Lung Metastases Imaging: Practice Essentials, Radiography, Computed Tomography
What To Know About Metastatic Breast Cancer To The Brain
Metastatic breast cancer to the brain is breast cancer that spreads outside of the breast tissue to the brain. Doctors may refer to it as secondary breast cancer in the brain or brain metastases.
Once cancer spreads to the brain, a person's life expectancy reduces considerably. Treatment can prolong a person's life and improve their quality of life while living with cancer.
Although metastatic breast cancer in the brain currently has no cure, treatment can help control the cancer and help people live longer after diagnosis.
In this article, we look at the outlook and life expectancy for people with metastatic breast cancer to the brain, as well as at managing symptoms and finding support.
Metastatic breast cancer is breast cancer that spreads outside of the breast tissue. Up to 30% of people with metastatic breast cancer develop brain metastases.
This percentage can vary based on the biological characteristics, or molecular subtypes, of the cancer. For example, HER2-positive and triple-negative breast cancers (TNBC) have a higher likelihood of metastases to the brain than other subtypes.
Metastatic breast cancer to the brain is a type of stage 4 cancer. Doctors refer to breast cancer that has spread to parts of the body away from the breasts as distant cancer.
According to the American Cancer Society, people with cancer that has metastasized to distant locations, including but not limited to the brain, have a 5-year relative survival rate of 31%.
It's important to note that these figures only apply to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment.
Breast cancer has relatively high survival rates. However, the survival rate once breast cancer metastasizes to the brain is lower.
In most cases, it is possible to treat but not cure this type of breast cancer.
A person's chances of survival, as well as the length of time they may survive, depend on several factors:
According to a 2022 study, TNBC generally has the worst outcome among the different subtypes of breast cancer. The average survival rate for TNBC after brain metastasis is 3.5 months.
Survival rates also depend on treatment. Even when cancer is not curable, treatment can prolong a person's life.
Doctors may use the graded prognostic assessment to estimate how long a person might survive. This figure takes into account age, overall health, and the subtype of breast cancer a person has.
The lower the score, the shorter the estimated survival. Scores of 0 to 1 suggest survival of about 3 months. Scores of 3.5 to 4 predict a median survival of about 25 months.
Breast cancer metastasizes when it travels to the lymph fluid or the bloodstream, allowing it to spread to other organs.
While any type of breast cancer can metastasize if left untreated long enough, certain risk factors make metastasis more likely:
Type of cancerTNBC and HER2-positive breast cancers are more likely to spread to the brain.
Time of diagnosisA 2022 research article notes that 5% of people with breast cancer had cancer in the brain at the time of diagnosis. However, this rate is higher in people with certain types of breast cancer, like HER2-positive and TNBC.
This suggests that the cancer spreads to the brain over time, so delayed diagnosis might increase the risk of finding cancer in the brain.
How aggressive the cancer isFaster growing cancers may be more likely to travel outside of the breasts.
A doctor may suspect a person has breast cancer in the brain based on symptoms or because a person has a very aggressive breast cancer.
While not all people with breast cancer to the brain have symptoms, some experience neurological issues, such as:
Breast cancer that has spread to the brain is not curable. Treatment for metastatic breast cancer focuses on controlling the cancer while maintaining the best quality of life possible.
This means a person has to weigh the benefits of treatment, which aims to prolong life, against the risks, which may include unpleasant side effects that could lower quality of life.
Also, understanding the cancer's characteristics is crucial for determining the most effective treatment plan.
Some treatment options may include:
Treatment may also include strategies to support a person living with cancer. This may include:
At the end of a person's life, some people find that hospice or palliative care relieves some pain and gives them a sense of control over their treatment.
Metastatic cancer in the brain can cause a range of symptoms, including neurological issues.
Treatment can also cause unpleasant symptoms, such as feeling sick or hair loss. Some options for managing symptoms include:
MedicationDoctors may be able to prescribe medications to help with cancer-related pain and to ease symptoms related to treatment, such as nausea. People can also ask their doctor about dietary changes that may help with nausea.
Social supportSupport groups and education about metastatic breast cancer may help a person better understand their options and advocate for themselves.
TherapySome people may find a cancer diagnosis overwhelming. A therapist can help a person confront their concerns, identify their needs, and plan for the future.
Lifestyle changesSome people find relief from lifestyle changes. Exercise may help, as can a modified work schedule or accommodations at work or school.
Every person's needs are different. The right support can help a person better understand their own needs, advocate for themselves, and live as well as possible.
Options for support can include:
Talking with loved ones can empower them to make decisions on behalf of the person living with cancer if necessary.
