From the Guidelines
Secondary breast cancer, also known as metastatic breast cancer, is generally not curable, but many treatments can effectively control it for extended periods, sometimes years, with the most recent and highest quality study suggesting that a more aggressive and multidisciplinary approach, including surgery, radiotherapy, and regional chemotherapy, may be beneficial for patients with oligometastatic disease 1.
Definition and Spread of Secondary Breast Cancer
Secondary breast cancer occurs when cancer cells from the breast spread to other parts of the body, with the most common sites being the bones, liver, lungs, and brain. The cancer cells break away from the primary tumor and establish new tumors elsewhere in the body through the bloodstream or lymphatic system.
Diagnosis and Staging
If you have been diagnosed with breast cancer, your doctor should perform staging tests to determine if the cancer has spread, including:
- Blood tests
- Imaging studies (CT scans, bone scans, PET scans)
- Possibly biopsies of suspicious areas
Treatment Options
Treatment for secondary breast cancer typically involves systemic therapies that target cancer throughout the body, including:
- Hormone therapy (such as tamoxifen, aromatase inhibitors)
- Targeted therapies (like trastuzumab/Herceptin for HER2-positive cancers)
- Chemotherapy
- Newer options like immunotherapy or PARP inhibitors The specific treatment regimen depends on factors such as the cancer's hormone receptor status, HER2 status, previous treatments, and your overall health.
Monitoring and Symptom Management
Regular monitoring with scans and blood tests every 2-3 months is typically recommended to assess treatment response. Managing symptoms and side effects is also an important part of care, often involving:
- Medications for pain (ranging from over-the-counter options to prescription opioids)
- Bone-strengthening drugs like bisphosphonates
- Supportive therapies
Recent Study Findings
A recent study published in 2010 found that a more aggressive and multidisciplinary approach, including surgery, radiotherapy, and regional chemotherapy, may be beneficial for patients with oligometastatic disease, which is characterized by solitary or few detectable metastatic lesions 1. However, another study published in 2017 found that intensive surveillance with imaging examinations did not improve overall or disease-free survival rates in asymptomatic breast cancer survivors 1.
From the FDA Drug Label
In the NSABP P-1 trial, 33 cases of endometrial cancer were observed in the tamoxifen group vs. 14 in the placebo group (RR = 2.48,95% CI: 1.27 to 4.92).
The FDA drug label indicates that tamoxifen is associated with an increased risk of endometrial cancer.
- The relative risk (RR) of endometrial cancer is 2.48.
- This suggests that tamoxifen may increase the risk of developing secondary cancer, specifically endometrial cancer, in patients with breast cancer.
- The use of tamoxifen is associated with other risks, including DVT, PE, stroke, cataract formation, and cataract surgery 2.
From the Research
Secondary Cancer from Breast Cancer
- Secondary cancers can occur in breast cancer patients, and the risk of developing these cancers can be influenced by various factors, including radiation therapy 3.
- Studies have shown that breast cancer patients who receive radiation therapy have a higher risk of developing secondary malignancies compared to those who do not receive radiation therapy 3.
- The use of imaging techniques such as PET-CT scans can help detect secondary primary malignancies in breast cancer patients 4, 5.
- PET-CT scans have been shown to be effective in detecting small tumors, multiple metastases, and lymph node metastasis in breast cancer patients 5.
- Other imaging modalities, such as PET/MRI, are also being explored for their potential in detecting and monitoring breast cancer, including the detection of secondary malignancies 6.
- The risk of secondary malignancies in breast cancer patients can vary depending on factors such as age, latency period, and radiation therapy 3.
- Certain imaging techniques, such as CT and PET/CT, are commonly used in the management of metastatic breast cancer, while others, such as WB DW-MRI and CCA, are emerging as potential adjuncts 7.