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.
What Does Cancer Remission Mean
Cancer remission is when the signs and symptoms of cancer have lessened or are undetectable.
In blood-related cancers like leukemia, this means youll have a decrease in the number of cancer cells. For solid tumors, that means that the tumor size has decreased. The decrease must last for at least one month to be considered remission.
types of cancer remission
There different types of remission:
- Partial. A reduction of at least 50 percent in measurable tumor size or cancer cells
- Complete. All detectable evidence of cancer is gone.
- Spontaneous. When cancer goes into remission without therapy considered adequate to otherwise lead to remission. This usually happens after a fever or infection, and is rare.
Remission is not a cure, and it doesnt mean that youre totally cancer-free. Even in complete remission, there can still be some cancer cells in your body, and these can start growing again.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
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Plans Have To Be Flexible
My energy is unpredictable, says Sendelbach. I literally never know how Im going to feel from one day to the next. Its so hard to make plans because if I say yes to something thats two weeks away, the day of, I could wake up and feel absolutely horrible.
When someone with metastatic breast cancer declines an invitation or cancels at the last minute, its most likely not because they dont want to be there. Says Sendelbach, We physically cant do it.
Silberman agrees. Ive been going through for a long time, she says, and Ive had friends drop away. Because of MBC and my treatments, its hard for me to be reliable.
Treating Everywhere And A Few Other Places
Aggressive, systemic treatment of metastatic cancer has evolved over time. For decades, it primarily involved chemotherapy, as well as hormone treatments for cancers like breast and prostate, but now includes a growing number of targeted therapies and immunotherapy.
This reliance on systemic therapies is linked in part to the way in which metastatic tumors are identifiednamely, imaging technologies such as PET and CT scans.
Were limited by the ability to accurately image metastases, Dr. Vikram said. Each year, seems to get better, he continued. But even the most cutting-edge approaches still have limitations and cant necessarily rule out the presence of tiny deposits of tumor cells, called micrometastases, hiding in the lungs, brain, or bones.
As a consequence, treating individual metastases has not been a common part of cancer care, aside from doing so to control pain.
One situation where directly treating metastases is not uncommon is in patients with colorectal cancer that has spread to a limited number of spots on their liver. In fact, several observational studies, including one conducted in the United States and one in Europe, have reported that approximately 20% of patients initially treated with surgery to remove only their primary tumors and metastatic tumors on their liver survived for at least 10 years.
Neither study was a prospective clinical trial, however, or comprehensively documented other treatments these patients may have received.
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How Often It Happens
Though we have clearly documented cases of spontaneous regression, it’s hard to know how common this phenomenon actually is. We know it is not rare, with over a thousand case studies in the literature. In addition to those studies which document a cancer which goes away without any treatment, it’s not clear how often a cancer make go away despite treatment or at least decrease in size despite treatment.
Some have estimated the incidence to be roughly one out of 100,000 people, but it’s difficult to know if that number is even in the ballpark. It does appear to be more common with some tumors rather than others, with spontaneous regression of blood-related cancers such as lymphoma, and skin cancers such as melanoma being reported more commonly.
Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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Progression During Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.
Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.
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Is Metastatic Cancer A Terminal
Most cancers of metastatic cancers do not have a good prognosis and are often labeled terminal. Metastatic breast cancer cannot be cured but can be managed with treatment. According to the American Cancer Society, the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 27%.
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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What I Wish People Knew About Metastatic Breast Cancer
Women with metastatic breast cancer think about fighting cancer very differently than women who don’t have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.
The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.
While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.
Treatment Options For Stage Iv Breast Cancer
For women with stage IV breast cancer, systemic therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help women live longer. These cancers are considered incurable.
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Patients With Stage Iv Breast Cancer In Complete Remission
The role of radiation treatment in the management of women with stage IV breast cancer has historically been confined to providing relief of painful bony metastases or other symptomatic areas of breast cancer. Unlike treatment of earlier stage breast cancer, radiation therapy has not been routinely used to prevent local cancer recurrence in the breast and axilla or other localized sites of disease. The results of a recent clinical study reported by investigators at Duke University, however, suggests that radiation therapy may reduce cancer recurrences and improve survival when used in women who have achieved a complete remission through conventional chemotherapy treatment.
