What Doesn’t Affect Survival
Just as there are factors associated with a better or worse prognosis, there are some factors that do not appear to make a big difference. These are generally less understood by the general public:
- Aggressiveness of treatment
- Having a positive attitude
The goal of treatment for metastatic breast cancer is often very different than that of early-stage disease, and this can raise anxiety among patients and loved ones of patients. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk that the cancer will come back.
In contrast, with stage 4 disease, the goal is usually to use the minimum amount of treatment possible to control the disease . Studies have found that more aggressive treatment does not improve survival rates but does reduce quality of life.
While having a good attitude may improve your sense of well-being, it has not been shown to affect survival rates. In fact, holding in negative emotions in order to appear positive may be detrimental to your health in general.
What Is Metastatic Breast Cancer
MBC is also known as stage 4 breast cancer or advanced breast cancer.
Stage 4 breast cancer is defined as having abnormal cancer cells that start in the breast. Then, they spread or metastasize to other areas of your body, such as your:
Stage 4 is the most serious stage of breast cancer. Most often, breast cancer is diagnosed in earlier stages. But its possible to receive a diagnosis when the cancer reaches this stage.
It can be a challenge to combat MBC, but there are many new treatment regimens that can help improve your outlook.
What Should You Tell The Patient And The Family About Prognosis
A pivotal component of the management of patients with metastatic breast cancer is the discussion of goals of care. Despite important advances in the treatment, metastatic breast cancer remains, as a general rule, an incurable disease. Median survival is 2 years and 5-year overall survival estimates range from 17-28%.
Patients with bone-only disease tend to have better prognosis than patients with visceral disease; patients with uncontrolled brain metastases have very poor prognosis. Patients with bone-only disease can have median survival of up to 5 years or more, compared with patients with brain metastases who tend to live less than 12 months.
Without treatment, median survival ranges 9 to 12 months. Among treated patients, responses and clinical outcomes depend on a number of factors, including the breast cancer tumor subtype, the patients performance status, the number and extension of the metastases, the disease-free interval, and prior therapies received, among others.
In rare instances , long-term remissions can be achieved. It is not possible to predict which individuals will fall into this group. They tend to be young, have good performance status and very low volume of disease. Also, in patients with solitary metastases, complete responses can be achieved and in few cases a multidisciplinary treatment approach with curative intent can be justified.
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A Note About Statistics
Survival rates are statistics, and as such tend to tell us how the “average” person will do with an “average” triple-negative breast cancer; but people and tumors aren’t statistics. Some people will do better and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior. And still there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
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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How Quickly Do Breast Cancer Tumors Grow From Stage To Stage
Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.
Stage 4 Breast Cancer
Advanced breast cancer refers to cancer that has spread beyond the breast to other parts of the body. This process of spreading from the original location to a new location is known as metastasis.
The most common places of breast cancer spread include the bones, liver, lung, and brain. However, breast cancer may also spread to other organs.
The majority of women who are diagnosed with metastatic breast cancer have been diagnosed with an earlier stage of breast cancer before. In this instance, the original cancer in the breast is called the primary cancer. However, for some women, a diagnosis of metastatic breast cancer may be their first diagnosis of cancer .
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Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cannot eat as much as usual. This means they may have difficulty maintaining their weight as well as providing the body with energy.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. You might find it easier to eat little and often instead of having set meals. If you still feel youre not eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietician for specialist advice. In some circumstances you may be prescribed medication to help stimulate your appetite.
Individualized Construction Of Nomogram And External Validation
According to the results of multivariate Cox analysis, separate nomograms were plotted to predict the 1- and 3-year OS and BCSS among patients with or without surgery . Since N staging and surgery type exerted no statistical significance in multivariate analysis , nine variables were finally incorporated into the nomograms. All the nine variables were demonstrated to be independent prognostic factors for OS and BCSS. According to the point scale in these nomograms, each patient with different clinicopathologic characteristics could get a total point that can be used to predict the survival . In addition, through comparing the survival outcomes predicted by those separate nomograms, we can also determine each patient’s survival prognosis when performing surgical treatment or not. In general, a higher score was considered to have worse prognosis.
