What is the survival rate for stage 4 (metastatic) breast cancer?

Stage 4 Breast Cancer Survival Rate

The 5-year survival rate for stage 4 (metastatic) breast cancer is approximately 25%, though this varies significantly based on cancer subtype, metastatic sites, and individual patient factors. 1, 2

Survival Statistics

• The median overall survival for metastatic breast cancer is approximately 25 months, with cancer-specific survival around 27 months 2
• Survival rates have improved over time, with 1-year overall survival increasing from 62% in 1988 to 72% in 2015 2
• Despite advances in treatment, metastatic breast cancer remains essentially incurable, though many treatments can improve and extend patients' lives 3

Factors Affecting Survival

Cancer Subtype

• Hormone receptor status and HER2 status significantly impact survival:
  • HER2-positive patients have slightly longer survival (median 27.6 months) compared to other subtypes 4
  • Triple-negative breast cancer has the worst prognosis among all subtypes 2
  • Luminal subtypes (hormone receptor positive) have significantly better overall and relapse-free survival, though they carry long-term risk of recurrence 1

Metastatic Sites

• Bone-only metastasis has the best prognosis among metastatic sites 5, 2
• Brain metastasis is associated with the worst survival outcomes 5
• The number of metastatic sites strongly impacts prognosis:
  • Patients with 1 site of metastasis have 5-year overall survival of 31% 2
  • Patients with ≥4 sites have 5-year overall survival of only 9% 2

Molecular Patterns of Metastasis

• Different molecular subtypes have distinct patterns of metastatic spread:
  • Luminal cancers primarily spread to bone
  • HER2-enriched cancers commonly metastasize to liver and lung
  • Basal-type (often triple-negative) cancers frequently spread to liver and brain 1

Age Considerations

• Younger patients (<40 years) with de novo metastatic breast cancer may experience longer survival (median 45 months) compared to those aged 40-59 (median 33 months), except in triple-negative disease 6

Treatment Approaches

• The National Comprehensive Cancer Network (NCCN) recommends systemic therapy as the primary treatment approach for metastatic breast cancer 1
• Surgery for the primary tumor in metastatic disease remains controversial:
  • Some studies show no survival benefit from surgery 1
  • The Turkish MF07-01 trial showed potential benefit in select patients (hormone receptor-positive, HER2-negative, younger than 55 years, or with solitary bone metastases) 1
• Clinical trials are considered the preferred treatment option whenever available 1
• Appropriate supportive care and symptom management should be offered from the time of diagnosis 1

Recent Trends

• Survival of metastatic breast cancer has only modestly improved since the late 1970s 4
• Changes in diagnostic capabilities and screening have altered the distribution of prognostic factors over time 4
• Accurate prognostic estimates are essential for patient care planning and decision-making 2

Common Pitfalls in Prognosis Assessment

• Focusing solely on overall statistics without considering individual factors like cancer subtype, metastatic sites, and patient characteristics 2
• Failing to recognize that some patients with limited metastatic disease may die from non-breast cancer causes 2
• Not accounting for the impact of new targeted therapies that may significantly improve outcomes for specific subtypes 1