Metastatic Breast Cancer

Section I

What is Metastatic Breast Cancer?

Metastatic breast cancer is an invasive breast cancer also known as stage IV and refers to breast cancer that has spread to other parts of the body. Most commonly, metastatic breast cancer spreads to the liver, bones, lungs, or brain. (BREASTCANCER.ORG) 

Metastatic breast cancer is the most advanced breast cancer stage, which initially develops when abnormal cells begin to divide at an increased rate that is difficult to control. These abnormal cells can form together to make what is known as a tumor. (Cleveland Clinic) 

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When a person living with breast cancer experiences metastasis (cancer spreading to a different body part), the type of cancer will continue to be referred to as breast cancer by healthcare professionals. Healthcare professionals classify cancer based on its primary place of origin. This means that if cancer cells found in bone have originated from the breast, they are still breast cancer cells and will continue to be referred to as breast cancer. (Cleveland Clinic) 

Section II

Signs and Characteristics

Individuals may experience different signs and characteristics when living with metastatic breast cancer. These signs and characteristics can be distinct based on the location of metastasis. The National Breast Cancer Foundation provides the following list based on locations: (National Breast Cancer Foundation)   

Metastasis in the bone may cause  

  • Severe, progressive pain  
  • Swelling 
  • An increased risk of bone fractures or breaks

 Metastasis to the brain may cause 

  • Persistent, headaches that are progressively getting worse, or pressure in the head 
  • Vision disturbances 
  • Seizures  
  • Vomiting or feeling nauseous   
  • Behavioral changes or personality changes  

  Metastasis to the liver may cause  

  • Jaundice (yellowing of the skin or eyes)
  • Itchy skin or rash  
  • Abnormally high enzyme counts in the liver  
  • Abdominal pain, appetite loss, nausea, and vomiting  

Metastasis to the lungs may cause  

  • Chronic cough or inability to get a full breath  
  • Abnormal chest X-ray  
  • Chest pain  
  • Fatigue, weight loss, and poor appetite (can be caused by other conditions or medication) 

While the parts of the body mentioned above are the primary areas where individuals experience the spreading of metastatic breast cancer, other areas can be affected too. The following list contains some other signs and characteristics that may arise if metastasis is in other areas of the body: (National Breast Cancer Foundation) 

  • Persisting back and spinal cord pain, bone pain, or joint pain  
  • Difficulty urinating (can be caused by cancerous growth pinching nerves in your back) 
  • Numbness or weakness in any area of the body  
  • Loss of balance  
  • Confusion  
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Section III


Systemic therapy is the main method used to treat metastatic breast cancer. The following list of systemic therapies is provided by the American Cancer Society and are the most commonly used treatments. 

  • Chemotherapy: Chemotherapy, or chemo, uses anti-cancer drugs that are inserted into the body by being injected into the vein or taken by mouth. These drugs travel through the bloodstream to reach cancer cells in most parts of the body. Depending on where the cancer cells are located in the body, chemo may be directly given to a certain area

  • Hormonal therapy: Some types of breast cancer can be affected by hormones, such as estrogen and progesterone. Breast Cancer cells have receptors that can attach to these hormones, which allow them to grow. Hormonal therapy aims to stop these hormones from attaching to these receptors, preventing the cancer cells from growing.

  • Immunotherapy:This method of therapy uses medicine to boost an individual’s immune system to specifically target and destroy cancer cells more effectively. Immunotherapy typically works on specific proteins in the immune system to make the immune response stronger. These drugs will have different side effects from the ones used in chemo.

  • Some targeted therapy may also be used with the utilization of certain drugs 

While these are just four of the systemic approaches for treatment of metastatic breast cancer you can find more information on treatment on the American Cancer Society website. 

Which treatment will be used? 

While there are a variety of treatment options for metastatic breast cancer, choosing the best method for an individual will often come down to that person's care team. Care teams plan treatment based on: 

  • Which parts of the body cancer has reached
  • Past breast cancer treatments
  • Symptoms 
  • Tumor biology, or how the cancer cells look and behave

(Cleveland Clinic) 

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Section IV

Risk Factors

Risk Factors for Metastatic Breast Cancer 

The type of initial breast cancer and corresponding growth rate can put individuals at a higher risk. For example, HER2-Positive Breast Cancer and Triple-Negative Breast Cancer may spread faster than Hormone Receptor Positive Breast Cancer. (Cancer.Net 1; Cancer.Net 2)
The progression of cancer when initially diagnosed, such as its size and how far it has spread. (Cancer.Net) 

Risk Factors for Breast Cancer 

  • Age: as you get older, the likelihood of developing Breast Cancer increases. 

  • Family History: You can inherit genetic mutations that may increase your risk of breast cancer. The most well-known genes connected to breast cancer are BRCA1 and BRCA2. For a more detailed look at gene mutations that increase your risk of breast cancer, click here. 

  • Radiation exposure at a young age may increase your risk of breast cancer. 

