Life Expectancy of Stage 4 Breast Cancer

Survival Rate With Metastatic Breast Cancer

In This Article

Many people wonder about the life expectancy for stage 4 breast cancer (metastatic breast cancer). In answering this question, it's important to note that everyone is different and survival rates vary widely. In addition, there are some people who survive many years and even decades with stage 4 disease. At the same time, it's important to understand that stage 4 breast cancer isn't curable.

It can be helpful to look at current statistics and consider the many variables that affect life expectancy. While it's important not to raise false hope, it may help to know the reality that there are some long-term survivors.

There are many people who wish to know the statistics about survival rates with metastatic breast cancer, but there are many who don't. If you're living with stage 4 breast cancer, there is absolutely no requirement that you know the prognosis. The information provided here is only for those who truly wish to know what the current research is—even this research has many limitations.

Variables

There are a number of factors that may increase or decrease the length of survival for someone who has stage 4 breast cancer. It's important to note, however, that there are many exceptions to these general rules. Some people who have a very poor prognosis survive many years or decades, while others with an excellent prognosis may live for a shorter time than average.

Some of these factors may be "actionable," meaning there are things people can do that may affect their prognosis, while many are not. Some factors associated with survival include:

  • Type. Some types of breast cancer are associated with better survival rates than others.
  • Age. While breast cancer has the reputation of being more aggressive in younger women, young women are more likely to become long-term survivors of breast cancer than older women.
  • Receptor status. People who have positive receptors (whether estrogen receptor, progesterone receptor, or HER2) tend to live longer than those who have negative receptors—especially triple negative disease.
  • Location of metastases. Breast cancer metastases to bones are associated with a higher survival rate than metastases to other regions such as the lungs, liver, and brain.
  • Treatment choices. This includes treatment of oligometastases. A 2019 study found that treating oligometastases (usually up to 5 areas) can sometimes significantly improve survival.
  • Physical activity.
  • Emotional and social support. People who have a supportive partner are more likely to live longer, and having a partner is one of the factors associated with long-term survival.
  • General health. General health plays a significant role in survival rates, and also affects the treatments that a person will be able to tolerate.
  • Cancer-related complications. Complications of advanced breast cancer such as blood clots, fractures, malignant pleural effusions, and more can decrease the projected life expectancy.

What Doesn't Affect Survival?

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. These are generally less understood by the general public.

  • Aggressiveness of treatment (in general)
  • Having a positive attitude

The goal of treatment for metastatic breast cancer is often very different than that of early-stage disease, and this can raise anxiety among patients and loved ones of patients. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk the chance 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. In fact, holding in negative emotions in order to appear positive may be detrimental to your health in general.

Survival Rates

The overall 5-year survival rate for metastatic breast cancer is reported as 27 percent by the National Cancer Institute looking at data from 2008 to 2014. This same rate is 22 percent as reported by the American Cancer Society, with the median survival (the amount of time after which 50 percent of people are still alive and 50 percent have passed away) is 3 years.

Disclaimer

With survival statistics, it's important to talk about what these numbers mean. For example, discussing survival between 2008 and 2014 isn't necessarily helpful in estimating survival in 2019.

Newer drugs have been approved since these studies were completed—there is no way of knowing yet whether these treatments will alter the survival rates in the future.

For example, newer HER2 targeted therapies, the addition of bisphosphonates, and other types of treatments are adding to the relatively new advances.

In addition, the newer immunotherapy drugs (while not as effective with breast cancer as some other cancers) have led to a durable response, or long-term response, for at least some people with advanced breast cancers.

Another area of treatment that is changing is the treatment of oligometastases. 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.

Recently, research has begun to look at the benefit of treating oligometastases, which are defined as one or only a few metastases to a particular organ. These isolated metastases may be treated with surgery or radiological techniques such as proton therapy or stereotactic body radiotherapy—these are techniques that treat the metastasis with curative intent.

With some cancer and metastases in some regions (such as lung cancer with brain metastases), treatment has an extended life and sometimes results in long-term survival. The research looking at treatment of oligometastases with breast cancer is relatively young, but hopefully will reveal similar improvement in life expectancy.

Long-Term Survivors

Being a long term survivor is usually defined as living 5 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 percent. (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, according to one study, 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 partners

Long-term survivors are also more often diagnosed with metastatic breast cancer at the onset (de novo breast cancer), rather than having had a 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 what might be making the difference.

Coping

Coping with stage 4 breast cancer is challenging, and it is very different than 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 be potentially 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 among the breast cancer community.

Support

Support is very important, and some studies suggest that social support even improves the length of survival.

Connecting with family and friends is paramount, 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 whether you can get pregnant after treatment. Instead, you may have drastically different concerns, such as how long you will live.

Being Your Own Advocate

While there aren't currently any studies looking at self-advocacy and survival, being your own advocate can't hurt in maximizing your survival. 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.

There are ways to learn about opportunities, however, that 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.

Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.

How to Handle Emotions

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 have to feel poorly 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. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.

While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.

For Family and Friends

Caring for a loved one with stage 4 breast cancer has special challenges as well. Fortunately, organizations such as CancerCare now offer support groups design for loved ones who are caring for someone with cancer. In addition to caring for yourself (which is necessary in order to care for a loved one), it's helpful to learn about metastatic breast cancer.

Common things that people learn about cancer usually refer to an early-stage disease, and myths about metastatic breast cancer can be painful for those living with advanced disease. For example, one of the things not to say to someone with metastatic breast cancer is "When will you be done with treatment?"

For the most part, people with metastatic breast cancer will require some type of treatment for the rest of their lives.

A Word From Verywell

In talking about statistics, it's important to know that people aren't statistics. Even with factors that may increase or decrease the prognosis, survival is very variable between different people.

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