De novo metastatic breast cancer refers to breast cancer that doctors diagnose for the first time after it has already spread outside of the breast to distant parts of the body.
Nearly 30% 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 6-10% 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 (de novo MBC).
There is no cure for de novo MBC, 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.
Symptoms of de nova MBC can vary depending on where the cancer metastasizes (spreads to). However, general symptoms may include:
- nausea and vomiting
- loss of appetite
- fatigue
- pain
The table below describes more specific symptoms that are associated with some possible sites of metastasis:
| Site of metastasis | Symptoms |
| bone | • sudden, noticeable new pain • commonly spreads to spreads to the ribs, spine, pelvis • can also spread to the long bones in the arms and legs |
| lung | • can often be asymptomatic • may cause pain or discomfort in the lung • may cause shortness of breath • may cause a persistent cough |
| liver | • can often be asymptomatic • may cause pain or discomfort in the midsection • may cause fatigue and weakness • may cause weight loss or poor appetite • may cause a fever |
| brain | • headaches • changes in speech or vision • memory problems |
Early diagnosis and treatment are important for preventing the spread of breast cancer. Delays in diagnosis and treatment
Often, early-stage breast cancer causes no symptoms. Early diagnosis is typically the result of routine screening with mammograms.
The
Doctors may also recommend screening for younger women who have an increased risk for breast cancer due to family history.
However, not all women follow the recommendations to get breast cancer screenings. Also, mammograms
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 due to something less serious.
- They were busy with caregiving or work responsibilities.
- They couldn’t afford to take off work.
- They had difficulty arranging transportation.
- They feared 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
- be younger than 40 years old
- be Black or a person 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 incomes or live in rural areas often lack access to high quality preventive health services.
The following factors
- being older
- having mutations in the BRCA1or BRCA2gene
- 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
Depending on your symptoms, your doctor may conduct a combination of the following tests to establish where your cancer has spread:
- physical exam
- blood tests
- whole-body bone scan
- X-rays of specific bones
- MRI (magnetic resonance imaging) of the spine or brain
- CT (computed tomography) scan of the chest, abdomen, pelvis, or brain
- PET (positron emission tomography) scan
- X-ray or ultrasound of the abdomen or chest
- bronchoscopy if you have a constant cough or trouble breathing
- biopsy
- a tap, removal of fluid from the area with symptoms to check for cancer cells (for example, a pleural tap, spinal tap, or abdominal tap)
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:
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.
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.
One
- 74.5% lived for at least 1 year following diagnosis
- 45.3% lived for at least 3 years after diagnosis
- 28.2% lived for at least 5 years after diagnosis
According to a
People with de novo MBC are “treatment naïve.” That means the cancer hasn’t had previous exposure 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.
Below are some commonly asked questions about de novo MBC.
How long can you live with de novo metastatic breast cancer?
According to a
- 74.5% lived for at least 1 year following diagnosis
- 45.3% lived for at least 3 years after diagnosis
- 28.2% lived for at least 5 years after diagnosis
Has anyone ever beat metastatic breast cancer?
Metastatic breast cancer is an incurable disease. However, if you receive a diagnosis of metastatic breast cancer, that does not mean you automatically have a terminal diagnosis.
While the disease will shorten your life, you can often manage it for several years.
What is the difference between recurrent and de novo metastatic breast cancer?
Recurrent breast cancer and de novo MBC are
Recurrent breast cancer refers to cancer that has returned after a period of remission or after initial treatment. This may recur locally in the breast or spread to distant sites in the body.
Meanwhile, de novo metastatic breast cancer refers to breast cancer that a doctor first diagnoses when it has already spread outside of the breast to distant parts of the body.
De novo MBC is breast cancer that a doctor first diagnoses 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.