Metastatic breast cancer (also called advanced or stage IV breast cancer) is breast cancer that has spread beyond the breast and nearby lymph nodes to other parts of the body. In the U.S., only a few women have metastatic disease when they are first diagnosed. More commonly, metastatic breast cancer arises months or years after a woman has completed treatment for stage I, II, or III breast cancer. Although metastatic breast cancer is not currently considered curable, it is treatable. Today, some women live many years with metastatic breast cancer as a long-term chronic condition. And, as treatment for both early-stage and metastatic breast cancer continues to improve, so does survival.
If breast cancer metastasizes, it most often spreads to the bones, liver and lungs. Although it may surprise some people, when breast cancer spreads 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.
The goals of treatment for a woman with metastatic breast cancer are to control tumor growth and prolong life while also maintaining quality of life. Treatment is highly personalized and depends upon the type of tumor and the type of side effects that a woman is willing to accept or able to tolerate. Not only does one person’s cancer differ from another’s, but personal choice guides treatment more than with early-stage breast cancers. Some treatments have side effects that impact quality of life, and the potential benefits of these treatments may be greater for some women than others. Together with her/his doctor, a person with metastatic breast cancer can find the balance of treatment and quality of life that is right for her/him.
The most common kinds of treatment for metastatic breast cancer include hormone therapy for estrogen receptor-positive (ER+) cancers, HER2/neu-positive (HER2+) targeted therapies for HER2+ cancers and standard chemotherapy for all cancers, regardless of type. Depending upon the location of the metastases and whether they cause any symptoms, some areas involved with cancer may also be treated with radiation. For example, radiation may be used to ease the pain of cancer that has spread to the bone. Surgery is not commonly used for metastatic breast cancer.
Treatment and prognosis are also guided by the treatment a woman had for her original breast cancer. Some treatments available today clearly appear to change the natural course of the disease and improve survival. One example is the drug trastuzumab (Herceptin). Trastuzumab specifically targets HER2+ cancer cells and changes the way that these breast cancers grow. With continued advances in treatments that are tailored to certain breast cancers, future treatments may help women with metastatic breast cancer live longer.
The most important thing to remember is that survival for metastatic breast cancer is highly variable. Although the average length of survival for women with metastatic breast cancer is in the range of 2-3 years, this is an average and does not predict how long any one person may live.1 About 25 percent of women with metastatic breast cancer live more than five years after diagnosis, and some women live 10 or 20 years beyond diagnosis.2 It is also important to note that these survival estimates are based on women diagnosed before some of the newer treatments for breast cancer were available. Current treatments may mean improved survival for women diagnosed today.
While certain features of a woman’s cancer and her medical history can affect the chance of long-term survival, our ability to make predictions remains limited. At best, prognosis for any patient is an estimate. We do know that some women will go on to live for many years with metastatic disease. And, as we learn more and breast cancer treatments improve, the number of these women should grow. According to Eric Winer, MD, chief scientific advisor to Susan G Komen for the Cure®, the treatment of metastatic breast cancer has evolved dramatically over the past 10 years, and will evolve even more in the next decade. "I look forward to a time when metastatic breast cancer will be entirely manageable with well tolerated therapy. It may be quite some time before we can cure metastatic disease, but women with metastatic breast cancer can expect to live far longer and far better in the years ahead than in the past. "
Susan G. Komen for the Cure® is a proud sponsor of the 2010 Metastatic Breast Cancer Network’s National Conference to be held Saturday, October 16 in Indianapolis, Indiana. The conference is free and open to patients, friends, family and health care professionals. The program includes discussions of the latest treatments, coping strategies and future therapies. Learn more about this conference or register to participate.
1. National Cancer Institute. Stage IIIB, Inoperable IIIC, IV, Recurrent, and Metastatic Breast Cancer. http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page8, 2010.
2. Altekruse SF, Kosary CL, Krapcho M, et al. (editors). SEER Cancer Statistics Review, 1975-2007. National Cancer Institute. http://seer.cancer.gov/csr/1975_2