Breast cancer bone metastases

Abstract

Bone metastases from breast cancer are very common and are the most significant cause of morbidity for breast cancer patients. Bony metastases are likely to cause pain, and may cause hypercalcemia, fracture, or rarely spinal cord compression. Most women present with bony metastases at the time of breast cancer recurrence. There are several distinct immunohistochemical subtypes of breast cancer that behave differently and have different treatment options. Estrogen receptor-positive breast cancer is disproportionately likely to metastasize to the bone, oftentimes being the only site of metastatic disease. Women with estrogen receptor-positive breast cancer are likely to live many years with good quality of life; thus aggressive management of their bony metastases is important. There are many imaging modalities available with bone scan being the best screening modality and CT scan being superior at characterization of a known bony lesion. Since the immunohistochemical profile of breast cancer often changes over time, obtaining repeat staining for estrogen, progesterone, and HER2 receptor status is important. A multimodality treatment approach is best for women with breast cancer metastatic to the bones and should include consideration of bisphosphonates or denosumab, radiation therapy, hormone therapy, and/or chemotherapy and orthopedic surgery.