Study Design And Setting
This nationwide historical cohort study was conducted in Denmark , whose entire population receives tax-supported healthcare from the Danish National Health Service. Since 1968, the Civil Registration System has assigned to every Danish citizen a unique 10-digit civil registration number encoded for date of birth and gender. The CRS also tracks address changes, dates of emigration and changes in vital status, and allows for unambiguous linkage among all Danish population-based administrative and health registries.
The nationwide Danish Cancer Registry has recorded all incident cases of cancer in Denmark since 1943. The DCR collects data on patient demographics, tumour site, tumour morphology and tumour stage at diagnosis. The Danish National Registry of Patients has collected electronic data on hospitalisations since 1977 and on outpatient and emergency room visits since 1995. For each hospital contact, the DNRP records dates of admission and discharge, surgical procedures, and up to 20 diagnoses coded by physicians at discharge as per the Danish version of the International Classification of Diseases, 10th revision .
How Effective Are Treatments For Bone Metastases
Although current treatments for bone metastases are unable to completely remove all cancer cells, many women with bone metastases can live for many years with extremely good quality of life.
The effect of bone metastasis on your prognosis is individual and depends on what type of cancer you have, where it has spread to and how you respond to various treatments. The main aim of any treatment is to control pain and other symptoms so you can enjoy your day-to- day activities as much as possible.
Surgery To Remove Lymph Nodes
Breast cancer can spread to other parts of the body. If it does spread, it usually first spreads to the lymph nodes in the armpit close to the breast. These lymph nodes drain the lymphatic fluid from the breast and arm.
It is important to know if there are cancer cells in the lymph nodes in the armpit and how many. This helps the doctors work out the stage of your cancer and plan the best treatment for you.
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All Types Of Primary Bone Cancer
Generally, for people with primary bone cancer in England:
- almost 75 out of 100 people survive their cancer for 1 year or more
- more than 50 out of 100 people survive their cancer for 5 years or more
These statistics are for people diagnosed with primary bone cancer in England between 1999 and 2013, with follow-up between 2009 and 2013.
Net survival and the probability of cancer death from rare cancers.P Muller and othersCancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
Other Patient And Clinical Characteristics
Level of comorbidity was assessed using the Charlson Comorbidity Index a weighted index based on 19 chronic conditions. A CCI score was calculated for each patient using all hospital diagnoses recorded in the DNRP during the 5years prior to the diagnosis date of BM. CCI scores were categorised as low medium or high . We also determined whether there were distant metastases to other sites prior to or on the diagnosis date of BM. In addition, we obtained information from the DNRP on SREs occurring on or after the diagnosis date of BM, including radiation to bone, pathological fractures, surgery to bone and spinal cord compression. It is important to note that we assumed that administration of any conventional external radiation was radiation to bone, since the code for radiation does not specify location and all patients in the study cohort had BM.
We used information from the Danish National Pathology Registry to assess immunohistochemistry expression among the breast cancer cases within ±90days of their diagnosis -positive/negative, progesterone receptor -positive/negative and HER2 -positive/negative). Data in the Pathology Registry are coded according to the Systematized Nomenclature of Medicine . We classified breast cancer cases according to ER status and into one of the following three subsets: ER/PR-positive and HER2-negative HER2-positive and ER/PR-negative and HER2-negative.
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Stage 4 Survival Rates
To get a perspective on the difference in survival rates during different stages of cancer, according to the American Cancer Society the rate of survival after diagnosis is:
- For those at stage 2 there is an expected five-year survival rate of over 90%.
- For those at stage 3 there is an expected five-year survival rate of 72%.
- For stage 4 there is an expected five-year survival rate of 22%.
Because the earlier stages of breast cancer have much longer survival rates, early detection and treatment are important.
Breast Subtypes And Prognosis Of Breast Cancer Patients With Initial Bone Metastasis: A Population
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Background: Metastatic breast cancer is a highly heterogeneous disease and bone is one of the most common metastatic sites. This retrospective study was conducted to investigate the clinical features, prognostic factors and benefits of surgery of breast cancer patients with initial bone metastases.
