Stage 4 Breast Cancer Survival Rates

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Life expectancy for stage 4 breast cancer (metastatic breast cancer) varies widely. Each person is different, and factors like your age, overall health, the type of breast cancer you have, and the organs where the cancer has spread (metastasized) can inform your prognosis (likely outcome).

Stage 4 cancer isn't curable, but it's important to remember that there isn't one set path for the disease. By learning about cancer survival rates—and the variables that influence them—you can get a better handle on what to expect and a stronger sense of control over the choices you make.

This article explains what cancer survival rates mean, how they apply to stage 4 breast cancer, and the different variables that do and do not have any impact on them.

Living with stage 4 breast cancer.

Verywell / Jo Zixuan Zhou

Five-Year Survival Rates

When discussing cancer prognosis, people will often ask how long they have to live. Because there is no reasonable way to predict how long that might be—as two people with the same disease can have entirely different outcomes—cancer specialists will respond by describing the relative survival rate.

Relative survival rates describe the percentage of people who live to or beyond a specific period of time. Most cancer specialists use a five-year survival rate as the standard measure.

So, if the type of cancer you have has a relative five-year survival rate of 50%, it means that 50% of people will live for at least five years. Many may go on to live for many years more.

The rate is determined by ongoing data compiled by the National Cancer Institute (NCI) of every person living with a specific type and stage of cancer in the United States. As such, it is an accurate representation of what the current outlook is overall.

Even so, the rate may not reflect your likely outcome given that the statistics are based on every person of every age and health status with breast cancer. This includes people who may be older or younger than you, healthier or less healthy than you are, or have a different subtype or grade of breast cancer than you.

As such, five-year survival rates provide you and your oncologist with a general snapshot of expectations that you can build on.

As of April 2023, based on data from the NCI's ongoing Surveillance, Epidemiology, and End Results (SEER) program, the relative five-year survival for female breast cancer is 31%.

As of February 2023, the American Society of Clinical Oncology (ASCO), drawing from SEER data, reports that a relative five-year survival rate for male breast cancer is 22%.

Limitation of Survival Rates

It is important to remember that the SEER data are historical and do not immediately reflect newer treatments that are extending survival time (including HER2 targeted therapiesbisphosphonates, and the ever-expanding list of immunotherapies). As such, the survival rate you receive today may be very different in the next couple of years.

Oligometastases and Treatment

Another area of treatment that is changing is the treatment of oligometastases, which are defined as one or only a few metastases to a particular organ. In the past, people with metastatic disease (whether to a single site or many) were treated the same way, via general treatments for metastatic cancer such as chemotherapy or hormonal therapy.

Research has begun to look at the benefit of treating oligometastases. These isolated metastases may be treated with:

With some cancer and metastases in some regions (such as lung cancer with brain metastases), treatment has extended life and sometimes results in long-term survival. Future advances may lead to similar improvements in life expectancy.

Variables and Breast Cancer Survival

There are certain variables that can positively or negatively influence survival rates if you have breast cancer. Many of these variables are fixed and cannot be changed, but there are some over which you have control.

By understanding which variables you have control over (and which you don't), you can make informed choices.

Survival Rates by Age

Age plays a significant role in breast cancer survival but not as you might expect. According to a 2020 study in Frontiers of Oncology, which drew upon SEER data, females under 40 and those over 79 have poorer outcomes than those diagnosed between these age groups.

By and large, younger females tend to get more aggressive types of breast cancer, while females over 79 are generally less healthy and are diagnosed when the spread of cancer is extensive.

Survival Rates by Location

The most common sites of metastases for breast cancer are the bones, liver, lungs, and brain. The location can influence the five-year survival rate, as described by a 2019 study in BMC Cancer:

  • Bone metastasis: 39.8%
  • Lung metastasis: 10.94%
  • Liver metastasis: 7.34%
  • Brain metastasis: 1.51%

Survival Rates by Cancer Subtype

Between 15% and 20% of breast cancers have higher levels of a protein known as HER2. While HER2 helps tumors grow quickly, they are more responsive to targeted therapies for metastatic breast cancer.

This is especially true if the tumor tests positive for HER2 receptors and tests positive for hormone receptors (HR) for estrogen and progesterone.

For people with stage 4 breast cancer, the presence or lack of these receptors can influence five-year survival rates, according to 2023 SEER data:

  • HER2-positive/HR-positive: 45.6%
  • HER2-positive/HR-negative: 39.5%
  • HER2-negative/HR-positive: 34%
  • HER2-negative/HR-negative: 12.8%

Survival Rate by Tumor Size

Cancer staging is estimated on several factors, including the size of the primary (original) tumor. With stage 4 breast cancer, the size of the primary tumor in the breast also influences the survival time even if the cancer has already spread.

According to 2019 SEER data evaluated by researchers at Cambridge University, the relative five-year survival rate for people with metastatic cancer decreases as the tumor size increase. This is broadly described as follows:

  • Primary tumor size of 4.8 centimeters and under: 50%
  • Primary tumor size over 4.8 centimeters: 25%

Survival Rates by Treatment Choice

The treatments used for metastatic breast cancer can influence survival rates. Although you may not have complete control over which treatments are available to you, knowing how they affect survival can help you better understand why your oncologist may recommend a certain treatment and not others.

A good illustration of this is the five-year survival rate for people with metastatic breast cancer who are treated with breast cancer surgery versus those who are treated with chemotherapy or hormone therapy:

  • Chemotherapy or hormone therapy as primary treatment: 30%
  • Radical mastectomy as primary treatment: 10%

Survival Rates by Performance Status

Performance status (PS) is a measurement used in cancer to assess a person's level of function and ability to take care of themselves. It is more than an assessment of a person's general health but takes into account their ability to remain active, do office or housework, and perform tasks without restriction.