Figure 3. Nomogram for predicting 1- and 3-year OS and BCSS in patients with metastatic breast cancer. OS for patients who undergo surgical treatment. BCSS for patients who undergo surgical treatment. OS for patients who does not undergo surgical treatment. BCSS for patients who does not undergo surgical treatment.
Its Never Too Late To Exercise
Exercise is important for your overall mental and physical health. Since fatigue is often a symptom associated with stage 4 breast cancer, it can help to plan your exercise during your most energetic time of day.
Consistency is key. Its better to exercise in small amounts every day than to follow an extreme pattern of occasional intense activity between long periods of inactivity.
While there are potential benefits to exercise when you have stage 4 cancer, its important to talk to your healthcare provider before starting an exercise program.
Also, your healthcare provider may recommend avoiding public places, like gyms, because of your risk for germ exposure.
Safety is always a concern when you have stage 4 breast cancer. Bleeding and risks of injury are important considerations.
Some women experience balance and foot numbness problems due to their treatments and fatigue. If this is the case, its best to do exercises that put you at less risk for falls. An example could be riding a stationary bicycle instead of running on a treadmill.
There might not be a direct link between exercise and stage 4 breast cancer survival rates, but you can reap other benefits from regular exercise.
For example, it may help you:
- lose excess body fat
- improve your quality of life
- reduce side effects from treatment
Tamoxifen And Other Anti
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For estrogen-receptor-positive metastatic breast carcinoma the first line of therapy is often tamoxifen or another anti-estrogen drug unless there are liver metastases, significant lung involvement, rapidly progressive disease or severe symptoms requiring immediate palliation.
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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.
Here are several things you should know about metastatic breast cancer and the women who are living with it.
Relative Survival Rate By Stage
The survival rates by stage are based on the stage at the time of diagnosis. Youve probably been given a number and letter for your cancer stage. Here, the terms localized, regional, and distant are used instead of numbers and letters. Heres what they mean and the 5-year relative survival rates for each:
- Localized breast cancer is only in the breast. This includes stage IA , some IIA , and some IIB . The 5-year relative survival rate is 99%.
- Regional breast cancer has spread to nearby tissue or lymph nodes. This includes stage IB , some IIA , some IIB , and all stage III . The 5-year relative survival rate is 86%.
- Distant breast cancer has spread to other parts of the body. This includes stage IV, pronounced stage 4). The 5-year relative survival rate is 28%.
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Seed And Soil Hypothesis
The “seed and soil” hypothesis states that specific organs harbor metastases from one type of cancer by stimulating their growth better than other types of cancer. This interaction is dynamic and reciprocal, since cancer cells modify the environment they encounter. Tumor embolus = seed and Target organ = soil.
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.
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Analysis Of Survival Benefits From Surgery
It has been recommended by the NCCN guideline that the primary treatment approach for women with metastatic breast cancer is systemic therapy rather than surgical treatment. In order to evaluate the survival benefits of local breast surgery in patients with metastatic breast cancer, the Kaplan-Meier plot was performed to compare the OS and BCSS between patients who had, or had not undergone local breast surgical treatment. The median follow-up duration in the training set was 30 months . Of all the 5173 patients with metastatic breast cancer, a total of 1947 patients were dead at the time of last follow-up and 1643 of which were dead directly from breast cancer. As shown in Figure 2, patients who had undergone surgical treatment had prominently better OS and BCSS than patients who had not .
Figure 2. Overall survival and breast cancer specific survival curves plotted by Kaplan-Meier method for patients received surgical treatment or not.
Table 2. Subgroup analysis of OS and BCSS outcomes.
I May Not Feel Like A Fighter Theres No Final Victory
The language used to describe cancer and its treatment is often the language of war: fighting cancer, battling cancer, being a warrior. But those words may not resonate with women who have metastatic breast cancer.