Below are some commonly asked questions about breast cancer metastasis to the brain.
How long will a person live once cancer spreads to the brain?Generally, the survival rate of brain metastases ranges from 3 to 35 months depending on where the primary cancer originates.
While some people may live much longer than average, most people have months to live by the time they receive a diagnosis.
What are the final stages of metastatic brain cancer?In the final stages of metastatic brain cancer, people may experience severe neurological symptoms such as cognitive decline, seizures, and paralysis.
Other symptoms may include worsening headaches, nausea, vomiting, and changes in vital signs, such as blood pressure and heart rate.
As the disease progresses, symptoms can cause significant issues that lead to a decline in overall function and quality of life.
Palliative care becomes essential to manage symptoms and ensure comfort during this stage.
Ultimately, the progression of metastatic brain cancer varies for everyone based on factors such as their overall health and the effectiveness of treatments.
What happens when breast cancer spreads to the brain?When breast cancer spreads to the brain, it can increase pressure and swelling in the brain. This leads to neurological symptoms like headaches, seizures, and other cognitive changes.
Breast cancer that metastasizes is not usually curable, but treatments can help prolong and improve quality of life.
People may find it easier to gather information about their condition gradually rather than trying to plan for everything at once.
With the right care, a person can live longer and more comfortably. People may find it helpful to talk with a support group.
People can also discuss any concerns, including about comfort and quality of life, with healthcare professionals.
New Drug Combo For Treating Brain Metastases In Breast Cancer
A study from the University of Michigan Health Rogel Cancer Center has found that combining a fatty acid inhibitor with chemotherapy could enhance treatment for patients with brain metastases from triple-negative breast cancer.
These promising results were published in npj Breast Cancer.
The brain is a challenging environment for cancer cells because it has very few available lipids, which are essential for the cells' survival.
This forces cancer cells to produce their own lipids. Dr. Nathan Merrill, the study's lead author and an assistant professor of hematology/oncology at Michigan Medicine, explained that the research aimed to exploit this weakness by inhibiting fatty acid synthase, an enzyme responsible for making fatty acids, in models of triple-negative breast cancer that had spread to the brain.
The study not only showed that combining fatty acid synthase inhibitors with chemotherapy improved treatment effectiveness, but it also revealed that using these inhibitors alone, even at low doses, reduced the cancer cells' ability to move and spread throughout the body.
Triple-negative breast cancer and HER2-positive breast cancer are known for their high risk of metastasizing to the brain.
To test the combination of fatty acid synthase inhibitors and chemotherapy, Merrill and his team looked for "synergy," which means evaluating if the two drugs work better together than separately.
Merrill highlighted a significant aspect of their work: the development of two new cell lines from a patient with brain metastases. These cell lines are unique because they came from the same patient and represent multiple resections of the tumor, providing a valuable resource for further research.
The team's next step is to understand precisely how fatty acid synthase inhibition affects metastases.
Merrill's lab has developed a device that mimics the brain environment, which they plan to use to identify which stages of the metastatic process are most affected by inhibiting fatty acid synthase. They also plan to test their findings in mouse models.
Fatty acid synthase inhibitors have already been shown to be safe in phase 1 clinical trials and are used in treating non-cancer conditions like metabolic dysfunction-associated steatotic liver disease. These inhibitors are also being evaluated as an add-on therapy for HER2-positive advanced breast cancers.
Although more research is needed, Merrill is hopeful that, with validation in mouse models, these findings could lead to improved treatments for patients with triple-negative breast cancer.
This study provides a new avenue for potentially more effective therapies for a particularly aggressive form of cancer.
If you care about cancer, please see recent studies about new way to increase the longevity of cancer survivors, and results showing new way to supercharge cancer-fighting T cells.
For more information about health, please see recent studies about how drinking milk affects risks of heart disease and cancer and results showing that vitamin D supplements could strongly reduce cancer death.
The research findings can be found in npj Breast Cancer.
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Answers To 10 Frequently Asked Questions About Metastatic Breast Cancer
ConferenceEducated Patient® Breast Cancer Summit
Here are answers to 10 questions patients asked at the CURE® Educated Patient® Metastatic Breast Cancer Summit about scans, treatment and clinical trials.
Questions about CT scans were answered during the CURE® Educated Patient® Metastatic Breast Cancer Summit.
Receiving a diagnosis of metastatic breast cancer or knowing someone who has can be overwhelming, especially when there's a lot to learn. So, during the CURE® Educated Patient Metastatic Breast Cancer Summit, two experts answered frequently asked questions about metastatic breast cancer.
