram-after-youve-had-breast-cancer-surgery.html

4. Gormley M et al. Exploring the effects of genomic testing on fear of cancer recurrence among breast cancer survivors. Psychooncology. 2021;30(8):1322-1331. doi:10.1002/pon.5679

5. Recurrent cancer. National Cancer Institute. Accessed September 19, 2022. https://www.cancer.gov/types/recurrent-cancer

6. Fillon M. Breast cancer recurrence risk can remain for 10 to 32 years. CA Cancer J Clin. 2022;72(3):197-199. doi:10.3322/caac.21724