It is important to understand that this clinical study was not designed to evaluate the role of radiation therapy in patients achieving a complete remission to chemotherapy. This information has limited immediate application because of the small number of patients and the investigators’ inability to perform a direct controlled comparison of the treatments. Future clinical studies will need to be designed to evaluate the role of radiation in a more formal manner. However, consolidative treatment with radiation therapy after chemotherapy-induced clinical remissions does appear to reduce the risk of cancer recurrence and may improve a patient’s chance of overall survival. (
Journal of Clinical Oncology, Vol 17, No 3, pp 887-893, 1999)
How The Absence Or Reduction Of Cancer Directs Treatment And Care
Many types of cancer can go into remission when they are treated. If you have had breast cancer, your healthcare provider will use the term remission, rather than cure after your breast cancer has been successfully treated, even when there are no remaining signs of cancer in your body. This term is used because there remains a possibility that breast cancer may return after it’s treated.
There are different types of breast cancer remission.
These include:
- Complete remission: Tests, scans, and exams are unable to find cancer in the body
- Partial remission: A tumor is still known to be present, but it is substantially reduced.
Each requires a different approach to management and treatment. Complete or partial remission means that you need ongoing monitoring to identify and treat a recurrence if it occurs.
Breast Cancer Discussion Guide
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Stage 4 Breast Cancer Life Expectancy
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Symptoms When Breast Cancer Has Spread To The Bones
The main symptoms of breast cancer that has spread to bone are:
- Pain particularly in the back, arms or legs, often described as gnawing which occurs when resting or sleeping, and may get worse when lying down especially at night
- Fractures
Find out more about the symptoms of secondary breast cancer.
Other possible effects include:
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Support For Living With Secondary Breast Cancer
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever is on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
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Many Women Live For Decades With Metastatic Breast Cancer
A stage 4 diagnosis is not an instant death sentence, says Renee Sendelbach, 40, from Austin, Texas, who was diagnosed seven years ago, when she learned that her breast cancer had moved into her lungs, bones, and lymph nodes.
Ive had metastatic breast cancer for five years and Im still kicking, says Susan Rosen, 53, from Franklin, Massachusetts.
According to a 2017 article in the journal Cancer Epidemiology, Biomarkers & Prevention, 34 percent of women diagnosed with metastatic breast cancer have been living with the disease for five years or longer.
The goal of treatment is to keep patients on their feet as long as possible so that they can continue to do what they want to do, says Gretchen Kimmick, MD, associate professor of medicine at the Duke Cancer Institute in Durham, North Carolina.
In recent years, treatment for breast cancer has vastly improved, largely because doctors are able to more accurately target therapy to the type of breast cancer a woman has. The discovery of the HER2 protein and medicines that block it has revolutionized treatment for women with cancers that overexpress this protein, Dr. Kimmick says. This cancer was pretty deadly two decades ago, and now we are starting to debate if weve cured it in some women.
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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 foundBreast 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.
A More Treatable Kind Of Metastatic Cancer
A plan for stereotactic body radiation therapy to treat a metastatic lung tumor.
Rarely are the terms cure and metastatic cancer used together. Thats because cancer that has spread from where it originated in the body to other organs is responsible for most deaths from the disease.
But in 1995, two cancer researchers put forth a controversial concept: There is a state of cancer metastasis that isnt necessarily fatal. They called it oligometastatic cancer, describing it as existing between a cancer that is contained to where it originated and one that has spread extensively throughout the body.
In oligometastatic cancer, the patient has only a few, usually small metastases . For some patients, this form of metastatic cancer should be amenable to a curative therapeutic strategy, Ralph Weichselbaum, M.D., and Samuel Hellman, M.D., both from the University of Chicago, wrote some 25 years ago.
At the time, and still today, most people with metastatic cancer are treated only with therapies meant to kill cancer cells anywhere they may be in the body, known as systemic treatment. The assumption being that any evidence of metastatic cancer, Dr. Weichselbaum said, means that metastases are everywhere, and thats not necessarily true.
Its taken time, but over the last 5 years or so, the duos hypothesis has been put to the test, primarily in small clinical trials.
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Why Is Metastatic Cancer Not Curable
Metastatic cancer causes most cancer deaths, but exactly why it is so difficult to treat is not precisely understood. Metastatic tumors often acquire additional genetic changes from those in the primary tumors that spawned them, and these genetic characteristics may cause them to resist standard treatments.