Treating metastatic breast cancer in the bone

Treatments for bone metastases are often effective at stopping the growth or decreasing the size of the cancer deposits in the bones.

Treatment for metastatic breast cancer in the bone can:

• help to relieve symptoms (especially pain)
• heal bone damaged by metastases
• delay the progression of the bone metastases
• prevent complications such as bone fractures and high levels of calcium in the blood ('hypercalcaemia').

The 3 main ways of treating bone metastases are:

• (the most common way) whole body or ‘systemic’ treatments such as chemotherapy and hormone-blocking therapy, targeted therapy and/or immunotherapy
• (less common) local treatment, such as radiotherapy, to treat a single bone or single part of the body
• medications to make the bones stronger (bisphosphonates or denosumab)

What influences treatment decisions

The treatments recommended for you will depend on:

• which bones are affected
• whether bones have been weakened and are in danger of breaking or have already broken
• the treatments you've had in the past
• your subtype of breast cancer, such as HR-positive and/or HER2-positive or triple negative
• whether other parts of your body are also affected by metastatic breast cancer
• your general health
• your personal preferences.

Systemic treatments

Options are hormone-blocking therapies, chemotherapy and targeted therapies, and immunotherapy.

The type of systemic treatment you have will depend on the subtype of breast cancer. This information is in your pathology report.

Find out about treatments for your subtype of breast cancer:

• hormone receptor positive
• HER2-positive
• triple negative.

Chemotherapy may be the best first approach if the cancer is causing more significant problems or affecting other organs.

Local treatments

Radiotherapy

Radiotherapy is used to reduce pain and help prevent fractures. Treatment may be a single dose or a course of up to 12 doses. Usually you have few side effects, depending on the area being treated. It takes 2 to 4 weeks for most people to get the maximum benefit from radiotherapy.

Read about Radiotherapy for metastatic breast cancer.

Surgery

Surgery is an option to:

• fix a bone that has fractured due to the cancer
• make a bone stronger or more stable if the cancer has made it weak
• help prevent a fracture.

Bone-strengthening treatment 

Your specialist may discuss medication to make your bones stronger, to reduce the risk of fractures and reduce the risk of the cancer returning. 

Find out about Bone-strengthening medications (bisphosphonates and biologic agents).

Your treating team

As part of the team involved in your care when you have metastatic breast cancer, you may also have:

• an orthopaedic surgeon, if you have a bone fracture or risk of fracture
• a neurologist or neurosurgeon if cancer in the spine (‘vertebrae’) is pressing on a nerve
• a dentist, who has an important role in keeping your teeth, gums and jaw healthy. This is particularly important if you have bone strengthening treatments.

Resources

Video: Understanding and managing pain with metastatic breast cancer with Medical Oncologist Dr Belinda Yeo. Part of our 'Ask the Expert' series.