Metastatic Breast Cancer Is On the Rise In Younger Women — Here's Everything You Need to Know
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You already know that October is Breast Cancer Awareness Month, but over the years, the conversation around the disease has become more nuanced — specifically when it comes to the various types of the disease. For example, ever since 2009, October 13 has been dubbed as Metastatic Breast Cancer Awareness Day, meant to draw attention to the alarmingly growing prevalence of the most advanced stage of the cancer.
Every year, an estimated 284,200 Americans are diagnosed with invasive breast cancer. Of those cases, roughly 6 percent of women then receive the diagnosis of metastatic breast cancer, or stage 4. This is the most advanced form of the disease where cancer spreads beyond the breast and lymph nodes to other organs.
And metastatic breast cancer isn't just something from the fifty- and sixty-something crowd to keep in mind. According to research published in JAMA, it's on the rise in women under 40.
As to why diagnoses are occurring more frequently in younger people, researchers aren't entirely sure. Pregnancy (or a lack thereof) might play a role, as women who haven't had a full-term pregnancy prior to age 30 tend to be at a higher risk for breast cancer when compared to those who have had at least one child before their thirties hit. (Again, doctors aren't really sure why that is.) Toxic chemicals in the environment, rising obesity rates, and spiking alcohol use among younger women could also play a role. But most likely, it's a combination of all these factors, researchers speculate. (Related: Signs Your Casual Drinking Could Be a Problem)
As daunting as this might all sound, stage 4 breast cancer is not always a death sentence, says Jane Mendez, M.D., Chief of Breast Cancer Surgery at Miami Cancer Institute, part of Baptist Health South Florida. Rather, she notes, "it's just the beginning of a long conversation."
Here's what Dr. Mendez and other breast cancer experts say that women — especially those under 40 — need to know about metastatic breast cancer.
What Exactly is Metastatic Breast Cancer?
Metastatic, or stage 4, breast cancer is the most advanced stage of the disease in which the cancer spreads to other organs beyond the breast and the axilla (the area of the body directly under the joint where the arm connects to the shoulder), explains Dr. Mendez.
"Most commonly, breast cancer [in stage 4] metastasizes to the bone," says Dr. Mendez, adding that it can also spread to the liver, lungs, brain, and other parts of the body.
All types of cancer — including breast cancer — spread by initially growing into healthy tissue, then moving through the walls of nearby lymph nodes and blood vessels, Dr. Mendez adds.
"All organs in our body are connected through a network of blood and lymphatic channels," explains Antra Mahaldar, M.D., breast cancer specialist for Kaiser Permanente in Vacaville, California. "As the blood and body fluids move out from the site of cancer in the breast, cancer cells get carried to other organs."
Approximately 155,000 women are currently living with metastatic breast cancer in the U.S., according to 2017 data published in Cancer Epidemiology, Biomarkers & Prevention. And, sadly, 20 to 30 percent of patients who are diagnosed with metastatic breast cancer will ultimately die from it within three to five years of diagnosis. This tends to occur if treatments don't work, the cancer spreads, or it is recurrent and returns after going into remission.
The Most Common Symptoms of Metastatic Breast Cancer
The signs a person has metastatic breast cancer aren't always uniform, says Dr. Mahaldar. That's because symptoms often depend on the organ in which the cancer has spread. She points to a few examples she sees most often that can be indicative of metastatic breast cancer:
Bones: Pain or weakening of bone that can lead to a fracture.
Lungs: Persistent cough, shortness of breath, chest pain.
Liver: Abdominal pain, nausea, loss of appetite, weight loss, jaundice, fever or abnormal liver tests.
Brain: Headaches, loss of function of a part of body, stroke-like symptoms, and changes in cognition or seizures.
Still, the signs of metastatic breast cancer are seldom clear-cut. The main thing to watch for, doctors say, is if something feels particularly off. "Any symptoms which are otherwise unexplained or persistent should be further evaluated by a physician," she notes, adding that metastatic breast cancer patients might also experience fatigue, unexplained weight loss, and a lack of appetite, all of which should be reported to a doctor ASAP as well.
