> Metastatic Breast Cancer (Stage IV or Advanced Breast Cancer) Introduction
Metastatic breast cancer (also called stage IV or advanced breast cancer) has spread beyond the breast to other organs in the body (most often the bones, lungs, liver or brain).
Although metastatic breast cancer has spread to another part of the body, it is still considered and treated as breast cancer. For example, breast cancer that has spread to the bones is still breast cancer (not bone cancer) and is treated with breast cancer drugs, rather than treatments for a cancer that began in the bones.
Some women have metastatic breast cancer when they are first diagnosed, but this is not common in the United States (five percent of diagnoses) . Most women with metastatic cancer develop it when the cancer returns at some point after their initial breast cancer diagnosis and treatment. This is sometimes called distant recurrence.
Learn more about breast cancer staging.
Learn more about recurrence.
Treatment for metastatic breast cancer
As hard as it is to hear, metastatic breast cancer cannot be cured. Unlike breast cancer that remains in the breast or nearby lymph nodes, you cannot get rid of all the cancer that has spread to other organs. This does not mean, however, that it cannot be treated.
Treatment of metastatic breast cancer focuses on length and quality of life. Your treatment plan is guided by many factors, including:
- Characteristics of the cancer cells
- Where the cancer has spread
- Your symptoms
- Past breast cancer treatments
If the cancer is hormone receptor-positive, the first treatment is hormone therapy. If the cancer is HER2/neu-positive, anti-HER2/neu drugs such as trastuzumab (Herceptin) may be given.
Chemotherapy and radiation can be used to shrink or slow the growth of tumors or to ease symptoms of the cancer itself. However, these therapies have side effects that can affect quality of life.
Talking openly about quality of life issues with your health care providers and your family can help you decide what treatments are best for you. Joining a support group may help you think through these issues.
Learn more about factors that affect treatment options.
Learn more about quality of life.
Learn more about support groups and other sources of support.
Prognosis for metastatic breast cancer
Survival for metastatic breast cancer varies greatly from person to person. Although the average length of survival is about two years, this is an average and does not predict how long any one person may live . About 15 percent of women live five or more years after diagnosis with metastatic breast cancer [47-48]. Some women may live 10 or 20 years beyond diagnosis .
It is important to note that these survival estimates are based on women diagnosed before some of the newer treatments for metastatic breast cancer were available. As treatments for both early-stage and metastatic breast cancer continue to improve, so does survival. So, women diagnosed today may have survival rates that are higher than these estimates.
Treatment guidelines for metastatic breast cancer
Although the exact treatment for metastatic breast cancer varies from person to person, guidelines help ensure quality care. These guidelines are based on the latest research and the consensus of experts. The American Society of Clinical Oncology (ASCO) and National Comprehensive Care Network (NCCN) are two respected organizations that regularly update and post their guidelines online. The National Cancer Institute (NCI) also has overviews of treatment options.
In September 2013, the Institute of Medicine (IOM) released a set of recommendations (below) on improving cancer care in the U.S. The report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis recommends improvements to fix shortcomings that add cost and burden to cancer care. In the U.S., there are about 14 million cancer survivors and more than 1.6 million new cases are diagnosed each year. By 2022, the IOM projects that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. Therefore, the IOM convened a committee of experts to examine the quality of cancer care in the U.S. and made recommendations for improvement. The committee concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce and rising costs. Changes across the board are urgently needed to improve the quality of cancer care.
Susan G. Komen® endorses these recommendations as they have special significance in the breast cancer field. “Issues of accessibility, quality treatments and survivorship are especially complex for breast cancer patients, who may be treated for many years,” said Chandini Portteus, Komen’s Chief Mission Officer.
The report identified key ways to improve quality of care:
- Ensure that cancer patients are engaged and understand their diagnosis so they can make informed treatment decisions with their health care providers
- Develop a trained and coordinated workforce of cancer professionals
- Focus on evidence-based care, using information technology to provide better information about the potential benefits of treatments
- Focus on quality measurements
- Provide accessible and affordable care for all
The study was chaired by a Susan G. Komen Scholar Patricia Ganz, M.D., with participation by Komen’s Chief Scientific Advisor, George Sledge, M.D. Komen was one of 13 organizations sponsoring the study. Read the full report at www.nas.edu and www.iom.edu.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.