Breast Cancer in the Spine? Understanding Metastatic Breast Cancer

Breast Cancer in the Spine? Understanding Metastatic Breast Cancer
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Image of the spine

Image of the spine

Dr. Susan Summerton, MD, Radiology

If you are a music fan or hear the news, by this time you must have come across this very disheartening news that Olivia Newton John’s breast cancer has returned in her spine which is why her concerts are being canceled. Ms. Newton John has been an advocate in the breast cancer community and she established the ONJCC in Australia where active research to combat breast cancer is happening . As a woman dealing with metastatic breast cancer for the last year, I wish she hadn’t joined this club and I am truly saddened for her. She was first diagnosed with Breast Cancer in 1992 and now 25 years later, she has been found to have breast cancer in her spine. I can imagine how devastating it must be for her and her family as I too live with metastatic breast cancer. I wish her great success in her upcoming treatment and sincerely pray that she will go in remission.

So what is happening when breast cancer is diagnosed in the spine? Is it now “bone” cancer? The answer is no. There is generally a lack of awareness about breast cancer that has spread to other organs called “Metastatic Breast Cancer” or MBC ( Also known as Secondary Breast Cancer ). A lot of people unfortunately don’t understand the reality of metastatic breast cancer which is the fact that incurable stage 4 of breast cancer . More importantly, although stage 4 breast cancer is incurable, it is treatable and many sub-types of breast cancer respond to treatment for a number of years.

.The common knowledge is that breast cancer occurs in breast and that it is easily cured. Most media captures the happy “beating the cancer” narrative of breast cancer and I am sure most people have witnessed such stories. What most people do not know is that among women who have been diagnosed with Breast Cancer, about 30 percent will experience the spread of cancer in organs other than breasts. Currently there are over 154,000 women living with MBC in the US who are chronically undergoing treatments. The five year survival rate with MBC is about 22 percent in stark contrast to Stage 1 which is closer to 100 percent.

Metastatic Breast Cancer is the leading cause of death in women with breast cancer. Some figures estimate that about 113 women die of metastatic breast cancer each day. And yes,even in this day and age, we still don’t have a cure for MBC. I was diagnosed with MBC, in Feb 2016 after two years of being in remission. This cancer has now metastazied in my spine but also in my liver. I live with the reality that my illness cannot be cured. There are some women who can go into remission with MBC but they are never cured and always need to be on treatment. This is another harsh reality of MBC is that the treatment never ends. Most patients go from one form of treatment to another after one treatment fails them. This keeps on happening until the patient runs out of all available treatment options and that leads to spread of the disease and eventually death. The treatment efforts are mostly directed at extending life and not to accomplish a cure.

If the patient has one metastatic lesion, their odds of going to remission are much higher as the single focus of the disease can be targeted. As in case of Ms, Newton John, the spot in her spine can be targeted via radiation. For some women, with an isolated spot say in the liver, it can be embolized or resected ( targeted surgical treatment) . Majority women, however, will have multiple foci of disease.

Also it is important to understand that breast cancer can recur after any length of time, and in the case of Ms. Newton-Johnson, it recurred after 25 years. This is why in my opinion; the whole narrative of “beating cancer” is so flawed. Breast cancer can stay dormant in the body and then take life again after decades. In most women however if the recurrence were to happen, it occurs most commonly in the first two years after ending of treatment. My cancer history is consistent with these numbers. My treatments ended in April 2014 and my metastatic lesions were diagnosed in liver in Feb 2016.

There is a lots of variation in the outcomes of women with metastatic breast cancer. Women who have only bone metastasis tend to live a little bit longer than those with soft tissue. However the median survival of women is considered around three years. Yes once cancer recurs in other organs it significantly reduces the survival rate. I hope that these numbers aren’t true for any of the women with metastatic disease.

People often speculate that women with metastatic breast cancer must have not done enough treatment or not followed the doctor’s advice. This is absolutely not true. We currently don’t know why cancer metastasizes to other organs or who are the women are at risk are for it specifically. This has nothing to do with the woman not doing the right thing or not doing treatment. I was treated with mastectomy, received 16 chemotherapy treatments, 33 radiation treatments, hormonal treatment therapy and I stayed active and fit through my treatment and after. My oncologist herself remarked, “You did everything that we had wanted you to do”. Despite doing everything that was recommended, I had recurrence of it in. While it’s true that a higher stage and grade of tumor puts an individual at higher risk for recurrence, many women experience metastatic disease when first diagnosed even with early stage breast cancer.

Breast cancer tends to metastasize preferentially to the bone, lung, liver, spine and larger bones, brain, in that order of prevalence. and lungs. These are the locations where the recurrence is most often diagnosed. As we see in Ms. Newton’s case, she started to have back pain which turned out to be a lesion of cancer in her spine. More often however, metastatic disease can be asymptomatic. Most oncologists in the US do not do scans on their patients to check for recurrence. They only do scans if the patient is having symptoms. This causes women to live in fear of their disease recurring. The medical data indicates the diagnosing metastatic disease early has no real bearing on the outcome or in other words, whether you are diagnosed early or late, the prognosis remains the same. This, however, is a very discouraging fact for those with breast cancer and especially those with MBC. The response to treatment after MBC is what determines how well a person will do. Those who become have NED (no evidence of disease) after MBC, tend to live longer than ones who never become NED.

MBC is a disease that isn’t talked about much. Our whole society is invested in seeing cancer warriors who “beat” their cancer and the metastatic breast cancer community feels marginalized in the survivor narrative. We are a group of women who did what they needed to do to survive cancer but it is our cancer that isn’t letting us survive. About ten percent of women are diagnosed with metastatic breast cancer from the get go, also known as “de novo breast cancer”. The research funding for this illness remains inadequate and its time we talk more about women who are dying of breast cancer. Although a recent study does indicate that women with MBC are living longer as compared to the 70s, the treatment of this disease continues to remains a challenge in the field of oncology.

( This article was kindly reviewed by Dr. Roohi Ismail-Khan MD MSc , oncologist at Moffitt Cancer Center in Tampa, Florida who specializes in breast oncology and Dr. Rasha Beg MD, oncologist at Florida Cancer Specialists, Orange City, Florida for medical accuracy )

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