Methods: From 2010 to 2015, 6,860 breast cancer patients diagnosed with initial bone metastasis were analyzed from Surveillance, Epidemiology, and End Results database. Univariate and Multivariable analysis were used to identify prognostic factors. A nomogram was performed based on the factors selected from cox regression result. Survival curves were plotted according to different subtypes, metastatic burdens and risk groups differentiated by nomogram.
Our study has provided population-based prognostic analysis in patients with initial bone metastatic breast cancer and constructed a predicting nomogram with good accuracy. The finding of potential benefit of surgery to overall survival will cast some lights on the treatment tactics of this group of patients.
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How Your Prognosis Might Affect You
It can be difficult to take in and make sense of information about your prognosis. Having a good prognosis may reassure you, although you may still worry. If your prognosis is less good, you may feel anxious about the future. However you feel, theres no evidence that peoples attitude to having cancer alters their prognosis.
No tests can tell you with complete certainty what will happen to you. Sometimes people with a poor prognosis live for a long time. Equally, breast cancer can come back in people with a seemingly excellent prognosis.
Its normal to want to make plans for the future and the uncertainty about a diagnosis of breast cancer can be hard to live with. Most people find that it gets easier over time but sometimes you may need more support. This can come in all sorts of ways: from your friends or family, your breast care nurse, specialist or GP. You can also be referred to a counsellor who is trained to help people explore their feelings following a diagnosis of, and treatment for, breast cancer.
Whatever challenges or concerns youre facing, Breast Cancer Now is here to support you. Whether you want to speak to our nurses, join our online Forum or connect with volunteers who have faced what youre facing now, we can help you feel more in control.
For more information, visit our support for you section.
Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
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Demographic And Clinicopathological Factors
Several studies have been performed in order to determine demographic, clinical, and pathological factors that could be associated with higher risk of BM. Some of these factors are summarised in Table 1.
Age
There are conflicting results when analysing the effect of age in the development of BM. Some studies have shown that BC patients who develop bone-only metastasis tend to be older than those who relapse with both visceral and bone disease . This conflict can be, in part, a result of different studies using different definitions of age: age at time of cancer diagnosis, or age at time of metastatic disease diagnosis.
In fact, in a retrospective German multicentre study , BC patients older than 65 at diagnosis had a 1.5-fold increased risk of developing bone-only disease when compared to younger women . In this study, when included in a multivariate model , age at diagnosis was the second most important factor for the development of BM after BC subtype .
Table 1. Clinicopathological factors related to the development of bone metastasis in breast cancer patients.
Menopausal status
Of note, there is an irrefutable association between menopausal status and age that has to be taken into account when interpreting these studies.
If, in fact, menopausal status proves to be a risk factor for BM, this might be part of the explanation why adjuvant bisphosphonate treatment in early BC seems to have an impact only in postmenopausal women .
Body Mass Index
Histological type
Grade
Signs That Breast Cancer Has Spread To The Bone
Most aches and pains arent cancer, stresses Huston. But its important to keep an open and honest dialogue with your doctor about any unusual or persistent discomfort you may be having. He or she can determine if getting images is appropriate to rule out bone metastasis. Here are the symptoms of bone metastasis to look out for:
If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam, blood tests, and a bone scan to check for bone metastasis. Depending on the results and where or how severe the bone pain is, he or she may also order an X-ray, PET scan, or CT scan. In some cases, a tissue biopsy is also done to confirm the diagnosis.
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About The Lymph Nodes
The lymphatic system helps protect us from infection and disease. It also drains lymph fluid from the tissues of the body, before returning it to the blood.
The lymphatic system is made up of fine tubes called lymphatic vessels. They connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
Recurrence Of Metastatic Breast Cancer
Metastatic breast cancer is considered a chronic disease, so it doesnt go away and recur.
But in recent years, people under age 50 have seen a particularly strong decline in death rates due to breast cancer, according to the Centers for Disease Control and Prevention .
These declines are due in part to improved screening and treatment for the disease.
