Life expectancy for stage 4 breast cancer (metastatic breast cancer) varies widely. Each person is different, and factors like your age, overall health, the type of breast cancer, and even the organ sites where cancer has spread (metastasized) can affect treatment outcomes.
Stage 4 cancer isn’t curable, so it can be helpful to look at long-term survival rates and other information to become better informed about a prognosis, or outcome. Keep in mind, though, that the data also has limitations and not everyone may find the current research helpful.
This article presents five-year survival rates for people living with stage 4 breast cancer but also includes the variables to consider when talking about these survival rates.
Five-Year Survival Rates
The American Society of Clinical Oncology (ASCO), drawing on 2022 data from the National Cancer Institute and American Cancer Society, reports an overall five-year survival rate of 29% for females living with metastatic breast cancer. The five-year survival rate is 22% for males living with the disease.
However, cancer survival statistics don’t immediately reflect changes in treatment that are improving breast cancer care. These advances include:
- HER2 targeted therapies
- The addition of bisphosphonates
- Newer immunotherapy drugs
While not as effective with breast cancer as some other cancers, immunotherapy drugs have led to a durable response, or long-term response, for at least some people with advanced breast cancers.
Oligometastases and Treatment
Another area of treatment that is changing is the treatment of oligometastases. In the past, people with metastatic disease (whether to a single site or many) were treated the same way, via general treatments for metastatic cancer such as chemotherapy or hormonal therapy.
Survival Rates and Statistics
The American Society of Clinical Oncology (ASCO) wants you to keep in mind that annual statistics for five-year survival rates are up to date but they rely on historical information. This means they don’t immediately reflect advances in treatment that are improving breast cancer care.
Research has begun to look at the benefit of treating oligometastases, which are defined as one or only a few metastases to a particular organ. These isolated metastases may be treated with:
- Surgery
- Proton therapy
- Stereotactic body radiotherapy
With some cancer and metastases in some regions (such as lung cancer with brain metastases), treatment has extended life and sometimes results in long-term survival. Future advances may lead to similar improvements in life expectancy.
Variables and Breast Cancer Survival
Life expectancy with stage 4 breast cancer is affected by many factors. Some of these factors may be “actionable,” meaning there are things people can do that may affect their prognosis.
Other factors, like your age or the type of cancer, are not things you can change. There are many exceptions to the general rules, too. Some people who have a very poor prognosis survive many years or decades, while others with an excellent prognosis may live for a shorter time than most.
Some factors associated with survival include:
- Type: Some types of breast cancer are associated with better survival rates than others.
- Age: While breast cancer has the reputation of being more aggressive in younger women, young women are more likely to become long-term survivors of breast cancer than older women are.
- Receptor status: People who have positive receptors, whether estrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 (HER2), tend to live longer than those who have negative receptors—especially triple negative disease.
- Location of metastases: Breast cancer metastases to bones are associated with a higher survival rate than metastases to other regions such as the lungs, liver, and brain.
- Treatment choices: This includes treatment of oligometastases. A 2019 study found that treating this type of spread (usually up to five areas) can sometimes significantly improve survival.
- Physical activity: Activity and exercise may improve survival. A study of 103 people diagnosed with stage 4 breast cancer found that one hour or more of activity each day led to longer survival times.
- Emotional and social support: People who have a supportive partner are more likely to live longer, and having a partner is one of the factors associated with long-term survival.
- General health: General health plays a significant role in survival rates, and also affects the treatments that a person will be able to tolerate.
Complications of advanced breast cancer such as blood clots, fractures, malignant pleural effusions, and more can decrease the projected life expectancy.
Variables That Don’t Affect Survival
Stage 4 breast cancer prognosis isn’t affected by all factors. Just as there are factors associated with a better or worse prognosis, there are some factors that do not appear to make a big difference.
People tend to not understand these factors as well. They include:
- How aggressive your treatment is (in general)Having a positive attitude
Treatment goals for metastatic breast cancer are often different than that of early-stage disease. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk that the cancer will come back.
