People living with metastatic breast cancer have more treatment options today than ever before. At Fred Hutch Cancer Center, we provide the latest in evidence-based care, including a wide range of supportive care services, to help you thrive while living with this form of breast cancer.
Many of our physicians also conduct research and offer the option to take part in clinical trials, which can give you access to promising therapies not available any other way. New treatments at Fred Hutch may put your cancer into remission and give you a good quality of life for years.
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What is Metastatic Breast Cancer and Who Gets It? | Treatment | Treatment Process | Clinical Trials | Is There a Cure? | FAQ | Resources
What is Metastatic Breast Cancer?
When breast cancer spreads outside the breast and nearby tissues to more distant parts of the body, it is called metastatic breast cancer. You might also hear it called stage 4 breast cancer or advanced breast cancer. Common places where breast cancer might spread include the bones, lungs, liver and brain.
Who Gets Metastatic Breast Cancer?
Anyone can get breast cancer, regardless of their sex or gender, though it’s most common in women. Metastatic breast cancer can happen in:
- Someone who is in treatment for non-metastatic breast cancer
- Someone who completed breast cancer treatment months, years or even decades earlier
- Someone who had never been diagnosed with breast cancer before
Treatment for Metastatic Breast Cancer
The breast cancer care team at Fred Hutch treats people with all types and stages of breast cancer, including metastatic disease.
Many of our patients have had all their cancer care at Fred Hutch. Others transferred their care to us from another treatment center — either because they moved to our area or they are looking for a higher level of expertise, more treatment options or access to research studies.
Metastatic breast cancer can differ greatly from one person to another, so there’s no single answer to how it’s treated. We will customize your care to you, and with you. The best way to learn about your treatment options is to meet with a Fred Hutch breast cancer expert to talk about your specific situation.
Our team meets weekly to discuss the care of patients with breast cancer. Our pathologists, radiologists, medical oncologists, radiation oncologists and surgical oncologists work together to make treatment recommendations.
Why Do Treatment Plans Differ?
The treatment plan we design for you depends on many things, including:
- How you feel now, like how much energy you have, what you are able to do and what you need help with
- Where your cancer has spread and if these areas are causing symptoms for you
- Your subtype of breast cancer, such as if your cancer cells have estrogen or progesterone receptors that can be treated with endocrine (hormone-based) therapy
- If the cancer is slow-growing (low-grade) or fast-growing (high-grade)
- The presence of mutations (changes) in genes like BRCA1 or BRCA2
- Any previous treatments you had for breast cancer
- Your age, overall health and menopause status
- Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial
What Does Treatment Typically Look Like?
Treating metastatic cancer is a lot like treating other chronic diseases, such as diabetes. You can expect to be on some form of medicine to help control the disease for the rest of your life. Your care team may recommend surgery or radiation, too, if they can help with symptoms or other problems caused by the cancer.
While you’re getting treatment, you’ll see your care team about every three months. Before each visit, you’ll have tests and scans. These can show if tumors have shrunk, stayed the same or grown. If tumors have shrunk or stayed the same and you feel OK with any side effects, your team will typically recommend staying on the same treatment.
Eventually, breast cancer cells will develop resistance to a given medicine. This means the medicine stops working for you. Then the tumors will grow. When this happens, your team will recommend switching to a different medicine.
How Is Treatment Different After Cancer Has Spread?
In early-stage breast cancer, physicians typically suggest taking a more aggressive approach to treatment. The goal is to hit the cancer hard in hopes of getting rid of it completely. This might mean putting up with difficult side effects for a while.
In metastatic breast cancer, the approach is usually different. Treatment cannot get rid of all the cancer. So, medical oncologists typically suggest finding a balance: being aggressive enough to control the disease but also gentle enough to keep you feeling as good as you can. In the same way, your radiation oncologist and surgical oncologist will focus on providing localized treatment such that the benefits outweigh any harms.
Medicines
Medicines are the main treatment for metastatic breast cancer because they can travel throughout your body to affect cancer cells wherever the cells are.
Types of medicine for breast cancer include:
Some medicines can be taken by mouth at home. Others are given by infusion at the clinic. For an infusion, liquid medicine is put into a vein through an intravenous (IV) line.
Surgery
Most people with metastatic disease do not have surgery because surgeons cannot remove all the cancer. But surgery can sometimes be an important option to help relieve the effects of the disease. For example, your care team might recommend a lumpectomy or mastectomy to remove a tumor in your breast if it causes symptoms that bother you. Or they might recommend surgery to make a bone more stable if a tumor seems likely to cause a fracture.
Radiation Therapy
Radiation therapy is another option to help control symptoms caused by cancer. If you’ve had radiation therapy before, it may still be possible and helpful to have radiation again in the same area or to use radiation against new tumors in other parts of your body. At Fred Hutch, we offer several types of radiation therapy, including:
- Conventional external-beam radiation therapy with photons for cancer anywhere in the body
- Gamma Knife radiosurgery for cancer that has spread to the brain
- Proton therapy for cancer that has spread to the membrane that covers the brain and spinal cord or within the fluid around these structures (leptomeningeal metastases)
Clinical Trials
Clinical trials for metastatic breast cancer typically test new medicines or new combinations of medicines. Your care team will talk with you about clinical trials that match your needs so you can think about taking part.
