Those with stage 4 breast cancer and no history of brain mets usually aren’t advised to have recurring brain scans.
But just because there are no brain tumor symptoms doesn’t mean there aren’t already brain mets stealthily getting bigger.
Patients with stage 4 breast cancer but no symptoms of brain metastases may need to consider getting routine MRI scans of their brain – based on a study paper in Neuro-Oncology (2025).
The researchers at Moffitt Cancer Center found that brain mets without symptoms are more common than previously believed.
Many women are currently living with stage 4 breast cancer, including that which has spread only to the bones, such as is the case with my sister.
She takes Verzenio daily to manage the tumors in her bones, and every three months, undergoes a CT scan of only her chest. No brain scan. None.
She told me that breast cancer spreads first to the chest area before the brain, so there’d be no point in getting surveillance brain scans.
Drugs for breast cancer will not destroy every last malignant cell.
Thus, even though the recurring chest scans in a patient may come back clear, doesn’t mean that there can’t be any breast cancer cells growing in the brain – but not enough (yet) to start causing symptoms.
Study: Breast Cancer in the Brain but No Symptoms
The Moffitt researchers examined 101 patients with no symptoms of secondary (metastasized) brain cancer, who already had a diagnosis of stage 4 breast cancer.
The breast cancer cases in the study included HER2-positive, triple-negative, and hormone receptor-positive/HER2-negative.
At the start of the study the patients had MRI head scans to screen for brain mets.
If this initial scan was clear, then only those patients underwent a second MRI six months later.
Results of the Initial MRI
Brain metastasis was found in 14%. Again, these women at the time of this first scan had no symptoms suspicious for a secondary brain tumor.
The rates of spread to the brain by breast cancer subtype were:
- 18% with triple-negative
- 15% with HER2-positive
- 10% with hormone receptor-positive/HER2-negative
The second MRI six months later, for the women whose first MRI had been clear, revealed that about 25% had brain mets – for all three subtypes.
So just six months later, in the absence of symptoms, the brain mets rate jumped considerably. This is alarming.
The MRI caught the brain metastases at both scan times at a smaller size than had the patients waited until symptoms began appearing to undergo an MRI.
Earlier detection of brain mets makes treatment outcome more favorable when compared to if treatment begins only when breast cancer in the brain has grown more significantly, enough to cause symptoms.
But though treatment outcome would be more favorable in terms of life expectancy and quality of life, there is still no cure for stage 4 breast cancer. The diagnosis remains at stage 4.
Following their diagnosis, the women in this study received early treatment for their brain tumors.
“Our study suggests that asymptomatic brain metastasis is quite common in stage 4 breast cancer,” notes principal investigator Kamran Ahmed, MD, in the paper.
Dr. Ahmed adds that though larger studies are needed to confirm their findings, it would be wise for patients to reconsider the current guidelines “that recommend against routine MRI surveillance in late stage breast cancer.”
Symptoms of Breast Cancer in the Brain
The Moffitt Cancer Center says the following can be caused by brain mets.
- Headache
- Memory loss
- Mood or behavior changes
- Impaired judgment
- Balance problems
- Dizziness
- Vision changes
- Paralysis or weakness on one side of the body
- Seizures
- Slurred speech
- Nausea, vomiting
Head Scans for Asymptomatic Stage 4 Breast Cancer Patients
It’s a great question: Why aren’t routine MRIs of the brain recommended alongside the quarterly chest scans?
Jonathan Stegall, MD, an integrative oncologist and medical director for The Center for Advanced Medicine adult cancer treatment center, addresses the vexing issue of MRI head scans to check for asymptomatic brain mets.
