Significant medical advances have contributed to breast cancer survival in the UK doubling in the last 40 years.1 In addition, public awareness and commitment across the country in providing research funding supports many women diagnosed with advanced stage breast cancer.
Despite this, breast cancer remains the most common cancer in the UK, with around 55,000 women diagnosed each year... that’s 150 women every day.2 Nearly a third of women diagnosed with earlier stages of breast cancer will eventually develop advanced disease.3,4
What is advanced breast cancer?
Advanced breast cancer or ABC (also known as secondary, metastatic or stage 4 breast cancer) is when the cancer originating in the breast(s) has spread to other parts of the body.4
The most common places that cancer can spread to include...5
Although advanced breast cancer cannot be cured, it can be treated. There are many different options of treatments that can keep it under control for longer, prolong life, relieve symptoms and maintain or improve quality of life. Potential treatments will depend on a patient’s prognosis.
The difference between primary and advanced breast cancer
In most cases, the first symptom of primary breast cancer people notice is a lump or an area of thickened tissue in the breast. While these are not always cancerous, it is recommended to have these checked by a doctor. Other symptoms of primary breast cancer can include:
A change in the size or shape of one or both breasts
Discharge from either nipple, which may be streaked with blood
A lump or swelling in either of the armpits
Dimpling of the skin around the breasts
A rash on or around the nipple
A change in the appearance of the nipple, such as when it becomes sunken into the breast6
People with advanced breast cancer often experience different symptoms depending on where the cancer has spread to. Some people may also have some general symptoms which include feeling much more tired than usual, loss of appetite, feeling generally unwell or unexplained weight loss.4
Advanced breast cancer in the bones
The most common symptom of breast cancer that has spread to the bone (bone metastasis) is a sudden, noticeable new pain. However, other possible signs include:7,8
Hypercalcaemia – elevated levels of calcium in the blood. Symptoms can include fatigue, weakness, nausea, loss of appetite, and/or dehydration. If left untreated, this can lead to a bone-weakening disease called osteoporosis
Bone fractures – this is when there is a break in the bone, which can be due to bone thinning or direct effect of cancer spreading to the bone and causes pain and inability to move the affected area without pain
Spinal cord compressions – pressure on the spine requires urgent treatment. Symptoms can include pain in the back or neck, numbness or weakness in an area of the body, difficulty passing urine or having bowel movements
Advanced breast cancer in the lungs
Spread of breast cancer to the lung(s) (lung metastasis) can be symptomless. However, symptoms can include discomfort in the lung, shortness of breath, coughing up blood and a persistent cough. Other signs include:7,9
Pleural effusion – build-up of excess fluid between the layers of tissue outside the lungs, which cause pain on breathing, cough, or shortness of breath
Wheezing – whistling or rattling sound in the chest
Pain in the lung
Advanced breast cancer in the liver
Liver metastasis might be found incidentally via abnormal LFTs and the patients could be completely asymptomatic. If the cancer spreads to the liver, patients may experience pain or discomfort in the lower right-hand side of the ribs. Other signs include:7,10
General feelings of unwellness
Loss of appetite
Jaundice – yellowing of the skin or eyes caused by a build-up of bile in the blood
Advanced breast cancer in the skin
If the cancer has spread to the skin, patients may experience the following symptoms:7
Lumps which can often be firm and painless
Inflamed skin – areas of redness, swelling, or irritation
Bleeding, pain, or infections
Advanced breast cancer in the brain
If the cancer has spread to the brain the symptoms patients experience may be dependent on which part of the brain is affected and can lead to the following symptoms:7,11
When a patient is diagnosed with ABC, their doctor will recommend some tests to be done on the cancerous tissue which will help determine the type of cancer the patient has. The results will guide the doctor towards the most appropriate treatment plan. Due to the individual nature of ABC and the hormones it affects, treatment plans tend to differ between patients. If a patient has been previously diagnosed with primary breast cancer (non-metastatic breast cancer), their doctor may recommend repeating some of the tests in order to see if the tumour cells have changed in any way since the previous test.5
Generally, tumour cells of ABC patients can be characterised by the presence (positive) or absence (negative) of different types of receptors (proteins) in or on the cells:
ER+, oestrogen receptor positive
ER-, oestrogen receptor negative
PR+, progesterone receptor positive
PR-, progesterone receptor negative
HER2, human epidermal growth factor receptor 2
ER+, ER-, PR+ and PR- breast cancer