  • Lack of physical activity and weight can increase your chances of breast cancer. 

  • Poor diet or overconsumption of alcohol: large amounts of saturated fats may or exceeding 1 drink a day can increase your likelihood of breast cancer. 

  • Hormone replacement therapy: HRT can increase your likelihood of breast cancer. 

  • Birth control and oral contraceptives:  Some studies have shown birth control and oral contraceptives may slightly increase your risk of breast cancer, however other studies found no link between birth control and increased risk of breast cancer. Studies remain ongoing concerning this topic. Talk to your doctor if you have any questions. (WebMD)

  • Personal history of cancer: if you have already had breast cancer in one breast, you have a higher chance of developing cancer in the other breast. 
  • Gender or ethnicity: breast cancer develops in women almost 100 times more than in men and is more common in Caucasian women.

  • Breast density: Many women live with dense breast tissue which can make it harder to detect tumors and lumps. Several states in the US legally require that mammogram results notify women if they have dense breasts. Ask your doctor if you have any questions regarding mammograms or breast density.

  • Smoking: smoking can cause cancer in almost any part of the body, including the breasts. 
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Sources: (Cancer.Net; National Breast Cancer Foundation; MayoClinic) 

Please note that 60-70% of people with breast cancer have no connection to these risk factors at all, and others can possess these risk factors yet never develop breast cancer. (National Breast Cancer Foundation) 

Section V


The earlier an individual receives a metastatic breast cancer diagnosis, the more effective treatment can be. The outlook is typically better when cancer is diagnosed and treated at an earlier stage. It is important that you talk to your provider about when you should start having regular breast exams and mammograms.

Self-exams may help as you can identify lumps in your body, set up an appointment with a doctor, and discover whether a lump is cancerous or harmless. Additionally, familiarity with your body and pre-existing lumps will help you better detect changes. It is important to note that self-exams are not a replacement for mammograms or breast exams. (National Breast Cancer Foundation) 

Although risk factors, like family history, cannot be prevented, there are lifestyle choices you can make to reduce the risk of breast cancer and help improve your quality of life:

  • Maintain a healthy weight: obesity increases your risk of breast cancer. Here is a chart to find your Body Mass Index (BMI). A healthy weight falls between 18.5 - 24.9 BMI. Please note that your BMI does not distinguish between weight from fat and weight from muscle. Consult your doctor for healthy and sustainable ways to lose weight, or to have your body fat measured. (CDC) 

  • Regular physical activity: every week, adults should get a minimum of 150 minutes of moderate exercise and do muscle strengthening activities, such as weightlifting or running, two days a week. Physical activity has a myriad of benefits, both physical and mental. (CDC) 

  • Avoid smoking: smoking can cause cancer in almost any body part. (CDC) 
  • Avoid excessive amounts of alcohol: your risk increases the more you drink. One drink a day is the recommended limit.

  • Healthy diet: large amounts of saturated fat and a lack of fruits and vegetables may increase your risk of breast cancer. A guide to an optimal diet can be found here. 

  • Breastfeeding: breastfeeding lowers the risk of breast cancer, particularly if a woman breastfeeds her child longer than 1 year. ( 

  • Radiation therapy to the chest before age 30 can increase your risk of breast cancer. 
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  • Talk to your doctor about hormone replacement therapy: it can increase your risk of developing breast cancer. 

Sources: (National Breast Cancer Foundation; MayoClinic) 

Metastatic breast cancer is not something you can prevent, predict or control, nor is it your fault. There is a possibility that treatment may fail to kill off all cancer cells, which can remain inactive or undetectable. These cancer cells may begin growing and spreading again at any time. The cause of cancer reactivation is unknown. (ClevelandClinic; MayoClinic) 


Section VI

Managing/Living with Metastatic Breast Cancer

Whether an individual is being diagnosed with breast cancer or metastatic breast cancer for the first time, it is normal for people to feel scared, stressed, angry, depressed, or even calm. There may be a lot of different emotions being felt, and there is no one way to feel about being diagnosed with metastatic breast cancer. It may be helpful to concentrate on understanding the diagnosis, learning about treatment options, and finding as much information as possible. Attaining as much information about metastatic breast cancer as possible can empower individuals to take control and can help manage any stress or fear they may be feeling. ( 

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Individuals who are feeling stressed and afraid at any period after a diagnosis can try some of these tips provided by to help feel calmer:

  • Go for a walk  

  • Write down any thoughts and feelings in a journal   

  • Meditate or pray   

  • Do exercises to completely relax your muscles (progressive muscle relaxation)   

  • Talk with a counselor, social worker, or psychologist about your feelings 

  • Join a support group   

  • Become a part of an online community, such as the discussion boards   

  • Do yoga or gentle stretching   

  • Listen to music   

  • Express yourself through hobbies 

  • Have fun with friends — go to the movies or invite a friend over for coffee and talk  
Section VII


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