Understanding Metastatic Breast Cancer (MBC):
Definition:
Metastatic breast cancer (MBC), also known as stage IV breast cancer, occurs when breast cancer cells spread from the original tumor in the breast to other parts of the body, such as the bones, lungs, brain, or liver. Metastasis happens when cancer cells break away from the original tumor and travel through the bloodstream or lymphatic system to distant areas. This can occur at any point after the diagnosis of localized breast cancer, referred to as metastatic recurrence. In some cases, stage IV breast cancer is diagnosed from the start, known as de novo metastatic disease.
“…people look at you, you walk down the street, and you look fine, but inside, no one knows, you know, that you have stage four cancer“
De Novo and Metastatic Recurrence
- De Novo Metastatic Disease: A new diagnosis of stage IV breast cancer without any previous history of breast cancer.
- Metastatic Recurrence: Cancer that spreads from its original location after treatment, or it may return to the same location after a period of being cancer-free
(Source: BreastCancer.org)
Diagnosis of MBC
“I just feel like for me, just a little bit more information. And then just more sense of urgency… I feel like if there’s like a sense of urgency, or just even just more information given to people, you know, you can kind of just like move things along a lot, a lot quicker.”
In some cases, depending on where metastatic breast cancer is located in the body, individuals may or may not have symptoms. It’s important to talk to your healthcare team about any symptoms that don’t go away so they can order the necessary tests. A physical exam can help identify any areas of concern, while imaging scans, such as CT scans or MRIs, can detect metastatic tumours that might not be found during a physical exam.
A biopsy, which involves taking a small sample from the suspected tumour, is used to examine and identify the type of cancer cells under a microscope. If MBC is confirmed, the biopsy will provide crucial information that can guide treatment. Although metastatic tumours often resemble the original breast cancer, they may not always be the same, which is why a biopsy is essential. For those diagnosed with de novo metastatic breast cancer, the biopsy will also help determine the best treatment options for your specific type of breast cancer.
If there are multiple sites of metastatic breast cancer in your body, your doctor may recommend biopsies from different locations to see if they are all the same type of breast cancer. If new tumours develop while you are undergoing treatment for metastatic breast cancer, your doctor may request a biopsy of these new tumours as well. This information will assist in identifying the most effective treatment for you.
(Source: BreastCancer.org)
Prognosis and Treatment Options
Whether metastatic breast cancer is a recurrence or a de novo diagnosis, it is considered treatable, although it is currently not curable. The prognosis, which refers to how well and how long a person may live with the disease, varies based on several factors, including the extent of metastasis, the specific locations of the tumours, and the type of breast cancer involved. Treatments can often be customized to align with your unique diagnosis, preferences, and goals. Responses to treatment can differ significantly from one person to another.
Living with metastatic breast cancer involves adhering to a lifelong treatment plan. The primary aim of MBC treatment is to slow cancer progression while minimizing side effects, allowing individuals to maintain a good quality of life. Your healthcare team will closely monitor both the symptoms of the cancer and the side effects of the treatment. It is essential to communicate openly with your healthcare team about any side effects you may experience so they can provide appropriate management.
Treatment strategies are tailored to each individual’s needs and may include:
- Systemic Treatments:
- Chemotherapy
- Targeted therapies
- Endocrine therapies
- HER2-directed therapy
- Immunotherapy
- Local Treatments:
- Radiation therapy
- Surgery (for symptom relief)
“[Black women] need to have culturally sensitive health care teams and people who can recognize that young black woman with metastatic breast cancer, have different needs, than the older white population, and that need to allocate resources and research… I think that structural change is slow… We need to have culturally sensitive health care teams and people who can recognize that young black woman with metastatic breast cancer have different needs…”
Additionally, clinical trials may also be a treatment option for people with breast cancer. If a clinical trial is not offered to you, you can talk to your doctor to find out if there are any that you might qualify to participate in. A clinical trial may offer a newer treatment for your type of cancer. It is important to discuss your preferences with your team and to understand how a clinical trial might meet your treatment needs. It’s vital for individuals diagnosed with MBC to collaborate closely with their healthcare team to develop a personalized treatment plan.
(Source: clevelandclinic.org)
“Right as COVID hit, my oncologist left the practice. So I wanted to go somewhere else. And when I went somewhere else outside of my immediate community, I then understood the disparities and inequities…”
“Black providers are important to me, but in the cancer space, you don’t find that many.”
Monitoring MBC
Monitoring metastatic breast cancer involves various methods to assess treatment effectiveness and overall health, including:
- Imaging Scans: (e.g., CT or MRI) to track cancer spread.
- Blood Tests: to monitor overall health and cancer markers.
- Bone Density Scans: to assess bone health.
- EKGs: to monitor heart health, especially if treatments may affect the heart.
Advanced Care Planning
Open communication with your healthcare team about symptoms is crucial. Advanced care planning, including early involvement with palliative care, can enhance quality of life. Palliative care focuses on symptom management and supporting you throughout your treatment journey, not just in end-of-life situations.
“Based on my socioeconomic status, I feel like I’ve had a better outcome than most people would have had [I recognize that not everyone has the same privileges]”
Who Treats Metastatic Breast Cancer?
The main physician for treating MBC is typically a medical oncologist. They may work with a multidisciplinary team that can include:
- Radiation Oncologists: Specialize in treating cancer with radiation therapy.
- Surgeons: May be involved if surgery is needed.
- Palliative Care Doctors: Focus on symptom management and quality of life.
- Psycho-Social Oncologists: Provide mental health support.
- Nurses: Often the first point of contact for questions and concerns and may administer treatments.
- Pharmacists: Essential for medication management, explaining dosage, timing, and potential side effects.
Importance of Communication with Healthcare Providers
Nurses are often the first point of contact for patients and can communicate any concerns to the doctor. Pharmacists play a critical role in advising how and when to take medications, explaining potential side effects, and ensuring that any herbal supplements or remedies are safe to use alongside prescribed treatments.
If you could summarize your MBC treatment experience in one word, what would that word be? Gruelling…But I have a great support network…I reached out to the Olive Branch of Hope. And they’ve been really, really, really good because you’re able to talk to people and gather information that will positively affect your treatment plan. And you also feel valued because you can give other people guidance.
References | Glossary
Graphics Designed Nafisa Salima
We are grateful for the support for this page from Pfizer and ReThink Breast Cancer
This site is best viewed on Chrome