“When will you be done with treatment?”
It’s the most common question metastatic breast cancer patients receive, but also one of the hardest to answer.
Unfortunately, unlike many other forms of cancer, there’s no current way to put an end to breast cancer once it’s metastasized.
Metastatic breast cancer, also known as stage 4 breast cancer, is breast cancer that’s spread to another part of the body, most commonly the liver, brain, bones or lungs, according to the American Cancer Society.
Breast cancer can come back in another part of the body months or years after the original diagnosis and treatment, and nearly 30% of women diagnosed with early-stage breast cancer develop MBC.
When patients are diagnosed with breast cancer at lower stages, oncologists often refer to it as curable, but when it reaches stage 4, it’s referred to as “treatable” rather than curable, as these patients will need ongoing treatment to keep the cancer at bay, explained Dr. Rena Callahan, an oncologist at UCLA Santa Clarita Valley Community Cancer Clinic.
“We’ll be in treatment for the rest of our lives,” said Eva Miranda Crawford, who was diagnosed with MBC in 2018. “Right now, it’s a terminal disease, and we want it to be chronic.”
MBC is currently considered incurable, and its three- to five-year survival rate is about 28%, according to the ACS.
However, there are treatments that slow the cancer, extending the patient’s life while also improving their quality of life, according to Callahan and Dr. Sylvia Fowler, chief of the department of hematology/oncology at Kaiser Permanente Panorama City.
Over the last few decades, an MBC patient’s average life expectancy has continued to extend as treatments emerge and evolve.
“As a result, we have over 150,000 women in the United States that are living with metastatic breast cancer,” Callahan noted, “and many of them are just going about their lives, many have jobs — and you might not even know it, depending on what kind of treatment they’re on … A lot of patients on these types of therapies are living with a disease as opposed to being completely defined by it.”
This has become true for Crawford, the daughter of city of Santa Clarita Mayor Bill Miranda, as well as Santa Clarita resident Tracey Bruckner, both of whom are finding ways to balance their lives and their ongoing cancer treatment.
Being diagnosed with incurable cancer is something Bruckner and Crawford described as being blindsided.
“None of us have any guarantee — you can walk outside and get hit by a bus,” Bruckner said.
“You could get hit by a bus tomorrow, and the only … difference is we see our bus, and we see it driving slowly toward us,” Crawford added.
One of the 30%
Bruckner, who has a family history of breast cancer, remembers the day she received her life-changing mammogram like it was yesterday.
A month late for the routine procedure and feeling fine, she recalls calling the doctor’s office and asking for their soonest appointment.
“They were like, ‘Well, we have a cancellation today,’ and I turned around and went,” Bruckner said, adding that it was then that doctors discovered a lump that turned out to be cancerous.
While the first oncologist told her she’d need a lumpectomy, she sought a second opinion and another found two more spots, both of which came back cancerous, as well.
Bruckner was diagnosed with stage 1 breast cancer, and though the lumps were all less than one centimeter, she opted for a double mastectomy.
“I was scared to death,” she added. “When you’re scared, you’re just like, ‘I don’t want to die, just take them off.’”
She then spent the next five years on a hormone blocker and returned for annual checkups, but it wasn’t until year eight that her blood test came back with elevated tumor markers, an alert that something isn’t right.
It was then that Bruckner joined one of the 30% of women whose cancer metastasized, as doctors discovered Bruckner’s cancer had spread to her T12 vertebra in her spine.
She then received stereotactic body radiation therapy, an innovative and precise treatment that delivers higher doses of radiation, and was put on a CDK4/6 inhibitor, a newer class of medicine that interrupts the process through which breast cancer cells divide and multiply.
While she’s had no evidence of disease since November 2019, Bruckner continues to have elevated tumor markers and has scans every three months.
“That’s a big part of living with it is the scans,” Bruckner said, noting it’s the uncertainty of whether she’ll get a call that says the cancer has returned that’s difficult.
Stage 4 from day 1
While Crawford, too, was diagnosed with breast cancer after a routine mammogram, she was told right off the bat it was stage 4 in July 2018.
Though she’d had back pain the year prior, an ER visit resulted in nothing found, and it wasn’t until she received more throughout scans following the mammogram that doctors discovered innumerable tumors all up and down her spine, hip, bones, skull and liver.
Crawford had hip surgery to stabilize her hip, and a prophylactic rod was placed in her left hip, leaving her learning to re-walk as she began chemotherapy.
Because she was in palliative care, Crawford had to get a nanny to help care for her kids, who were 3, 5 and 7 years old at the time.
Crawford received chemotherapy until December 2018, followed by a lumpectomy when the cancer had cleared out elsewhere, physical therapy to get her strength back and then more than 40 rounds of radiation.
Since then, Crawford has improved but continues to receive hormone blockers every three weeks via infusion through a port in her arm.
This has become her new normal, as she works to spread awareness for MBC.
Shining a light on MBC
“We often talk about early breast cancer, but we don’t talk about metastatic breast cancer enough,” Fowler said.
Bruckner, who said she continues to find herself saying that she doesn’t want to scare people, and Crawford both believe it’s time to start talking about MBC, finding new ways to look at breast cancer awareness.
“We’re all working together to eradicate or at least make the disease viable,” Crawford said. “The more we help the (stage) 4’s, the less any other stage has to be afraid of the 4’s.”
While 98% of all breast cancer-related deaths are from MBC, only 2-5% of the money for breast cancer research is dedicated toward understanding MBC or finding solutions to extend the lives of MBC patients, according to METAvivor, an organization dedicated specifically to those with MBC.
Conversely, 100% of funds raised by METAvivor go toward research grants, which remains the sole U.S. organization dedicated to awarding annual stage 4 breast cancer research, according to METAvivor.
METAvivor is teaming up with Moore Fight Moore Strong on Oct. 13 for the third annual #LightUpMBC global landmark campaign, aimed at shining a light on the importance of awareness and funding for stage 4 MBC research.
Here in the SCV, Santa Clarita City Hall is set to join landmarks across the globe in illuminating in green, pink and teal for the nationally recognized Metastatic Breast Cancer Awareness Day.
For more information or to donate, visit donate.metavivor.org/fundraiser/3273809.