PS scores typically range from 0 to 100, with 100 being optimal function and 0 being dead. (Other methods calculate PS on a scale of 0 to 5, with 0 being optimal and 5 being dead.)

Ultimately, people with a higher PS score—meaning that they are stronger and better able to take of themselves—are more likely to fare better on cancer treatment than those with a lower PS score.

Your PS also factors into what treatments your oncologist will prescribe as they consider whether you can tolerate them or not. As a result, your PS can have a direct impact on your relative survival.

This is best illustrated by a study from the University of Toronto which described the median survival times for people with stage 4 breast cancer based on their performance status:

  • PS score of 80 to 100: median survival of 221 days
  • PS score of 60 to 70: median survival of 115 days
  • PS score of 40 to 50: median survival of 51 days
  • PS score of 10 to 30: median survival of 22 days

Variables That Don't Affect Survival

Stage 4 breast cancer prognosis isn't affected by all factors. Just as there are factors associated with a better or worse prognosis, there are some factors that do not appear to make a big difference.

People tend to not understand these factors as well. They include:

  • How aggressive your treatment is (in general)
  • Having a positive attitude

Treatment goals for metastatic breast cancer are often different than that of early-stage disease. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk that the cancer will come back.

In contrast, with stage 4 disease, the goal is usually to use the minimum amount of treatment possible to control the disease (at least at the current time). Studies have found that more aggressive treatment does not improve survival rates but does reduce quality of life.

While having a good attitude may improve your sense of well-being, it has not been shown to affect survival rates. On the other hand, nearly 42% of people diagnosed with breast cancer experience anxiety. Trying to appear positive rather than expressing your concerns may be harmful to your health in general.

Who Are Long-Term Survivors?

Being a long-term survivor is usually defined as living five or more years beyond a diagnosis of stage 4 breast cancer.

Living 10 or more years isn't unheard of, and the 10-year survival rate for primary or de novo metastatic breast cancer is around 13%. (This rate is based on de novo cases, or cases in which stage 4 was the initial diagnosis.)

Characteristics

While there is a significant degree of variability, long-term survivors are:

  • More likely to be younger (this is in contrast to early-stage breast cancer in which the survival rate is lower for younger people with the disease)
  • More likely to have estrogen receptor, progesterone receptor, and/or HER2-positive tumors
  • Less likely to have other medical conditions (co-morbidities)
  • Less likely to have "visceral" metastases, such as metastases to the abdomen and liver metastases
  • More likely to have a higher household income
  • More likely to have a partner

Long-term survivors are also more often diagnosed with metastatic breast cancer at the onset (de novo breast cancer), rather than having had previous early-stage breast cancer that recurred at distant sites.

In different studies, the length of response after the first treatment for metastatic breast cancer was linked to survival. That said, it can be difficult to predict who may survive for a lengthy period of time based on measurements currently available.

Recently, research has begun to focus on people who survive longer than expected, or "outliers," to gain insight into genetics and other factors that may be making the difference.

Coping With Stage 4 Breast Cancer

Coping with stage 4 breast cancer is challenging, and it is different from coping with early-stage disease. For those who originally faced early-stage breast cancer, not only do they need to face cancer again but this time they aren't dealing with a disease that can potentially be cured.

Metastatic breast cancer often comes with more symptoms as well, such as bone pain due to bone metastases and itching with liver metastases. On top of all of this (and despite all of the "awareness" that has taken place), people with stage 4 disease may feel left out within the breast cancer community.

Support

Support is very important, and some studies suggest that social support even improves the length of survival. Family and friends are key but becoming involved in a support group or breast cancer community is extremely helpful as well.

Through these communities, you have the opportunity to connect with others who are facing some of the same challenges.

Many people with stage 4 breast cancer prefer a social community dedicated to metastatic breast cancer. If you're living with metastatic cancer, it may be hard to listen to others talk about concerns common with early-stage, such as hair loss or the chance of pregnancy. You may have drastically different concerns, such as how long you will live.

Cancer and Caregivers

Caring for a loved one with stage 4 breast cancer has special challenges as well. Some support groups are designed for loved ones and can help you to learn more about self-care as well as your loved one's needs. Most people with metastatic breast cancer will require some type of treatment for the rest of their lives, and support can help you to become better equipped.

Being Your Own Advocate

The relationship between self-advocacy and survival is unclear, but being your own advocate can't hurt in maximizing your survival. For example, some studies show that informed decision-making may improve among people attuned to their breast cancer symptoms.

Oncology is changing rapidly and it's difficult for any oncologist—even those who specialize in breast cancer—to stay aware of all of the latest research and clinical trials taking place.

It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.

Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.

Some opportunities don't require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.

Larger cancer centers may offer remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about treatment options that may not be available elsewhere.

Palliative Care and Coping

Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will feel poorly for the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.

Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors.

Some research suggests that people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer too.

Summary

With stage 4 breast cancer, the spread (metastasis) of the disease changes the priorities people have at an earlier stage of diagnosis. Treatment options are different, and so is your outlook on how your cancer will progress.

Five-year survival rates are a common and reliable measure of prognosis, but they never tell the whole story. Each person is different and the variables affecting your cancer diagnosis, including its receptor status and related therapies, affect the outcome.

Life expectancy for people living with stage 4 breast cancer also continues to evolve on the basis of new research discoveries. Your healthcare team can help you to understand your disease, make informed choices, and connect you and your loved ones with support resources.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."