Breast cancer survival has increased and the number of deaths associated with this disease has decreased, largely due to factors such as earlier detection and a personalized approach to treatment. But early detection is key. Generally, it is asymptomatic in early stages. Hence the importance of staying informed about risk factors and screening tests. It could save your life or that of a loved one.
However, approximately 20 to 30% of patients who received a diagnosis of breast cancer “in early stage” will later be diagnosed with metastatic cancer, even though they were told that their initial early stage cancer was “cured”. And another 8% of new cases are already metastatic at the time of initial diagnosis.
I remind you that metastatic breast cancer means that the cancer has spread to other organs outside the breast.
Breast cancer stage:
The stage or phase is determined according to the size, the location of the primary tumor, the spread of the cancer to nearby lymph nodes and other parts of the body, the grade of the tumor, and the presence of certain biomarkers.
What is known as the TNM system is used in the following way:
• Tumor (T) indicates the size and location of the tumor
• Lymph node (N) indicates the size and location of the lymph nodes where the cancer has spread.
• Metastasis (M) indicates spread of cancer to other parts of the body.
There are sub-classifications for T depending on the dimensions of the tumor and according to certain characteristics of the tumor.
There are sub-classifications for N that indicate whether the cancer has spread from 1 to 3 axillary nodes, from 4 to 9, from 10 or more and where the nodes are.
There are also sub-classifications for M that indicate whether the cancer has spread to other parts of the body, almost always to the bone, lung, liver or brain and other characteristics.
Cancer can spread through tissue to nearby areas, and through the lymphatic system and blood to more distant parts. In the case of the lymph and blood, it can form metastatic tumors in other parts of the body.
The grading system also considers how abnormal the cancer cells look under a microscope. There are three possible grades:
Biomarkers determine if breast cancer cells have some receptors that bind to female hormones (estrogen and progesterone), for example. Tests are done to determine if the cells for breast cancer have the following biomarkers:
- Estrogen receptor (ER) test)
- Progesterone receptor (PR) test)
- Human epidermal growth factor receptor 2 (HER2/neu or HER2) test to determine if breast cancer cells have a larger than normal amount of HER2 receptors on the surface
- Triple negative cells (if they do not have receptors for estrogen, progesterone, or an amount larger than normal HER2 receptors)
- Triple positive cells (if they have ER; PR and a number larger than normal HER2 receptors)
Combine results from all the studies your doctor receives and the characteristics of the tumor to determine the treatment nt indicated in your particular case. Breast cancer treatment depends, in part, on the stage of the disease.
Metastatic Breast Cancer
The main difference is that when breast cancer is Diagnosed at an early stage can be cured. When it spreads elsewhere or metastasizes, it can be treated, but it can no longer be cured. Treatment is for life. The focus is to prevent it from spreading to other places, to treat the symptoms (if the person has symptoms), and to ensure that the person has a good quality of life for as long as possible.
Deaths caused by cancer of the breast are due to metastatic breast cancer. This includes young women as well. In the United States, an estimated 5% of new breast cancer cases and 3% of deaths are in women younger than 40. Metastatic cancer is the leading cause of death in this group. And it is estimated that 27% of new cases of breast cancer and 16% of deaths correspond to women under 50 years. By the way, men can get breast cancer too, but they only account for 1% of new cases and 1% of deaths from metastatic disease.
In 2022, about 2710 new cases of cancer are expected to be diagnosed invasive breast cancer in men. For men, the lifetime risk of breast cancer is 1 in 833.
When a woman with metastatic breast cancer undergoes a radiological study (for example: a tomographic study) and the report says that there is no evidence of disease, it is cause for celebration. It means that metastases cannot be detected on that image, but since there are breast cancer cells circulating in the body, treatment must continue. That is why the term of referral is not used.
Unfortunately the amount of money spent to study metastatic breast cancer is very low. Several years ago, the Metastatic Breast Cancer Alliance did a study and found that, of all research grants funded by major public and private sources between 833 and 2006, only 7% of the funds studied metastatic breast cancer, despite the fact that metastasis is what makes breast cancer becomes a deadly disease.
Aliza A. Lifshitz, known for her extensive experience in the Hispanic media as Dra. Aliza, is the expert in health of the educational television network for the Hispanic community HITN. On HITN she hosts the daily Vida y Salud programming block, a space in which she shares information and tools for Hispanics to lead healthier lives and communicate better with their doctors.