How Stage 4 Breast Cancer Is Diagnosed
As noted above, there's really no single, standard way that metastatic breast cancer is detected in patients. Instead, folks will generally see their doctor about an unusual symptom, like a lump in their chest or uncharacteristic joint pain, hip pain, or spine pain, which then leads to a diagnosis.
For example, Dr. Mendez recalls a 30-year-old woman who came in regarding a lump in her breast. Before ordering the biopsy, the woman mentioned that she hit her left hip playing basketball and had been experiencing pain in the area for several weeks.
"Lo and behold, [her] biopsy [came] back positive for breast cancer," recalls Dr. Mendez. "I started the rest of the [paperwork], and I never forgot the fact that she had mentioned that she had that hip pain." The patient ended up having metastatic breast cancer that spread to her bone (hence the hip injury), she adds.
Physicians rely on imaging, like an X-ray or CAT scan of the chest, abdomen, pelvis, and a bone scan, to locate metastases, or cancer lesions or malignant growths, beyond the breast area. They might also use a PET-CT (positron emission tomography), which will light up the areas that have metastatic disease, says Dr. Mendez.
"It takes very careful listening — from both the physician's and the patient's standpoints," says Dr. Mendez, explaining that it's key for the patient to be in tune with their body, and for the doctor to pay attention to the details the patient gives them. (Related: How Fitness Coach Alicia McKenzie Is Raising Awareness About Racial Disparities In Breast Cancer)
When it comes to metastatic breast cancer detection, Dr. Mendez stresses, "it's a two-way street."
On the other hand, earlier-stage breast cancers are diagnosed via mammogram and confirmed with an ultrasound and biopsy.
So, when should you start screenings? "We usually recommend that women start getting mammograms at age 40, and annually thereafter," says Dr. Mendez. However, she notes, women with a known family history of breast cancer should talk to their doctor to see if earlier testing might be the best route. "Typically, if a patient has a family history [of breast cancer], we'll usually recommend screenings 10 years before the age at which the first-degree relative was diagnosed with breast cancer."
Metastatic Breast Cancer Treatment and Prognosis
The type of treatment for metastatic breast cancer depends on the subtype of cancer that the patient is diagnosed with, says Dr. Mahaldar.
"We check for certain protein molecules on cancer cells," she explains. "These are some of the currently known drivers for breast cancer. Treatment depends on which combination of these molecular receptors are present or absent."
Depending on which protein molecules are present, patients could be diagnosed with:
Estrogen-positive (ER+) cancer: With this type, cancer cells have estrogen receptors, so treatment includes hormonal therapy.
HER2-positive cancer: Cancer cells feature high amounts of the a growth-promoting protein called HER2, so treatment will involve antibody drugs that target the protein.
Triple-negative breast cancer: There are no hormonal receptors or HER2 proteins at play here, so treatment involves chemotherapy, immunotherapy, and other drugs. "For these patients, once they're done with the initialy treatment, we focus on increased surveillance with blood work to keep track of cancer markers," explains Dr. Mendez.
The bottom line: "While there is no cure for metastatic breast cancer, there are surely means by which to slow the cancer, maintain or improve one's quality of life, and even extend life," says Savita Ginde, M.D., Chief Healthcare Officer at Stride Community Health Center in Denver, Colorado. "It's important to work with your care team to come up with the best plan for you."
Another point that's heartening to hear: "Survival rates for those with metastatic breast cancer have generally improved over the years," says Dr. Ginde. The current five-year survival rate for women with metastatic breast cancer is 28 percent while the rate for men is 22 percent, according to Cancer.net.
That said, survival varies from person to person and depend on the subtype you're dealing with, says Dr. Mahaldar.
How You Can Be Proactive About Your Health
When it comes to metastatic breast cancer, Dr. Mendez urges women to know their family history and be in tune with their bodies. Then, if something feels off or changes, you can feel even more empowered to take action.
Dr. Mahaldar adds that while metastatic breast cancer may sound scary, it's actually a very treatable disease. "The goal in most cases is disease control," she says. "There are multiple options for treatment if one stops working. Metastatic, hormone positive breast cancer is treated like a chronic disease, sometimes for years, and many people continue to maintain their quality of life while on treatment."
