Breast Cancer on the Run in October: (Day 29) Stage 4 Breast Cancer as A Chronic Disease


Stage 4 breast cancer, metastatic breast cancer–these words terrify patients. And for good reason. Few people in the past survived the diagnosis for very long.

img_1666Breast cancer that spreads beyond the breast and underarm area is Stage 4 breast cancer. The cancer commonly spreads to bone, liver, lung, and brain.

Very few patients these days present with Stage 4 disease at the time of their initial diagnosis. It is the appearance of the disease years later after being successfully treated locally and regionally that make up the vast number of stage 4 cases today.

Unlike other cancers where survival success is more sharply defined in 5 year survival milestones, breast cancer tends to hang around longer and then unpredictably show up at odd times.

That’s the bad news. The good news is that our success in treating it has improved significantly. This is primarily due to the development of new drugs and new strategies.

Targeted therapies is the new buzz word in breast chemotherapy with new smart drugs that target specific structures at the molecular level or certain pathways that control cell growth.

These includes drugs like Herceptin, a number of drugs knows as Aromatase Inhibitor, and a class of drugs called Taxanes (Taxol, Taxatere). These can be used alone or in combination with more established chemotherapy drugs.¬†Expect future drugs manipulating the immune system and the cell’s genetic mechanisms.

Success in holding off the disease depends largely on the underlying biology of the tumor. Unfortunately, there are still patients with unresponsive tumors,  though they, too, can buy time with the new regimens.

The medical oncologist now has a large menu of drugs to select from to help patients with metastatic disease. They can package different drugs and change strategies depending on tumor characteristics and measures of efficacy and toxicity.

The project here is to convert metastatic disease into a chronic disease, much like diabetes is. We don’t cure diabetes, but learn to live for longer and longer times with it.

We don’t cure all Stage 4 breast cancers, but we are achieving significant success in prolonging life for those in whom the cancer has unfortunately spread beyond the reach of the surgeon and the radiation therapist.


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