Breast cancers expressing oestrogen receptors (ER) and/or progesterone receptors (PR) are called “hormone receptor-positive.” These receptors are proteins found inside the tumour cells. Tumours that have oestrogen receptors are called “ER-positive.” Tumours that have progesterone receptors are called “PR-positive.” These cancers may depend on the hormone’s oestrogen and/or progesterone to grow. Hormone receptor-positive cancers can occur at any age. However, they may be more frequent in women who have gone through menopause. About 60% to 75% of breast cancers have oestrogen and/or progesterone receptors. If the cancer does not have ER or PR, it is called “hormone receptor-negative.”5
Tumours that are ER positive or PR positive are much more likely to respond to hormone therapy than tumours that are ER negative or PR negative.5
HER2 and triple-negative breast cancer
About 15% to 20% of breast cancers depend on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers are called “HER2-positive” and have many copies of the HER2 gene or high levels of the HER2 protein. The HER2 gene makes the HER2 protein, which is found on the cancer cells and is important for tumour cell growth.5 This type of tumour can either be hormone receptor-positive or hormone receptor-negative (see above). Cancers that have no or low levels of the HER2 protein and/or few copies of the HER2 gene are called “HER2-negative.”5
If a person’s tumour does not express ER, PR, or HER2, the tumour is called “triple-negative.” Triple-negative breast cancers make up about 15% of invasive breast cancers.5
For over 30 years, Novartis has been committed to patients and patients’ families whose lives have been impacted by breast cancer.
Novartis commitment to breast cancer
Novartis tackles breast cancer with superior science, collaboration and a passion for transforming patient care. We’ve taken a bold approach to our research by including patient populations often neglected in clinical trials, identifying new pathways or mutations that may play a role in disease progression and developing therapies that not only maintain, but also improve, quality of life for patients. Our priority over the past 30 years and today is to deliver treatments proven to improve and extend lives for those diagnosed with advanced breast cancer.
Investing in clinical trials
At Novartis, we are committed to progressing scientific research and are the leading commercial clinical trials sponsor in the UK, with 622 trials conducted over the last 10 years. Conducting clinical trials locally can lead to improved quality of care for patients in those communities, and in 2019, we sponsored 146 clinical trials, conducting studies in a quarter of all trial site organisations in the UK.12
Through our research, advances for many diseases have been made possible, giving people in the UK and around the world alternative and improved treatment options.
Collaborations with patient groups and patients
Collaborating with patient groups helps us better understand the needs of women living with ABC and how we can help deliver improved care. For more information on our work with patient groups, click here.
We partner with patient advocacy groups (PAGs) and patients to reinforce overall support for patients and the healthcare system.
The following patient advocacy groups (PAGs) provide extensive support for people living with and caring for those with ABC, and are also involved in funding vital breast cancer research.
Breast Cancer Now
At Breast Cancer Now we’re here for anyone affected by breast cancer. Our breast cancer nurses, expertly trained staff and volunteers, and award-winning information make sure you can get the support you need to help you live well with the physical and emotional impact of breast cancer.
We’re here to help everyone living with cancer live life as fully as they can, providing physical, financial and emotional support. So whatever cancer throws your way, we’re right there with you.
For information, support or just someone to talk to, call 0808 808 00 00 or visit www.macmillan.org.uk
At abcdiagnosis we are supporting primary and secondary breast cancer patients to make informed choices. Sharing information and up to date news on treatments, breast surgeries, consultants, hospitals and providing useful links.
METUPUK is a Metastatic Breast Cancer (MBC) patient advocacy group. We are working to improve outcomes for those living with MBC. We won’t stop until it is downgraded from an incurable disease to a chronic illness. We want people with MBC to gain access to the very best medicines to help them live longer and improve their quality of life. We ultimately work towards the day when MBC will be cured.
We work in collaboration with the NHS to improve breast cancer services and care for people living with breast cancer. We call these Joint Working Projects and in March 2018 we launched a project with the Christie NHS Foundation Trust to address care pathway inconsistencies in breast cancer.
The project includes a partnership with IQVIA, a leading global provider of information and innovative technology solutions, to analyse current breast cancer pathways and identify opportunities to enhance care. The project will also evaluate patient journeys by enabling patients to record their experiences of treatment pathways through the use of innovative technology provided by the app, uMotif.
It is anticipated that findings from the project will lead to improvements in the timeliness of treatment interventions for patients, and provide clarity on where to focus resource efforts, subsequently helping to address any variation in access to treatment. To find out more about our joint working projects please click here.