“De novo” breast cancer refers to breast cancer that’s first diagnosed when it has already spread outside of the breast to distant parts of the body.
Most people with breast cancer first get a diagnosis when the cancer is in the local or early stages of development. At that point, the cancer is only in the breast and sometimes in surrounding lymph nodes.
Early-stage breast cancer is highly treatable. However, breast cancer can return after treatment, in what’s known as recurrence.
Nearly 30 percent of women who receive a diagnosis of early-stage breast cancer eventually develop metastatic breast cancer (MBC). This happens when the cancer spreads to distant parts of the body or recurs there.
Roughly 6 percent of women with breast cancer first get a diagnosis after the cancer has already spread to other parts of the body. This is de novo breast cancer, or de novo MBC.
De novo MBC isn’t curable, but new treatment options have improved survival rates and quality of life over the past few decades.
Read on to learn more about de novo MBC.
Early diagnosis and treatment are important for preventing the spread of breast cancer. Delays in diagnosis and treatment may lead to de novo MBC.
In many cases, early-stage breast cancer causes no symptoms. Early diagnosis is often the result of routine screening with mammograms.
The U.S. Preventive Services Task Force recommends that women ages 50 to 74 get a mammogram every 2 years to screen for breast cancer.
Doctors may also recommend screening for younger women who have increased risk for breast cancer due to family history.
However, not all women follow the recommendations to get breast cancer screenings. Also, mammograms sometimes fail to detect breast tumors.
Some people do develop noticeable symptoms of breast cancer but don’t seek treatment soon enough to get an early diagnosis. Many people face barriers to accessing screening services or visiting a doctor when they have symptoms.
In a 2019 study of people with symptomatic breast cancer, participants said they delayed seeking medical care because:
- They thought the symptoms were caused by something less serious.
- They were busy with caregiving or work responsibilities.
- They couldn’t afford to take off work.
- They found it hard to arrange transportation.
- They were afraid that their healthcare team would judge them for not attending regular check-ups or making an appointment sooner.
People who receive a diagnosis of de novo MBC are more likely than those who receive an early-stage diagnosis to:
- be younger than 40 years old
- be Black or a woman of color
- have low income
- live in a rural area
Younger women are less likely than older women to get routine screening mammograms.
Those who have low income or live in rural areas often lack access to high-quality preventive health services.
The following factors increase your risk for breast cancer in general:
- being older
- having mutations in the BRCA1 or BRCA2 gene
- having a close family member with breast cancer or ovarian cancer
- getting your first period before the age of 12
- going through menopause after the age of 55
- not having children, or having your first child after the age of 30
- having had radiation therapy to the chest or breasts
- having dense breast tissue
- being overweight or having obesity
- using hormone replacement therapy (HRT)
- drinking alcohol
If you have de novo MBC, your treatment options will depend on:
- where in the body the cancer has spread
- the size, number, and genetic characteristics of the tumors
- your symptoms and treatment priorities
Your recommended treatment plan may include any of the following:
- radiation therapy
- hormone therapy
- targeted therapy
Your care team may also recommend palliative treatments such as pain medication to relieve breast cancer symptoms or treatment side effects.
Depending on where the cancer has spread, your doctor might recommend surgery, radiation therapy, or both to treat the primary tumor in your breast. However, these local treatments won’t kill or slow the growth of cancer cells that have spread to the bones, liver, lungs, brain, or other parts of the body.
New research suggests that removing the primary tumor may improve survival rates when de novo MBC has spread to the bones, liver, or lungs, but not the brain. Removing the primary tumor didn’t appear to improve survival when the cancer had spread to the brain.
Systemic therapies such as hormone therapy, targeted therapy, or chemotherapy are needed to kill cancer cells outside of the breast.
De novo MBC isn’t curable. However, survival rates have improved in recent decades due to the development of targeted therapies.
- 74.5 percent lived for at least 1 year following diagnosis
- 45.3 percent lived for at least 3 years after diagnosis
- 28.2 percent lived for at least 5 years after diagnosis
A small proportion of people with de novo MBC live for 10 years or longer.
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People with de novo MBC are “treatment naïve.” That means the cancer hasn’t been previously exposed to treatment and may be more responsive.
Research is ongoing to improve early diagnosis of breast cancer and to determine the best treatment approach for people with de novo MBC.
One 2020 case report describes a woman with de novo MBC who experienced complete clinical remission after treatment with ribociclib (Kisqali) and letrozole (Femara). Clinical trials are ongoing to study the safety and effectiveness of this regimen and similar treatment approaches.
De novo MBC is breast cancer that’s first diagnosed after it has already spread to distant parts of the body.
While there isn’t a cure, treatment options have improved survival rates and quality of life over the last few decades.
Speak with your cancer care team to learn more about your outlook and treatment options for de novo MBC.