Many breast cancers are discovered in the late stages. Is it really too late? You need to know these coping strategies!

Author: Song Guohong, Chief Physician, Peking University Cancer Hospital

Reviewer: Rong Long, Chief Physician, Peking University First Hospital

Breast cancer is divided into stages I, II, III, and IV.

Stages I and II are early stages, with smaller tumors and fewer lymph node metastases; Stage III is still confined to the breast, but the tumor is larger and there are more lymph node metastases; in Stage IV, distant metastasis will occur, which is what we call the late stage.

Some breast cancer patients are diagnosed at an advanced stage.

1. Why are many breast cancers already in the late stages when they are discovered?

Simply put, distant metastasis of breast cancer to any location is considered advanced. If you have regular physical examinations and regular breast cancer screening, you can detect it in the early stages.

Some women may not pay much attention to their breast health and wait until they have symptoms or feel a large lump in the breast before going for a checkup. By then, distant metastasis may have occurred. Some breast cancers are more malignant and develop faster, and are more likely to metastasize to the advanced stage.

Therefore, we recommend that women undergo regular screening for two cancers (cervical cancer and breast cancer) to detect and treat them early.

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Currently, the main means of screening for breast cancer are B-ultrasound and mammography. For women over 40 years old, it is recommended to have B-ultrasound and mammography once a year; for some high-risk women, they should be checked once a year around the age of 25-30.

2. How long does it usually take for breast cancer to develop from early stage to late stage?

This time is uncertain.

Some breast cancers will never metastasize or reach the advanced stage; some breast cancers, such as triple-negative breast cancer, are relatively more malignant and may reach a peak of metastasis in two or three years. Of course, some hormone receptor-positive breast cancers are relatively less malignant and may metastasize in about ten years.

So the time is different. Some breast cancer patients can be cured in the early stages and will not develop to the late stages.

3. If breast cancer has metastasized to distant sites, is there no way to treat it?

That’s not the case. Advanced breast cancer must be treated based on its type.

How is breast cancer classified? If estrogen receptor (ER) and/or progesterone receptor (PR) are positive, it is called hormone receptor-positive breast cancer; if epidermal growth factor receptor 2 (HER-2) is positive, it is called HER-2-positive breast cancer; if ER, PR, and HER-2 are all negative, it is called triple-negative breast cancer.

For HER-2 positive breast cancer, chemotherapy combined with anti-HER-2 targeted drug therapy has a very good targeted treatment effect.

Endocrine therapy is a very good choice for patients with ER or PR positive advanced breast cancer. The main target population for endocrine therapy is patients with receptor positive breast cancer. Under the action of estrogen, receptor positive breast cancer will promote the proliferation of tumor cells. Endocrine therapy inhibits the level of estrogen through different mechanisms of action, reduces the stimulation of estrogen on tumor cells, and achieves the purpose of controlling the proliferation of tumor cells. This is the simple treatment principle of endocrine therapy.

ER/PR-positive breast cancer is more sensitive to endocrine therapy, and there are some targeted drugs for endocrine therapy, such as CDK4/6 inhibitors. On the basis of conventional endocrine therapy drugs, such as aromatase inhibitors and fulvestrant, combined with CDK4/6 inhibitors, the overall survival of patients will be significantly improved. Of course, there are other targeted drugs, such as HDAC inhibitors, which can be used in combination with conventional endocrine therapy drugs to further improve the efficacy of endocrine therapy and increase the survival of patients.

When breast cancer reaches the late stage, we still have many treatment methods and means. Some patients with advanced breast cancer can survive for a long time, so even in the late stage, we must actively cooperate with the doctor for corresponding treatment.

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4. Can patients with advanced breast cancer still receive surgical treatment?

Surgery is not recommended for most advanced breast cancer patients, because advanced breast cancer has metastasized and there is more than one metastasis site, so surgery is not suitable for them. Systemic treatment is recommended, such as chemotherapy, endocrine therapy, targeted therapy, etc.

Which patients with advanced breast cancer can consider surgery? After systemic treatment, if the lesions are very localized and well controlled, such as if there is only an isolated lesion in the lung or a relatively small lesion in the liver, local treatment can be considered. Local treatment is not necessarily limited to surgical resection, and radiofrequency and radiotherapy can also be used.