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Breast cancer impacts millions of people every year. But metastatic breast cancer—which is breast cancer that has spread—is less common. Only about 30% of people who have breast cancer later develop metastatic disease.While breast cancer can spread anywhere, the most common area for breast cancer to metastasize to is the bones, Dean Tsarwhas, MD, head of the oncology program at Northwestern Medicine Lake Forest Hospital, told Health.In fact, 70% of breast cancer patients who later develop stage 4 cancer have bone metastases, according to 2017 data. GettyImages AdobeStockBut what are the implications of metastatic breast cancer in the bones, and how does that affect a patients treatment and prognosis?Heres everything you need to know, according to top oncologists.As mentioned earlier, metastatic breast cancer is when cancer has spread beyond the breast and the surrounding lymph nodes to other parts of the body. When it spreads to your skeletal system, cancer cells move into parts of your bone, replacing healthy cells with cancer cells. That can cause lesions.It can happen when cancer returns after treatment (called recurrent cancer). It can also occur because your cancer didnt respond to treatment or wasnt treated in time.Researchers still dont understand precisely how cancers metastasize, said Nancy Lin, MD, a medical oncologist specializing in breast cancer treatment at Dana-Farber Cancer Institute in Boston.We know that at some point the cancer manages to find its way into the bloodstream and then through that is able to get to other parts of the body, Lin said. Beyond that, its unclear why certain cancers spread to specific spots, but there are some theories.Evelyn Toyin Taiwo, MD, hematologist and oncologist at Weill Cornell Medicine and NewYork-Presbyterian Brooklyn Methodist Hospital, theorized that some types of breast cancer could spread to the bone because it has estrogen receptors. That might provide a favorable environment for rogue cancer cells to grow.More research is needed to understand the association better.Metastatic cancer can affect any part of your skeletal system, but the spine is the most common site. Other areas include the hip, femur, upper arm, ribs, and skull.All three doctors said that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones.I always tell patients to inform me if theres pain thats not getting better, said Dr. Tsarwhas.People can sometimes confuse the pain with arthritis or other pre-existing chronic pain issues, Tsarwhas added, which is why breast cancer patients need to be proactive about any new pain they encounter.New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas added. Cancer can weaken bones and make them break more easily.New lumps or bumps in the lymph node area ... could be a sign of recurrent breast cancer as well, Tsarwhas said.People with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.Metastatic breast cancer in the bones is typically not curable.Dr. Taiwo said that doctors instead focus on slowing cancer growth and managing symptoms.The focus really is trying to extend life and maintain quality of life, Taiwo said.Healthcare professionals usually prescribe traditional medications like chemotherapy and immunotherapy. Theyll also try targeted treatments for specific cancer types. That might look like hormonal treatments for estrogen receptor-positive breast cancer, said Dr. Tsarwhas.But many bone-strengthening medications are also used to help people, like Prolia (denosumab.) Theyre used to help slow bone degradation and reduce the risk of fractures, Tsarwhas said.Dr. Lin said many of the treatments are similar to what people with osteoporosis take.Localized radiation treatment can also help shrink bone cancer cells and reduce pain. This can improve a patients quality of life, Taiwo said, as bone lesions can be painful.We also look for any bones that might have the potential to cause a problem in terms of a fracture, Dr. Lin added. In those cases, Lin said doctors often send people to orthopedic surgeons for preventative surgeries to help stabilize bones.For example, surgeons can use medical-grade bone cement to seal and support existing fractures, or recommend joint-replacement surgery to ensure a person has pain-free mobility. Metastatic breast cancer in the bones is not curable, and the prognosis typically isnt as favorable as earlier-stage cancers.The five-year relative survival rate for people with distant breast cancer (metastatic cancer) is estimated to be 29%.That means people with metastatic breast cancer are about 29% as likely to be alive five years after diagnosis as people who dont have that cancer.However, data shows that metastatic breast cancer in the bones seems to have the best survival rate compared to other types of metastatic breast cancer.A 2019 study published in the journal BMC Cancer looked at five years of data to track the survival rates of stage four breast cancer patients and calculated specific rates based on the site of metastasis.The researchers found that patients with bone metastasis had the best overall survival (OS) rate, with 50.5% surviving for over three years.For comparison, people with brain metastases had a three-year OS rate of 19.9%. People with liver metastasis and lung metastasis had a three-year OS rate of 38.2% and 37.5%, respectively.Other research published in BMJ Open has estimated that the one-year survival rate of metastatic breast cancer in the bones is 51%, and the five-year survival rate is 13%.But these numbers are estimates, not foregone conclusions.A lot of factors can impact a persons prognosis, said Dr. Lin, including the type of cancer they have, where it spread, how old they are, and any other pre-existing conditions or health problems.And some cancers respond better to treatment than others, which can positively affect a persons survival.Overall, treatment and life expectancy for metastatic breast cancer has improved drastically over the past few decades.We have many more options for metastatic cancer patients living longer, said Dr. Tsarwhas. The existing drugs and therapies cant cure, but they can significantly improve the length and quality of a patients life—which is the next best thing.Breast cancer can sometimes spread from your breast area into your bones. Its called metastatic breast cancer, and when it makes it to your bones, it can cause symptoms like new bone pain.Theres no cure for metastatic breast cancer in bones, but your healthcare team can offer many options to treat symptoms, slow the spread of your cancer, and prolong your life.The five-year survival rate is estimated to be about 29%. However, many factors can impact a persons prognosis, including the type of cancer you have, where it spread, how old you are, and what, if any, other pre-existing conditions or health problems you may have. Thanks for your feedback!
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