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Listed below are MBC facts, information, and observations. They are not intended to be medical advice and are for information purposes only.

Metastatic breast cancer starts in the breast but then spreads to other parts of the body. For example, it could spread to the bones or the lungs. It’s also referred to as stage 4 or advanced breast cancer. It is the most severe form of the disease. 

Fortunately, not everyone who receives an early-stage breast cancer diagnosis will develop MBC. Approximately 20-30% will. That is why it is so important to recognize the signs and symptoms of MBC and act promptly if experiencing any of them.

Breast cancer metastasis most commonly occurs in one or more of four sites: bones, lungs, liver, and brain. Therefore, signs and symptoms of MBC may vary widely from patient to patient depending upon where their cancer has spread. Bone metastasis can cause fractures, back, neck, and hip pain, and numbness or weakness in the arms and legs. Shortness of breath, a cough that won’t go away, and chest pain can be symptoms of possible spread to the lungs. Nausea, vomiting, itchy skin, and jaundice could point to liver involvement. Headaches, blurred or double vision, and seizures may be indicators of brain metastasis.

Someone previously diagnosed with early-stage breast cancer may notice body changes before a medical professional detects it in a routine exam. That is why it is vital to promptly contact a doctor upon experiencing any symptoms indicative of MBC and have it diagnosed or ruled out as quickly as possible. Not ignoring or dismissing symptoms, seeking an early diagnosis, and rapidly embarking on a treatment plan: that should be the GOAL for living your best life with MBC!

Diagnosing Metastatic Breast Cancer (PART 1 of 2): Medical professionals can employ various testing options to diagnose MBC. But every patient shouldn’t expect to undergo every test available. Instead, doctors select the appropriate diagnostic tests for a particular patient based on an individual’s medical history, symptoms, and physical exam results. X-rays are sometimes used; for instance, a chest X-ray can help detect cancer that has spread to the lungs. Bone scans, CT scans, PET- or PET-CT scans, and MRIs can be utilized to help identify tumors or abnormalities in organs, bones, and tissues outside the breast and measure the dimensions of such tumors. Various blood tests can be possible indicators of cancer. One such test can analyze mineral levels and enzymes in the blood, which, if found to be abnormal, might suggest that cancer has spread.

Diagnosing Metastatic Breast Cancer (PART 2 of 2): A biopsy is essential in confirming an MBC diagnosis. While any one of the previously mentioned tests might indicate the location and size of potentially cancerous tumors, a biopsy is the only procedure that can provide a definitive diagnosis. During a biopsy, a small amount of tissue is extracted from lymph nodes, lungs, liver, other organs; bones, skin, or fluids that might be considered suspicious for cancer based on symptoms and other testing. A pathologist then conducts lab tests to evaluate the specimen and, from that analysis, can determine whether or not cancer is present. There is much to be learned from the biopsy results beyond simply confirming an MBC diagnosis.

Biopsies are instrumental in helping doctors ascertain whether a patient’s Metastatic Breast Cancer (MBC) has the same characteristics as the prior cancer that was diagnosed months, years, or even decades ago. Analyzing samples of tumors or tissue located beyond the breast provides important information regarding the status of the three breast cancer receptors: estrogen (ER), progesterone (PR), and HER2. As was the case upon a patient’s initial diagnosis of breast cancer, these factors remain key to determining the appropriate course of treatment for MBC. Some options for treatment may be familiar, such as hormone therapy for breast cancers that previously were, and are once again, ER- and/or PR- positive. However, if the negative or positive status of the three receptors is not the same upon metastasis, a different approach to treatment may be necessary. There is no one-size-fits-all plan for treating either early-stage breast cancer or MBC.

Following a biopsy, what’s next: Once testing is complete, the biopsy is analyzed, an MBC diagnosis is made, and a treatment plan must be formulated. Achieving the longest possible survival time, minimizing and mitigating side effects, and ensuring the best quality of life are among the main objectives of any treatment plan. Medical professionals consider many factors when developing an appropriate and individualized course of treatment. These include where the cancer has spread, whether the hormone and HER2 receptors are positive or negative, possible gene mutations, specific symptoms exhibited, and overall physical health.

Although rates of recovery from metastatic breast cancer are lower than for other forms of cancer, the number of U.S. women living with the disease is growing. New treatments can lessen symptoms and keep the cancer from spreading further, helping women live longer.