Sendelbach recalls using fighting words when she was first diagnosed with stage 1 breast cancer. I was 30 years old, and I was in fight mode, she says. I was like, Hell yeah, I can kick cancers ass and so on. When she was diagnosed with stage 4, though, she realized there would be no end in sight, no final victory for her.
Theres not a finish line, she says, so to be in fight mode doesnt really work. There has to be an end in sight to stay in that place.
For her, metastatic breast cancer is something she deals with day to day. She describes her journey as a marathon, not a sprint. If you have to stop sometimes to walk and take water breaks, she says, you should. If you try to run as fast as you can all the time, its inevitable that youre going to fail.
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Living With Stage 4 Breast Cancer
Metastatic breast cancer affects people in different ways. Some women who are diagnosed with metastatic breast cancer may experience a reduction in their overall health as a result of disease progression and/or the resulting side effects of their treatment. If you are experiencing any symptoms that concern you or if symptoms get worse, it is important that you discuss these with your doctor. In addition, while there is no strong evidence that a special diet will improve the prognosis of metastatic breast cancer, healthy lifestyle choices can help you to feel your best, manage symptoms and improve your overall wellbeing.
Many women also find the uncertainty of their situation difficult to manage. Some people cope best by living in the present and not thinking too much about the future. Other people prefer to plan ahead, which gives them a greater sense of control. The best approach is the one that works best for you.
Can Metastatic Breast Cancer Go Into Remission
Metastatic breast cancer may never go away completely. But treatment can control its spread. Cancer may even go into remission at some points. This means you have fewer signs and symptoms of cancer.
A treatment break may be considered in certain situations, including if remission occurs or if someone is experiencing intolerable side effects. A pause in treatment can help you feel your best and improve your quality of life.
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Treatment For Advanced Breast Cancer
Treatment of metastatic breast cancer aims to control the growth and spread of the cancer, to relieve symptoms, reduce pain, and improve or maintain quality of life.
The treatment recommended by doctors will depend on which treatments are likely to control the breast cancer and what side effects the person can cope with. Treatment options may involve:
How To Cope With Metastatic Breast Cancer
Metastatic breast cancer does not always develop because you have taken the wrong treatments or have been irregular with your treatment. There are reports of women developing cancer after being disease-free for months and years. Even after medications and surgeries, there are chances that some cancer cells are still present. These cells migrate to organs, leading to the metastatic condition.
The time when your doctor reveals to you that you have reached an advanced stage of cancer can be emotionally devastating. However, you need to accept the conditions and prepare yourself to explain the same to your loved ones. It is OK to take some time and find the right time to share the news with them.
The treatment for metastatic breast cancer is an ongoing treatment and evolving through clinical trials. There is no hope for a cure. However, medications can help you deal with the symptoms and live a longer life than without the treatment.
You may decide to stop the medications for metastatic breast cancer because of the severe side effects that come with the treatment. You may opt for hospice or palliative care, which is available in many hospitals. Palliative care is a special kind of treatment reserved for people with a terminal illness. It aims to alleviate the symptoms, as well as provide you comfort and better quality of life.
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Risk Factors For Metastatic Breast Cancer
Any type of breast cancer can metastasize. It is not possible to predict which breast cancers will metastasize. Whether metastasis happens depends on several factors, including:
- The type of breast cancer, such as hormone receptor-positive and/or HER2-positive, or triple-negative breast cancer .
- How the cancer grows. For example, is it a faster growing cancer or a slower growing cancer?
- The stage of the cancer when first diagnosed, including the tumor size and whether cancer was found in nearby lymph nodes.
There is no proven way to completely avoid developing metastatic breast cancer. Research continues to evaluate why metastatic breast cancer occurs and how to prevent, slow, or stop the growth of metastatic cells.
The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems metastatic breast cancer can cause. Use the menu to choose a different section to read in this guide.