Q and A: Understanding Metastatic Breast Cancer

Metastatic breast cancer (MBC), also known as stage 4 breast cancer, is cancer that started in the breast but has spread to and proliferated in other parts of the body, such as the bone, liver, lung or brain. Wilmot Cancer Institute’s Dr. Alissa Huston specializes in treating patients with breast cancer and answers some of the commonly asked questions about MBC.

Q: How does breast cancer become metastatic?

A: For some, breast cancer is initially diagnosed as metastatic or stage 4. However, the vast majority of MBC cases are in those who have been previously treated for more limited stage breast cancer. Cancer cells have the ability to travel early on throughout the body. One way to understand this is to think of a dandelion that has gone to seed. You can take out the dandelion itself and that helps the immediate problem greatly, but if any of the dandelion’s white seeds have blown away and spread throughout the lawn, more dandelions could potentially grow later.

Cancer is similar. We can take out the lump or mass from the breast but if cancerous cells have spread before this happens, a surgery wouldn’t affect those smaller pieces of cancer that have circulated throughout the body and have the potential to become cancer somewhere else. Therefore, we use chemotherapy, hormone blocking therapy or radiation therapy to treat any cancer that may have spread. Chemotherapy and hormone blocking therapy go throughout the whole body and often can help get rid of any potential microscopic pieces of cancer that had spread, while radiation therapy can be used to target specific sites where the cancer has spread.

Q: Will removing both breasts reduce my chances of getting metastatic breast cancer?

A: Interestingly, even though breast cancer cells can travel throughout the body, they usually don’t travel to or recur in the other breast. If a person is diagnosed with breast cancer in her other breast, it would be considered a second cancer, rather than metastatic breast cancer. Therefore, removing both breasts doesn’t impact a person’s chances of MBC in the future. If you’re diagnosed with breast cancer, it’s important to talk with your care team about what treatment options and surgeries may be best for you based on your situation.

Q: What treatments are available for MBC?

A: Although treatment for MBC has a ways to go, it has come a long way, too. Today, treatments are very individualized to the patient. Although it’s long term, treatment for MBC strives not only to keep cancer from continuing to spread, but also to allow the patient to feel as good as possible for as long as possible. Treatments include chemotherapy, hormone blocking medications, antibody therapy and even radiation therapy. Immunotherapy is also now under investigation as an additional treatment option.

It’s important to talk with your provider about all of the options available and to find a care team that you feel comfortable with and that tailors treatments to your specific situation. By working with their oncology team on a personalized treatment plan, the majority of patients with MBC are able to have a positive quality of life for years after their diagnosis.

Alissa J. Huston, M.D., is a medical oncologist at Comprehensive Breast Care at Pluta and an associate professor of Medicine.