De Novo Metastatic Breast Cancer: Treatments, Outlook, and More

De novo breast cancer refers to breast cancer that is first diagnosed when it has already spread outside the breast to distant parts of the body.

Most people with breast cancer are first diagnosed when the cancer is in the local or early stages of development. At that point, the cancer is only in the breast and sometimes in the surrounding lymph nodes.

Early stage breast cancer is very treatable. However, breast cancer can return after treatment, which is known as relapse.

Nearly 30 percent of women diagnosed with early-stage breast cancer eventually develop metastatic breast cancer (MBC). This happens when the cancer spreads or returns to distant parts of the body.

About 6 percent of women with breast cancer are first diagnosed after the cancer has already spread to other parts of the body. This is de novo breast cancer, or de novo MBC.

De novo MBC has no cure, but new treatment options have improved survival and quality of life over the past few decades.

Read on to learn more about de novo MBC.

Early diagnosis and treatment are important to prevent the spread of breast cancer. Delays in diagnosis and treatment can lead to de novo MBC.

In many cases, early-stage breast cancer does not cause symptoms. Early diagnosis is often the result of routine mammogram screening.

The U.S. Preventive Services Task Force recommends that women between the ages of 50 and 74 get a mammogram every 2 years to screen for breast cancer.

Doctors may also recommend screening for younger women who have an increased risk of breast cancer because of their family history.

However, not all women follow the recommendations to get breast cancer screened. Mammograms also cannot detect breast tumors.

Some people develop noticeable symptoms of breast cancer, but do not seek treatment quickly enough to receive an early diagnosis. Many people face barriers to accessing screening services or seeing 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 caused by something less severe. They were engaged in caregiving or work responsibilities They could not afford to get off work, they found it difficult to arrange transportation, they were concerned that their care team would condemn them for not attending regular checkups or earlier make an appointment.

People diagnosed with de novo MBC are more likely to have:

are under 40 years old are black or a woman of color have little income in a rural area

Younger women are less likely than older women to get routine screening mammograms.

Those on low incomes or living in rural areas often lack access to quality preventive health services.

The following factors generally increase your risk of breast cancer:

are older with mutations in the BRCA1 or BRCA2 gene have a close relative with breast or ovarian cancer; 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 with radiation therapy to the chest or breasts shaving dense breast tissue overweight or obese have hormone replacement therapy (HRT) use alcohol to drink

If you have de novo MBC, your treatment options will depend on:

where in the body the cancer has spread size, number and genetic characteristics of the tumors your symptoms and treatment priorities

Your recommended treatment plan may include:

surgery radiation therapy hormone therapy targeted therapy chemotherapy

Your health care team may also recommend palliative treatments, such as pain medications, to relieve breast cancer symptoms or side effects from treatment.

Depending on where the cancer has spread, your doctor may recommend surgery, radiation therapy, or both to treat the primary tumor in your breast. However, these topical treatments will not kill or slow the growth of cancer cells that have spread to the bones, liver, lungs, brain, or other parts of the body.

New research suggests that removing the primary tumor may improve survival when de novo MBC has spread to the bones, liver, or lungs, but not the brain. Removing the primary tumor did not seem to improve survival once the cancer had spread to the brain.

Systemic therapies such as hormone therapy, targeted therapy, or chemotherapy are required to kill cancer cells outside the breast.

De novo MBC cannot be cured. However, survival rates have improved in recent decades thanks to the development of targeted therapies.

A 2020 study found that in women with de novo MBC:

74.5 percent lived at least 1 year after diagnosis 45.3 percent lived at least 3 years after diagnosis 28.2 percent lived at least 5 years after diagnosis

A small proportion of people with de novo MBC live 10 years or more.

According to a 2020 review, multiple studies have found higher survival rates for women with de novo MBC than for women with recurrent MBC.

People with de novo MBC are ‘treatment naive’. That means the cancer has not been exposed to treatment before and may be more responsive.

Research is underway to improve early breast cancer diagnosis and to determine the best treatment approach for people with de novo MBC.

A 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 underway to study the safety and effectiveness of this regimen and similar treatment approaches.

De novo MBC is breast cancer that is first diagnosed after it has already spread to distant parts of the body.

While there is no cure, treatment options have improved survival and quality of life over the decades.

Talk to your cancer care team to learn more about your outlook and treatment options for de novo MBC.

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