Consultant oncologist at University Hospital, Waterford
New treatments mean many women with advanced breast cancer are living longer than in the past.
In the past, a diagnosis of metastatic breast cancer was seen as the prelude to an early death, but now, new treatments are prolonging life for more patients.
Dr Miriam O’Connor, Consultant Oncologist at University Hospital, Waterford, who has a special interest in metastatic breast cancer, says: “average life expectancy for patients with this condition used to be quoted as two to three years, but now new treatments mean many women live well beyond that.”
When breast cancer cells spread to other parts of the body
Metastatic breast cancer (MBC), also called advanced, stage four, or secondary breast cancer, is the term used when breast cancer cells spread to other parts of the body, such as the bones, lungs, liver, or less commonly, the brain.
It most commonly occurs in people who have already had breast cancer and may occur many years after the initial diagnosis. Occasionally women present with metastatic breast cancer at the time of diagnosis (de novo MBC).
There are three many types of MBC: a) hormone positive (oestrogen/progesterone), b) HER2 positive, and c) triple negative type (oestrogen, progesterone and HER2 negative). Molecular profiling allows identification of these subtypes.
All three types of metastatic breast cancer are treated with drugs, but the oncologist must ascertain which subtype it is, how far the cancer has spread and whether there are other medical problems.
Treating the breast cancer and its associated problems
The first-line treatment, usually one or a combination of drugs, will be given for an agreed period before being reviewed for effectiveness and side effects. If the initial treatment is not working effectively or the side effects are difficult to manage, second-line, further drugs will be tried.
“This is a frightening and life-changing diagnosis for patients and their families. They will need support from their family, friends and work colleagues.
“The MBC journey is akin to a rollercoaster with ups and downs. It is often scary and overwhelming at the start but there will be periods of stability for months and often for years. But, relapses can occur, which require changes in therapy, with the goal being achieving stability again.”
Adjusting to life with metastatic breast cancer
“These women have to learn to adjust their day-to-day life with MBC, its therapies and frequent hospital visits for the duration of their illness,” says Dr O’Connor.
“Due to our increased understanding of the subtypes and through the process of clinical trials, successful new drugs are being made available to our patients. This process does take time, but it ensures we can advise patients on what to expect, both from controlling their cancer and side effects management.
“Progress in MBC is being made and patients are living longer, but there is still much work to be done.”