In contrast, with stage 4 disease, the goal is usually to use the minimum amount of treatment possible to control the disease (at least at the current time). Studies have found that more aggressive treatment does not improve survival rates but does reduce quality of life.
While having a good attitude may improve your sense of well-being, it has not been shown to affect survival rates. On the other hand, nearly 42% of people diagnosed with breast cancer experience anxiety. Trying to appear positive rather than expressing your concerns may be harmful to your health in general.
Who Are Long-Term Survivors?
Being a long-term survivor is usually defined as living five or more years beyond a diagnosis of stage 4 breast cancer.
Living 10 or more years isn’t unheard of, and the 10-year survival rate for primary or de novo metastatic breast cancer is around 13%. (This rate is based on de novo cases, or cases in which stage 4 was the initial diagnosis.)
Characteristics
While there is a significant degree of variability, long-term survivors are:
- More likely to be younger (this is in contrast to early-stage breast cancer in which the survival rate is lower for younger people with the disease)
- More likely to have estrogen receptor, progesterone receptor, and/or HER2-positive tumors
- Less likely to have other medical conditions (co-morbidities)
- Less likely to have “visceral” metastases, such as metastases to the abdomen and liver metastases
- More likely to have a higher household income
- More likely to have a partner
Long-term survivors are also more often diagnosed with metastatic breast cancer at the onset (de novo breast cancer), rather than having had previous early-stage breast cancer that recurred at distant sites.
In different studies, the length of response after the first treatment for metastatic breast cancer was linked to survival. That said, it can be difficult to predict who may survive for a lengthy period of time based on measurements currently available.
Recently, research has begun to focus on people who survive longer than expected, or “outliers,” to gain insight into genetics and other factors that may be making the difference.
Coping With Stage 4 Breast Cancer
Coping with stage 4 breast cancer is challenging, and it is different from coping with early-stage disease. For those who originally faced early-stage breast cancer, not only do they need to face cancer again but this time they aren’t dealing with a disease that can potentially be cured.
Metastatic breast cancer often comes with more symptoms as well, such as bone pain due to bone metastases and itching with liver metastases. On top of all of this (and despite all of the “awareness” that has taken place), people with stage 4 disease may feel left out within the breast cancer community.
Support
Support is very important, and some studies suggest that social support even improves the length of survival. Family and friends are key but becoming involved in a support group or breast cancer community is extremely helpful as well.
Through these communities, you have the opportunity to connect with others who are facing some of the same challenges.
Many people with stage 4 breast cancer prefer a social community dedicated to metastatic breast cancer. If you’re living with metastatic cancer, it may be hard to listen to others talk about concerns common with early-stage, such as hair loss or the chance of pregnancy. You may have drastically different concerns, such as how long you will live.
Being Your Own Advocate
The relationship between self-advocacy and survival is unclear but being your own advocate can’t hurt in maximizing your survival. For example, some studies show that informed decision-making may improve among people attuned to their breast cancer symptoms.
Cancer and Caregivers
Caring for a loved one with stage 4 breast cancer has special challenges as well. Some support groups are designed for loved ones and can help you to learn more about self-care as well as your loved one’s needs. Most people with metastatic breast cancer will require some type of treatment for the rest of their lives, and support can help you to become better equipped.
Oncology is changing rapidly and it’s difficult for any oncologist—even those who specialize in breast cancer—to stay aware of all of the latest research and clinical trials taking place.
Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.
It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.
Some opportunities don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.
Larger cancer centers may offer remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about treatment options that may not be available elsewhere.
Palliative Care and Coping
Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.
Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors.
Summary
With stage 4 breast cancer, the spread (metastasis) of the disease changes the priorities people have at an earlier stage of diagnosis. Treatment options are different, but so is your outlook about how your cancer will progress.
Some research suggests that people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.
Five-year survival rates are a common and reliable measure of prognosis, but they never tell the whole story. Each person is different and the variables affecting your cancer diagnosis, including its receptor status and related therapies, affect the outcome.
Life expectancy for people living with stage 4 breast cancer also continues to evolve on the basis of new research discoveries. Your healthcare team can help you to understand your disease, make informed choices, and connect you and your loved ones with support resources.
