When a woman is first diagnosed with breast cancer -- any stage of breast
cancer -- one of her greatest fears is "What if it's spread?"
Not long ago, a diagnosis of metastatic breast cancer, meaning the disease
has spread well beyond the breast into places like the bones, lungs, or liver,
meant it was time to get your affairs in order. In the 1970s, only 10% of women
were still alive five years after a diagnosis of metastatic breast cancer,
according to a comprehensive review by the MD Anderson Cancer Center in
Houston, published in January 2004.
Cancer didn't catch Christina Applegate unprepared. Because her mother had battled both breast cancer and ovarian cancer, Applegate had been going for regular mammograms since the age of 30. "But when I turned 36, my doctor said that my breasts were just too dense for mammography alone, and he referred me for screening MRIs at Cedars-Sinai Medical Center," she recalls.
Just a few months before she learned she herself had breast cancer, the actor got a shocking insight into the struggles faced...
Today, say the MD Anderson researchers, as many as 40% of women with
recurrent or metastatic breast cancer survive at least five years. "More
and more, both doctors and patients approach it as a chronic condition,"
says Eric Winer, MD, director of the Breast Program at Boston's Dana-Farber
Cancer Institute. "We can't cure it, but we can manage it for many
Managing metastatic breast cancer as a chronic condition isn't the same as
managing a disease like diabetes. "Diabetes, ultimately, can shorten one's
life, but that's over the horizon of a few decades," Winer says.
"With breast cancer metastases, the majority of women know that this is
an illness that's ultimately going to take their life. That may not be in a
year or two or three, but it certainly tends to be in less than a
However, enormous treatment improvements do mean that thousands of women are
living longer and better lives even though they have metastatic breast
Treatments for Breast Cancer that Has Spread
Treatments for metastatic and earlier-stage breast cancer are very
different. For earlier-stage breast cancer -- particularly for women who are
relatively young and healthy -- doctors will often advise a very aggressive,
rigorous course of treatment aimed at getting rid of the cancer completely. The
side effects can be difficult, but there's a finish line in sight: initial
breast cancer treatment usually lasts no more than six to nine months.
With metastatic cancer, some form of treatment will be a fact of life more
or less from now on. This means the treatment philosophy changes. "We're
looking to gain maximal control of the tumor at the lowest possible cost in
terms of toxicity," says Clifford Hudis, MD, chief of the Breast Cancer
Medicine Service at New York's Memorial Sloan-Kettering Cancer Center.
That usually involves one or more of three primary options:
Hormonal therapies, like Tamoxifen or Arimidex. These
treatments tend to have fewer side effects than chemotherapy. They control
metastatic disease just as well as or better than more aggressive treatment,
doctors say. They are only effective in women whose disease is
Herceptin. A monoclonal antibody, Herceptin works by
specifically targeting cells that overexpress the Her2 protein -- something
that happens in about one of every four breast cancers. Trials show that
Herceptin can lengthen survival for these women by an average of about 13
Chemotherapy. Chemotherapy for metastatic disease is a
very different animal from the aggressive regimens for early-stage breast
cancer. This often involves relatively high doses of multiple drugs.
"For metastatic cancer, we usually prefer to use sequential
single-agent chemotherapy rather than a combination," says Hudis. "Our
goal is enough of a response rate to control the tumor while having a minimal
impact on the quality of a woman's life."
Although the precise chemotherapy drugs used may vary, one of the best
currently available for metastatic disease is Xeloda, which is long lasting and
effective and can be taken at home in pill form.