Treatment for de novo metastatic breast cancer

When metastatic breast cancer is your first diagnosis of breast cancer, you have several treatment options.

Doctors usually recommend a ‘systemic’ treatment. This destroys cancer cells wherever they have spread in the body. Systemic treatments work at the same time on:

• the cancer cells in the breast
• cancer cells in other places of the body (the ‘metastases’).

Systemic treatments for metastatic breast cancer are:

• hormone-blocking therapy (‘endocrine therapy’)
• chemotherapy
• targeted therapy.

Surgery usually isn’t the first step. Surgery is a ‘local therapy’, meaning it removes cancer only in the 'local' area of the breast. Specialists may consider surgery to control the cancer after drug treatment, depending on how far the cancer has spread in your body.

At the moment, there's no clear evidence to suggest that surgery will lead to a better outcome.

How doctors decide on treatment

Treatment for metastatic breast cancer is tailored to the individual.

Doctors need to consider many factors including:

• the subtype of metastatic breast cancer, which is in the pathology report
• how far in the body the cancer has spread
• age
• pre-menopausal or post-menopausal status
• medical history
• general health
• personal preferences.

Radiotherapy for metastatic breast cancer

Your oncologist might recommend radiotherapy to the breast or another area such as a bone. Radiation can reduce the size of the cancer and control its growth. In this case, they will refer you to a radiation oncologist to talk about the potential benefits.

Find out about radiotherapy for metastatic breast cancer.

Treatment differences for de novo metastatic breast cancer

A diagnosis of de novo metastatic breast cancer may offer different treatment options, compared to early breast cancer that returns.

De novo metastatic breast cancer hasn’t been exposed to anti-cancer treatments before. This is described as ‘treatment naïve’. You may have more or different options than people who had previous treatment for early breast cancer.

When surgery may be an option

Some people feel very anxious if surgery is not part of their initial treatment plan because the tumour remains in the breast. There is often no benefit to survival or outcomes, but there may be a psychological benefit for you.

This decision will depend on your personal situation.

If you have questions about surgery as part of your treatment plan, talk to your oncologist. They can help you understand the recommendations.

Surgical options could include:

• mastectomy to remove the whole breast (one or both breasts)
• lumpectomy to remove just the lump and some tissue around it
• other surgery, if there is a risk the cancer may cause problems such as ulceration through the skin.

How de novo metastatic breast cancer responds to treatment

Many people treated for de novo metastatic breast cancer notice the cancer in their breast getting smaller. Physical exams and scans such as mammograms and ultrasounds can also check these changes and progress.

Many people find it reassuring that their treatment is working for them.

Clinical trials

Clinical trials aim to find new or better cancer treatments. Your oncologist might talk to you about a trial for metastatic breast cancer.

You may want to Find a clinical trial or read about the benefits and how they work at About clinical trials.