From questions about scans, treatment advances to clinical trials, Dr. Jennifer M. Matro and Dr. Rebecca A. Shatsky, medical oncologists at the University of California San Diego Health, provided responses to patients at the summit.
Here are 10 answers to frequently asked questions about metastatic breast cancer.
1. How would the test Signatera (a type of circulating tumor DNA blood test) be used in monitoring metastatic breast cancer?Matro and Shatsky: Currently, Signatera is not used in monitoring metastatic breast cancer. We use scans and labs/tumor markets to monitor. This is an area of research, though.
2. What about frequent nuclear bone scans?Bone scans are done in combination with CT scans (imaging procedure to take detailed, two-dimensional pictures of the entire body) of the chest, abdomen and pelvis. It typically would be done approximately every three months or even more frequently if needed for suspected disease progression (worsening or spreading) or aggressive disease.
3. Since we are surviving metastatic breast cancer for longer periods, is there updated information about the frequency (especially for CT scans) regarding the risk of radiological scans? What should we do to reduce or monitor for issues?There is no data whatsoever that suggests that frequent CT scans have any negative effects on patients with active metastatic breast cancer. CT scans are very necessary for disease monitoring and the benefits of monitoring metastatic breast cancer far outweigh any theoretical risks of radiation from CT scans.
4. Is it reasonable to request scans during monitoring and follow-up appointments? Surveillance of cancer for me is a physical exam and periodic blood tests. My monitoring feels inadequate because my original tumor was not palpable. I would feel confident about my health status if I was undergoing diagnostic testing as part of my appointments.Scans are not used in stage 1 to 3 breast cancer for almost any patient. Insurance does not pay for them, as they have not been shown to improve outcomes.
5. If the first-line treatment is Kisqali (ribociclib)/Femara (letrozole), with the new data, what CDK inhibitor could patients switch to? Would hormone therapy chance as well?Data from the phase 3 postMONARCH trial, presented at ASCO this year, suggested that changing the hormone therapy and changing the CDK inhibitor to Verzenio (abemaciclib) provides greater benefit than a new hormone therapy on its own. So, in the absence of other mutations, this may be an option for some patients.
6. Does Enhertu (trastuzumab deruxtecan) work for leptomeningeal disease?Yes, there are emerging data that Enhertu is very beneficial in leptomeningeal disease and brain metastases.
7. Many patients with metastatic breast cancer die of brain metastases or leptomeningeal disease. Should a baseline brain MRI (a scan that takes pictures of the body's anatomy and physiological processes) be done when a person's disease becomes metastatic?The development of leptomeningeal disease and the risk of brain metastases or leptomeningeal disease depends on the specific subtype of breast cancer patients have. The highest risk or rates are for HER2-positive and triple-negative breast cancer. Brain metastases are rarer in estrogen-positive HER2-negative breast cancer, but the rates are increasing as patients live longer. The rates of leptomeningeal disease are higher also in patients with lobular breast cancer. There is no data that suggests that routine brain MRIs in asymptomatic patients improve outcomes.
READ MORE: Oncologist Debunks Clinical Trial Myths
8. How often does hormone receptor (HR)-positive cancer mutate into a triple-positive cancer when it becomes metastatic?This happens approximately 10% to 15% of the time, where the cancer recurs (comes back) in a different form than the initial presentation. That's why we always do a biopsy and receptor testing on newly diagnosed metastatic breast cancer.
LEARN MORE: Biomarker Testing Is Essential in HR-Positive Metastatic Breast Cancer
9. If a person does not live near a National Cancer Institute-designated cancer center, must they travel to the trial center? Does it make a difference if a person is in the state of the ongoing trial, such as California?A patient must travel to wherever the trial they want to enroll in is being run. If they are in the state where the trial is being run and they want to hear more about it, they may be able to ask for a telemedicine visit to hear more about it. But to enroll, they will need to go there physically. If they want to get an opinion from a clinical trialist and don't live nearby, it's a great idea to ask for a telemedicine visit with a specific doctor at a big center that runs clinical trials.
10. If patients are reluctant to receive the standard of care and aren't eligible for a trial, do doctors ever offer label treatments or try to get a trial drug on compassionate use (receiving promising but not-yet-approved drugs when no other treatment options are available)?Unfortunately, doctors are not able to prescribe therapies that are not FDA-approved through compassionate use, unless the respective drug company allows doctors to, which is incredibly rare.
I only prescribe "off-label therapy" when there is a good clinical rationale for using that therapy and a good chance it might work based on pre-clinical data (this is for drugs that are already FDA-approved in other cancer types. We cannot do this with drugs that are not yet approved).
It would be against the oncology code of ethics to prescribe a therapy that does not have good data for its use and that may benefit the patient.
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