When breast cancer cells metastasize, or spread beyond the breast into other areas of the body, it is referred to as stage 4 breast cancer. This is different from a recurrence, which is when the cancer comes back after an initial course of treatment after which the cancer was not detectable.

Some common places for breast cancer to spread and grow are the bones, liver, brain, lungs, and distant lymph nodes. Once metastasis occurs, the cancer is considered to be incurable. Even so, the prognosis can be vastly different for different people.


Statistics can be very misleading, as they are based on a large population of people with widely varying characteristics. Overall, people with stage 4 breast cancer have a 22 percent rate of survival after five years compared to their peers without breast cancer. This in no way means that you (if you’re the patient) or your loved one has only a 22 percent chance of survival. In fact, according to a fact sheet published by the American Cancer Society, deaths from breast cancer have declined steadily since 1990. Only a specialist who takes into account many factors unique to the situation can offer an appropriate prognosis.

Factors Affecting Prognosis

No two stage 4 breast cancer patients are exactly alike, so it makes sense that the prognosis isn’t the same for everyone. Several factors can play a role in determining a patient’s prognosis, such as:

  • time between treatment of the original diagnosis and recurrence/metastasis
  • type of metastasis: local or distant
  • soft tissue or bone metastasis
  • presence of hormone receptors
  • treatment

Time Factors

Patients whose cancer has metastasized five years or longer from the time of their initial treatment have a better prognosis than those whose cancer spread within two years. If breast cancer is going to metastasize, it usually will do so within two years.

Type of Metastasis

The best prognosis applies to more local metastases of the chest wall or armpit. Generally speaking, the more distant the metastatic cancer, the poorer the prognosis.

Type of Tissue

The poorest outcomes usually are found in patients whose cancer has spread to distant soft tissues like the brain, liver, or lungs. Bone metastases lie in the middle, with moderate outcomes expected compared to local and distant soft tissue cancers.

Presence of Hormone Receptors

According to the American Cancer Society, about two out of three breast cancers are hormone receptor-positive. This characteristic gives doctors and patients an extra weapon to use in treatment: hormone therapy. Drugs such as aromatase inhibitors stop or slow the production of estrogen, slowing the growth of estrogen receptor-positive tumors. Tamoxifen works by blocking the estrogen from facilitating tumor grow.


Treatment is, of course, designed to improve the prognoses of breast cancer patients. The level of improvement can depend on the treatment chosen. The two main types of treatment are:

  • local treatment, which is designed to treat a specific tumor. Local treatments include surgery to remove the tumor and radiation to shrink or destroy the tumor.
  • systemic treatment, which travels via the bloodstream throughout the body. Chemotherapy drugs and hormone therapy are systemic treatments.

Systemic treatments can destroy cancer cells “floating” around the body as well as small tumors that have not yet been found. For this reason systemic treatments offer a better prognosis than local treatment alone.

What Can You Do?

If you have been diagnosed with stage 4 breast cancer, the best thing you can do is work closely with a doctor (or team of doctors) whom you trust. Be open with your doctor, expressing any concerns regarding your symptoms, your treatment, and your prognosis. Do your homework, making sure you understand the recommended treatments and why they were recommended. Finally, stay on track with all treatment options that you and your doctor have chosen.