While the vast majority of MBC patients have previously experienced an early-stage diagnosis, approximately 6% are found to have metastatic spread upon their initial diagnosis. This is called de novo metastatic breast cancer. Following through with regular screening mammograms and contacting a doctor promptly if lumps or changes in the breast are detected is essential. An early-stage diagnosis may be easier to treat and may reduce the number of de novo MBC cases.

There is no “one size fits all” approach to treating Metastatic Breast Cancer. MBC is a stage, not type, of cancer. Treatment plans are based on several factors such as identifying the sub-type of breast cancer and determining the site(s) where metastasis has occurred.

MBC treatment objectives include reducing the size of tumors, preventing the cancer from spreading further, and helping alleviate symptoms. While treatment may be long-term or even lifelong, it can allow patients to live longer and feel better with fewer side effects.

How does Metastatic Breast Cancer occur? In the majority of cases, MBC is recurrent cancer. It is cancer that has come back following a treatment protocol. Breast cancer comes back when chemotherapy, radiation, hormone therapy, or another treatment intended to destroy cancerous cells is not able to kill all of them. Sometimes, cancer cells migrate to other tissues, lymph nodes, or the bloodstream before surgery to remove a cancerous tumor. The weakened cells, not destroyed by treatment or left behind following surgery, can travel through the bloodstream or lymphatic system to distant body parts. Sometimes, these cancer cells may lie harmlessly dormant for many years. Though it’s not clear why, sooner or later, something activates the cells to grow and spread cancer to distant tissues, bones, or organs; this is Metastatic Breast Cancer.

When it’s time to make MBC treatment decisions, two suggestions may deserve consideration.  First, this could be a good time to inquire about clinical trials. A clinical trial is a form of research through which doctors can learn whether a new treatment is safe, effective, and perhaps even better than the current standard of care. Doctors can provide information about any pertinent trials currently underway, as well as assess a patient’s suitability to participate. New drugs may be tested, new combinations of current therapies employed, or new dosages of existing drugs tried, all to achieve more and more successful outcomes.
Secondly, while it’s important to consult doctors who are experienced in treating Metastatic Breast Cancer, sometimes their opinions about the best course of treatment differ.  It may be beneficial to obtain a second opinion to feel more comfortable when making decisions about treatment options.

Medication is the key component of most MBC treatment plans. Several types of medication are available to treat patients, including hormonal therapy, chemotherapy, targeted therapy, and immunotherapy. They can be administered intravenously or taken orally and may be prescribed as a single therapy or a combination of therapies. Eventually, metastatic breast cancer can stop responding to a particular drug, sometimes making it necessary to switch fairly often to alternatives. Though used less frequently, radiation and surgery are treatment plan options that can be used to reduce the size of or remove tumors, especially with the goal of alleviating pain.

Hormonal therapy, also known as endocrine therapy, is used to treat patients with tumors that test positive for estrogen receptors (ER) and/or progesterone receptors (PR). These drugs work to lower estrogen and progesterone levels in the body. They also block those hormones from reaching cancer cells, thereby thwarting them from fueling cancer cell growth. Hormonal therapy is broadly indicated for patients with hormone receptor-positive MBC. The specific drug treatment option prescribed is based on the patient’s gender, menstruation/menopause status, time that has elapsed between cancer diagnoses, and other individual factors.

Chemotherapy is the MBC treatment most familiar to the majority of people. It works differently from endocrine therapy and targeted- and immuno-therapies. Chemotherapy uses medication to destroy cancer cells by preventing them from growing, dividing, and exponentially increasing their numbers. It can be administered in regimens from once a week to every second, third, or fourth week. While patients may experience one or several side effects such as fatigue, nausea, vomiting, hair loss, neuropathy, etc., it’s often possible to either prevent or manage such symptoms through the use of supportive medications. Some patients feel well enough during chemo to maintain nearly normal activity and exercise levels. Chemotherapy is typically given continuously for as long as it proves effective in fighting cancer and/or for as long as side effects can be tolerated.

A recent study from the National Cancer Institute found:

  • In 2020, an estimated 168,000 women in the U.S. are living with metastatic breast cancer.
  • The five-year survival rate of women diagnosed with metastatic breast cancer is increasing, especially among women aged 15 to 39.
  • About one-third of women diagnosed with metastatic breast cancer have lived with it for five or more years.
  • Some women may live ten or more years after being diagnosed.

More research is needed to address the healthcare needs of women who live with this condition, according to the study.

Source: National Cancer Institute