There are a few general facts that are helpful to know about breast cancer outlook:
- Breast cancer is the most common cancer diagnosis in the United States, according to the
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Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
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Benefits Of Primary Tumor Surgery In Patients Subdivided By Molecular Subtypes And Metastatic Sites
In the whole cohort, primary tumor surgery could prolong OS . In terms of molecular subtypes, surgery provided extra survival benefit in all subtypes . In terms of metastatic burden, BOM, bone and liver metastasis as well as bone and lung metastasis patients could benefit from surgery . However, surgery did not significantly benefit patients with bone and brain metastasis . Similarly, the analysis of BCSS showed consistent results.
Figure 4 Survival of de novo bone metastatic patients in different subtypes according to primary surgery. OS and BCSS in patients with HR+/HER2 tumors OS and BCSS in patients with HR+/HER2+ tumors OS and BCSS in patients with HR/HER2+ tumors OS and BCSS in patients with HR/HER2 tumors.
Figure 5 Survival of de novo bone metastatic patients in different metastatic burdens according to primary surgery. OS and BCSS in patients with bone-only metastasis OS and BCSS in patients with bone and brain metastasis OS and BCSS in patients with bone and liver metastasis OS and BCSS in patients with bone and lung metastasis.
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Pathophysiology Of Breast Cancer Metastasis To The Bone
BC spread is a complex multistep process. It begins with the epithelial-to-mesenchymal transition of locally invasive carcinoma cells which then enter the lumina of blood vessels, a process called intravasation . Once in the systemic circulation, these circulating tumour cells must survive a variety of stress factors in order to reach the bone marrow, namely the stress imposed by matrix detachment , the shear forces, and the predation by cells of the innate immune system . To evade these threats, CTCs form relatively large emboli via interactions with blood platelets . However, the majority become trapped in capillary beds during its first passage through the circulation . Nevertheless, some CTCs may avoid this rapid trapping because of their plasticity or chance passage through arteriovenous shunts . Eventually, some CTCs become lodged in the microvasculature of distant organs and initiate intraluminal growth, rupturing the walls of surrounding vessels, and placing cells in direct contact with the parenchyma of a specific organ . Also, CTCs may be able to extravasate from the vessels lumina into the stromal microenvironment by penetrating the endothelial cell and pericyte layers .
When Do People Get A Metastatic Breast Cancer Diagnosis
Metastatic breast cancer can occur at different points:
- De novo metastatic breast cancer: About 6% of women and 9% of men have metastatic breast cancer when theyre first diagnosed with breast cancer.
- Distant recurrence: Most commonly, metastatic breast cancer is diagnosed after the original breast cancer treatment. A recurrence refers to the cancer coming back and spreading to a different part of the body, which can happen even years after the original diagnosis and treatment.
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A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.
What Is Secondary Breast Cancer In The Bone
When cancer that started in the breast has spread to the bones, its called secondary or metastatic breast cancer in the bone.
Some people also refer to it as bone metastases or bone mets.
The bones most commonly affected are the:
- Spine
- Pelvis
- Upper bones of the arms and legs
The cells that have spread to the bone are breast cancer cells. Its not the same as having cancer that starts in the bone.
Breast cancer cells can spread to the bone through the lymphatic system or the blood.
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The Role Of Caregivers
Caregivers also play a vital role in helping a person with cancer be as comfortable as possible. To help, a caregiver can:
According to the American Society for Clinical Oncology, in 2018, doctors will diagnose invasive breast cancer in an estimated 268,670 people in the United States.
The ACS state that the 5-year relative survival rate for people with metastatic breast cancer is around 22 percent. This means that people with metastatic breast cancer are 22 percent as likely as people without the condition to live at least 5 years following diagnosis.
However, many factors can affect how long a person with metastatic breast cancer lives for, including:
- the type of breast cancer
- the stage of breast cancer
- where the cancer has spread to
- how well the cancer responds to treatment
- any other health issues that the person has
Everyoneâs outlook is different. It is also important to note that survivals rates are just estimates, and that doctors base these figures on data from at least 5 years ago. Continuing advancements in cancer treatments means that survival rates are improving.