The clinical course of bone metastases from breast cancer

Abstract

Summary All patients with carcinoma of the breast seen in this Unit since 1970 were reviewed to study the incidence, prognosis, morbidity and response to treatment of bone metastases. The biological characteristics of the primary tumour were compared in patients relapsing first in bone or liver.Sixty-nine percent of patients dying with breast cancer had bone metastases and bone was the commonest site of first distant relapse. Bone relapse was more common in receptor positive or well differentiated (grade 1) tumours.The median survival was 24 months in those with disease apparently confined to the skeleton compared with 3 monlhs after fiist relapse in liver.Ten percent of patients with breast cancer developed hypercalcaemia. All had metastatic disease and 85% had widespread skeletal involvement. Fifteen percent of patients with disease confined to the skeleton developed hypercalcaemia.The response in bone to primary endocrine therapy, and chemotherapy, was apparently less than the overall response achieved. A large proportion had apparently static disease reflecting the insensitivity of the UICC assessment criteria. The duration of survival in these patients was similar to responding patients, suggesting a tumour response may occur in the absence of discernable radiological evidence of healing.The majority of patients with advanced breast cancer have evidence of skeletal metastases by the time of death (Galasko, 1981 patients, all with skeletal involvement, receiving a variety of Br. J. Caticet-(1987), 55, 61-66

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

“…In patients with metastatic breast cancer, skeletal involvement is very frequent, with an incidence of 47-85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31,43]. Among reported clinical series of spinal epidural metastases, breast cancer is again common, accounting for 9-40% of all cases [11, 20, 22, 24, 28, 44-47, 49, 50].…”

“…In North American and Western European women, carcinoma of the breast is the most common malignancy and the second most common cause of cancer-related death [7,12,21]. In women with metastatic breast cancer, skeletal involvement is very frequent, with reported incidences between 47 and 85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31].…”

“…In women with metastatic breast cancer, skeletal involvement is very frequent, with reported incidences between 47 and 85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31]. About onethird of these spinal metastases become symptomatic, causing intractable pain, neurological deficits, and/or biomechanical instability requiring surgical treatment [19,34].…”

Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

“…Globally, it accounted for approximately 1.67 million cases in 2012 and 0.52 million deaths, and both numbers have continued to increase 1. Approximately 5% of patients present with distant metastases at their initial diagnosis of breast cancer, with bone being the most common site 2, 3. Of those patients who die of breast cancer, approximately 70% will have evidence of bone metastases 4…”

Bone resorption predicts for skeletal complications in metastatic bone disease

“…Additionally, a proportion of patients will die as a direct consequence of their skeletal disease. Owing to the prolonged course of metastatic bone disease (Coleman and Rubens, 1987), the frequency of skeletal events in relation to average patient survival assumes particular importance. Without bisphosphonate therapy, a major skeletal event occurs on average once every 3 -4 months (Hortobagyi et al, 1996;Theriault et al, 1999).…”