Once a woman is diagnosed with only bone mets from breast cancer, does this mean the beginning of the end?
Just how long can she live? Is she terminal?
For this topic I consulted with Jonathan Stegall, MD, an integrative oncologist and medical director for The Center for Advanced Medicine, an adult cancer treatment center in Alpharetta, GA.
The bones are the most common metastatic location for breast cancer, but not every location site for a first relapse is the bones.
A woman may initially be diagnosed with one of numerous types of stage 2 breast cancer.
So for instance, stage 2A (or IIA) has several definitions. One of those is that the primary tumor is two centimeters or smaller; however, there’s cancer cells in one, two or three axillary (armpit) lymph nodes.
The patient undergoes a double mastectomy, radiation and chemotherapy, and is given the “all clear” in that there’s no evidence of disease.
“No evidence of disease” means that all scans and other workups have come up negative for detectable cancer cells.
The patient does fine for several years, until one day they begin experiencing hip pain.
An X-ray reveals a tumor in a hip bone: a breast cancer metastasis. Tumors are also discovered in the vertebrae bones and an arm bone.
This is now stage 4 (stage IV) breast cancer with bone metastases.
“The cancer is back,” is the common saying.
This is misleading, though. What may have happened is that at the time of the initial diagnosis, there were already micro-metastases in the bones that had gone undetected.
They went undetected because medical science has not yet developed a way to detect every single micro-metastases.
These stubborn micro-mets somehow escape radiation and chemotherapy.
For several years after the patient’s treatment ends, these microscopic clusters of breast cancer cells either lie dormant and then begin proliferating, or, they’ve been proliferating all along.
It may take several years before one of these tumors becomes big enough to either start causing symptoms or become visible on a surveillance scan or a scan for an unrelated reason (e.g., X-ray after a car wreck).
Bone Mets Are Stable; No Other Mets
The patient, having only bone spread, is prescribed a drug to “shrink” the tumors in the bones. X-rays will show how the tumors are responding.
There are also non-pharmaceutical treatments for bone mets.
If the treatment gets a good response, the tumors will still be present — but will have shrunk quite a bit (bone mets are incurable).
The patient feels great and is able to lead a normal life, including exercise.
So this begs the question: Do bone mets mean the beginning of the end?
After all, the patient now has stage 4 breast cancer.
Just how much are bone mets predictive of survival?
Dr. Stegall explains, “Although consistent treatment for bone metastases can be quite effective and allow for a good quality of life for the patient, it is important to keep in mind that bone metastases are related to reduced survival.
“While feeling well can sometimes be a good indicator of disease control, bone metastases can be unpredictable, and that only a slight worsening of a bone lesion can cause a significant increase in symptoms such as pain and discomfort.”
Bone mets, in and of themselves, do not shorten lifespan or cause death – as long as they stay in the bones.
But according to the medical literature, once a patient is diagnosed with breast cancer bone mets, survival may range from one to 10 years (there are numerous variables that affect life expectancy), with only a very small percentage living 10 years out.
In fact, some studies show that only half of patients with only bone mets at first relapse live about a year out, while around 13% to 29% are alive five years later.
- One study showed that the median survival rate was 2.3 years following a bone-mets-only diagnosis.
- Another study for this diagnosis showed it was 24 months. The median survival rate is three to five years.
Variables for survival include whether or not the initial cancer responded well with the first treatment modality, age of initial diagnosis, time lapse between initial diagnosis and bone mets diagnosis, type of breast cancer and lifestyle modifications such as exercise.
In a nutshell, the overall or average prognosis for breast cancer that has spread to the bones is grim.
“One of my biggest concerns in patients with bone metastases is that we have now established that their cancer is stage IV, and has shown the ability to spread outside of the original tumor area,” explains Dr. Stegall.
“If cancer has spread to bone, it could also spread to other locations, including critical organs such as the liver, lungs and brain.
“A significant portion of the mortality in patients with bone metastases is due to her cancer also spreading to other, more serious locations.”
Thus, the presence of bone mets can be considered a marker or barometer for future survival, because these have shown that the cancer has spread.
In fact, if scans show that a patient has only bone mets, this doesn’t mean that there aren’t micro-mets already brewing in the liver, lungs or brain – cell clusters too tiny to be detected by CT scan or MRI.
• Brain tumor symptoms include headache, nausea, vomiting, speech or cognitive problems, one-sided weakness, clumsiness, vision changes, a bulging eye.
• Liver cancer can manifest as upper-right abdominal pain, appetite loss, weight loss, nausea, distended stomach, pale stools, jaundice (yellow skin).
• Lung cancer symptoms commonly are a persistent cough, tiring easily, shortness of breath, weight loss.
It may take a few years or longer for those tiny clusters to grow big enough to finally show up on routine surveillance scans (usually once every three months) or become symptomatic.
Additional Information: Why Aren’t Brain Scans Routine for Bone Mets?
New Technology Tracks Residual Cancer DNA
Jonathan Stegall, MD, provides a long-awaited remedy for our cancer problem. Having a successful integrative oncology practice in Atlanta, GA, he’s seen firsthand what works and what doesn’t with cancer treatment. Dr. Stegall is the creator of the Cancer Secrets Podcast and author of “Cancer Secrets,” available on Amazon.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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