For many of our patients, the last day of treatment feels like a finish line. The scans are clear, the hair is growing back, and life slowly returns to normal. But for some women, breast cancer comes back, sometimes within months and sometimes after more than a decade.

This Breast Cancer Awareness Month, our surgical oncologist and Head of Surgery and Anaesthesiology, Dr. Sameer Pandya, shares what every survivor should understand about recurrence, and why the end of treatment is not always the end of the journey.

Breast Cancer in Kenya

Breast cancer is the most common cancer among women worldwide. In Kenya, about 8,000 new cases are diagnosed every year, and roughly 3,400 women die from it. Earlier diagnosis and better surgery, radiotherapy, and medicines mean many women now achieve long-term remission. Even so, recurrence remains a real concern for survivors and their families.

Three Ways Breast Cancer Can Return

• Local recurrence: The cancer reappears in the same breast, at the original site, or on the chest wall after a mastectomy.
• Regional recurrence: It shows up in nearby lymph nodes, such as under the arm or around the collarbone.
• Distant recurrence: The cancer spreads to other organs, most often the bones, liver, lungs or brain. This is known as metastatic breast cancer.

A recurrence is also different from a second primary breast cancer, which is a completely new cancer. Our team uses imaging, laboratory tests and tumour analysis to tell them apart, because the distinction shapes the treatment plan.

When Can It Happen?

There is no single timeline. Many recurrences occur within the first two to five years, particularly with aggressive types such as triple-negative and HER2-positive breast cancer. Hormone-receptor-positive cancers, on the other hand, can return after five or ten years or longer. That is why we encourage long-term follow-up, even when you feel completely well.

What Increases the Risk?

• Advanced disease at diagnosis, including larger tumours and lymph node involvement
• Aggressive tumour biology, such as high-grade cancers
• An incomplete response to treatment
• Stopping chemotherapy, radiotherapy or hormone therapy early
• Inherited gene mutations such as BRCA1 and BRCA2

Across Kenya, delayed diagnosis, cost, limited access to specialist care and gaps in long-term follow-up make things harder for many patients. The country also lacks reliable national data on recurrence, something that needs to change.

Can You Prevent It?

No one can promise prevention, but you can lower your risk:

• Complete your full treatment plan, and talk to your care team about side effects instead of stopping on your own
• Attend every follow-up appointment
• Keep a healthy weight, stay active, eat plenty of vegetables and fruit, and limit alcohol
• Ask about genetic counselling and testing if you have a strong family history or were diagnosed at a young age

Please be cautious of claims that a specific food, supplement, or herbal remedy can stop cancer from returning. There is no evidence for this.

What Follow-Up Looks Like

A typical schedule is a clinical review every three to six months for the first three years, every six to twelve months in years four and five, and once a year after that. Your own schedule may differ, depending on your risk and the treatment you received. Women who have had breast-conserving surgery should have a mammogram every year. Routine CT scans, PET scans and tumour-marker blood tests are generally not recommended when there are no symptoms.

Contact your doctor promptly if you notice a new lump, changes to the chest wall, bone pain that won’t go away, unexplained weight loss, a persistent cough, ongoing headaches or any neurological symptoms.

If the Cancer Does Return

Treatment depends on what you received before and on the biology of the tumour. Options can include surgery, radiotherapy, chemotherapy, hormone therapy, HER2-targeted drugs and immunotherapy. We usually recommend a biopsy of the new tumour, because its hormone receptor and HER2 status can differ from the original cancer, and that can change the treatment.

Care today is more personalised than ever. Newer options such as CDK4/6 inhibitors, HER2-targeted therapies, antibody-drug conjugates, genetic testing and more precise radiotherapy are improving outcomes. Some of these are costly or not available everywhere, which is why stronger pathology services, access to essential medicines and multidisciplinary care matter so much.

Our Message to Survivors

A recurrence is serious, but it does not mean your treatment failed. Many recurrences can be treated successfully, and even advanced disease can often be controlled with a good quality of life. Keep your follow-up appointments, stay alert to changes in your body, and seek medical advice early.