Our Patient Guide to Clinical Trials can help you get familiar with topics like:
- The different types and phases of clinical trials
- How researchers protect your safety when you’re in a study
- What to think about when deciding if you want to participate
- What costs are covered by health insurance if you’re in a clinical trial
Ongoing and Supportive Care
At Fred Hutch, care always involves more than treating your disease. Your care team will see you regularly to check how well your treatment is working. We’ll also check if you need help with symptoms, side effects or supportive care services, like nutrition, integrative medicine or mental health counseling.
Palliative care can be a great support to enhance your quality of life. It’s available to anyone with cancer regardless of the stage of their disease (not only near end of life) and you can get it alongside cancer treatment.
Learn more about treatment for breast cancer.
Can Metastatic Breast Cancer Be Cured?
Currently, there’s no cure for metastatic breast cancer. But researchers at Fred Hutch, like those with the Center for Metastasis Research eXcellence (MET-X), and around the world continue to work on options that might one day eliminate this disease. In recent decades, treatment has improved greatly. It’s reasonable to hope for a fulfilling life for many years to come.
Your care team will work with you to understand your goals for treatment. We’ll do everything we can to align your care with your goals. Common goals we hear from people with metastatic breast cancer include:
- “I want to live as long as I can while having a good quality of life.”
- “I want to feel better, stay feeling good and prevent new symptoms.”
- “I want to explore all treatment options and try the latest therapies.”
- “I want to get enough time to be part of important family milestones (like seeing a child graduate or get married). I’m willing to deal with more difficult side effects if that helps get me more time.”
- “I want to be able to do certain things, like travel. These experiences are more important to me than the amount of time I’m alive.”
- “I want to help improve outcomes for future patients by participating in a clinical trial.”
- “I want to learn about the financial aspects of care and take these into consideration because it’s a concern for me and my family.”
- “I’m not sure what my specific goals are except that I want a team I trust to take good care of me.”
One or more of these goals might feel like they fit you, and you might have others. Patients tell us they find it helpful to talk with family, friends and their care team to clarify their goals so they can seek treatment that’s right for them.
If you’re a new patient to Fred Hutch, we’ll typically look at your recent tests or scans. Then we’ll let you know if you need any other tests or scans before you see the care team here. We typically verify any staging (checking how far your cancer has spread) in order to confirm the results. We may order body imaging, such as a computed tomography (CT) scan of your torso, a bone scan or a positron emission tomography (PET) scan if you haven’t recently had these. We might also ask for a brain magnetic resonance imaging (MRI) scan. We’ll explain what you need based on the details of your situation.
The decision to have treatment is always up to you. But, yes, even if you feel fine right now and aren’t noticing any symptoms, we recommend following an evidence-based treatment plan. Metastatic breast cancer is serious and can become life threatening. Treatment may help prolong your life — and give you a good quality of life — possibly for many years.
If you were a Fred Hutch patient in the past, please feel free to contact us about coming back for care. Even if you live out of state and ultimately decide to seek care closer to home, we would be happy to talk with you about your current needs so you can make the decision that’s right for you.
Please contact us to request an appointment. We’ll walk you through any steps that need to happen, such as getting your medical records, in order to set up a visit and start care here.
We have a specialized program called ASSIST for people with metastatic breast cancer who are new to Fred Hutch. A nurse from ASSIST will contact you before your first appointment with your Fred Hutch medical oncologist. The nurse will talk with you about supportive care, clinical trials and other aspects of getting treatment here. Learn more about ASSIST.
De Novo Metastatic Breast Cancer
If you’re a new patient to Fred Hutch, we’ll typically look at your recent tests or scans. Then we’ll let you know if you need any other tests or scans before you see the care team here. For example, we will probably ask for body imaging, such as a positron emission tomography (PET) scan, if you haven’t recently had one. We might also ask for a brain magnetic resonance imaging (MRI) scan. We’ll explain what you need based on the details of your situation.
A medical oncologist will be the lead person on your care team. They will guide the design of your treatment plan and manage your medicine-based treatment. Most people with metastatic breast cancer get chemotherapy, endocrine therapy, targeted therapy or immunotherapy (or more than one of these).
Your medical oncologist will involve other specialists as needed, like a surgeon, radiation oncologist, palliative care specialists or other supportive care providers.
We have a specialized program called ASSIST for people with metastatic breast cancer who are new to Fred Hutch. A nurse from ASSIST will contact you before your first appointment with your Fred Hutch medical oncologist. The nurse will talk with you about supportive care, clinical trials and other aspects of getting treatment here. Learn more about ASSIST.
When breast cancer is only in the breast and nearby tissues, physicians do surgery with the goal of getting all the cancer out. (Patients usually get medicines or have radiation, too, to kill any microscopic cancer cells that might remain.) When cancer has spread outside the breast and nearby tissues to more distant parts of the body, surgery can’t get all of it out. Having an operation will not improve the outlook for your disease. So, for most people, it’s better to avoid being under anesthesia, going through an operation, having to heal from surgery and pausing systemic therapies to allow for healing. Instead, your care team will focus on keeping you as healthy as possible with other types of treatment.
Resources
Here are some resources to help you take the next step in learning about metastatic breast cancer.
- CancerCare Treatment Update: Metastatic Breast Cancer
- National Breast Cancer Foundation, Inc.: Metastatic Breast Cancer
- National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Breast Cancer, Metastatic
Your care team, including social workers at Fred Hutch, can help connect you with more resources based on your questions and needs. We can help with a wide range of topics like getting emotional support, making financial decisions and coping with changes in your family and intimate relationships.
