Living with advanced breast cancer

Lillie Shockney, RN, BS, MAS, is the administrative director of the Johns Hopkins Avon Foundation Breast Center. She writes a regular column for Living With Cancer Health Monitor to help cancer survivors live well. As a breast cancer survivor herself and a healthcare professional, she speaks to audiences and has written books about breast cancer.

When I was 12 (I’m now 54), my mother’s best friend was diagnosed with stage IV breast cancer, which is cancer that has spread beyond the breast to other organs of the body.

Back then certainly, and even today, when you hear that a woman has stage IV breast cancer, your first thought may involve attending her funeral.

Indeed, my mother’s friend’s oncologist told her to get her affairs in order because he believed that even with aggressive treatment she would be dead in less than five months.

At that time, breast cancer treatment was grueling. Doctors routinely performed drastic surgery, administered radiation more toxic than what’s offered today instead of just the affected area, and had relatively few chemotherapy drugs to offer.

Instead of giving up, however, my mother’s friend made it her goal to outlive her oncologist. She followed his treatment advice fully and determined to live each day to the fullest, stay optimistic as long as it was realistic to do so, and find something to laugh about every day to help build her immune system.

She lived another 21 years.

Cancer as a chronic illness
Although her case was very unusual, especially for the time, my mother’s friend shows that some women can and do live with advanced breast cancer long-term. Things today are changing for the better for women diagnosed with stage IV breast cancer. Though some are swiftly swept away, others survive for many years. In many cases, they continue to work and enjoy their families while managing their disease as a chronic illness, much as people with diabetes learn to live with their condition by watching their diet and taking medication faithfully.

How is this possible?
Long-term survival very much depends on where a woman’s cancer has spread and other so-called prognostic factors, which help predict the course of the disease. These include not only the type and stage of the cancer but also various molecular traits of the tumor, the woman’s age, and whether or not she has other medical conditions. Breast cancers in which the spreading is fairly localized—where, for example, there are only one or two lesions in the bone or one small lesion in a lung—may respond well to today’s therapies and remain stable for years.

Significant advances in breast cancer treatment have been made since my mother’s friend was diagnosed. Some of these include biologic therapies like trastuzumab (Herceptin) and lapatinib ditosylate (Tykerb), which are members of a new generation of medicines that target tumors without killing lots of healthy cells; Gamma Knife surgery, which is actually carefully aimed radiation that can help control brain metastases; and hormonal therapies that reduce or block tumor-fueling estrogen. All of these options are offering real hope to women with advanced breast cancer.

I salute these women for their courage, personal drive, and ability to show the world that metastatic breast cancer isn’t necessarily a death sentence.

By the way, my mother’s friend accomplished her goal: She did end up outliving her oncologist.