Metastatic Breast Cancer

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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Living With Uncertainty

Each person with metastatic breast cancer is different, and so is their treatment. But one experience many patients share is the challenge of living with uncertainty. If you have questions, from the practical to the spiritual, you’re not alone. It’s normal to wonder about everything from finances and employment, to how long treatment will work, to how to find joy as you live a life that’s different than it used to be.

It’s also normal to need support to navigate these questions and cope with whatever you’re feeling. Fred Hutch has people who can help, like our social workers, mental health counselors, Spiritual Health team and the staff in our Patient and Family Resource Center.

Getting a Second Opinion

At Fred Hutch, we are available to provide second opinions for people diagnosed with metastatic breast cancer. For non-metastatic breast cancer, treatment choices tend to be fairly straightforward based on the features of the disease and the stage. For metastatic breast cancer, the choices can be more complex. That’s because metastatic disease is more likely to have genetic mutations or develop resistance to certain medicines. Factors like this mean each patient’s treatment is highly individualized. Getting a second opinion may help you feel confident about how to move forward.

If you came here first and want to get a second opinion somewhere else, we understand. This is a common practice, and it’s OK to bring this up with your Fred Hutch care team.

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

Progressive or Recurrent Metastatic Breast Cancer

Most of the time, breast cancer is diagnosed before it has spread far from the breast where it began. Treatment — like surgery, radiation therapy and chemotherapy or other medicines — may control or even cure non-metastatic disease. But even with expert care, some people’s cancer will progress, or spread, during treatment. Or it will come back (recur), sometimes in a distant part of the body, after their initial treatment ended.

De Novo Metastatic Breast Cancer

In some cases, the first time a person learns they have breast cancer is when the disease has already spread somewhere else in their body. This is called de novo metastatic breast cancer. De novo means “anew” or “from the beginning.”

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.

Treatment Process

At Fred Hutch, we discuss your therapy options with you. Together we select, combine and schedule your treatments based on what fits best with your goals and desires. Your care team will make sure you understand each type of treatment and all of your choices.

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:

Chemotherapy

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow).

Targeted therapy

Targeted therapy is more exact than chemotherapy in affecting cancer cells specifically.

Endocrine therapy

Endocrine therapy, also called hormonal therapy, reduces or blocks the body’s production of hormones or the effects of the hormones.

Immunotherapy

Immunotherapy uses the power of your immune system to find and fight breast cancer cells.

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)
Patient and provider

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. 

Frequently Asked Questions

Progressive or Recurrent Breast Cancer

The most important thing you can do is go to all your follow-up visits with your cancer care team. These visits give you and your team a chance to talk about any changes in your symptoms or other aspects of your health. You’ll also have tests and scans on a regular schedule. These help us detect signs of cancer. The sooner we know about any such signs, the sooner you can get the care you need.

Between follow-up visits, call your care team if you notice any symptoms that concern you, that get worse over time or that keep happening for no clear reason. Your team can arrange a visit sooner than your regular follow-up.

De Novo Metastatic Breast Cancer

Getting this news can be scary and overwhelming. We’re here for you, and we want to help. You have treatment options, and there are resources to help answer your questions and provide the support you will need.

Please contact us to request an appointment. See if a family member or friend can come with you to your first visit. They can help keep track of information from your care team and make sure your questions get answered. We encourage you to bring someone with you to any of your appointments.

Resources

Here are some resources to help you take the next step in learning about metastatic breast cancer.

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.

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