Stage 4 Breast Cancer Overview

What is Stage 4 breast cancer?

According to the National Cancer Institute, approximately 30% of women initially diagnosed with early-stage breast cancer will ultimately develop Stage 4 (metastatic) breast cancer, often months or years later.

Any type of breast cancer, except for ductal carcinoma in situ (DCIS), which is non-invasive, can become Stage 4. In order for an earlier stage of breast cancer to later become Stage 4, the cancerous cells would have already spread to at least one of the distant organs where it was later found. However, at the time of the initial diagnosis of breast cancer, this spread of cancerous cells may be been too small to see on a scan. But after a period of dormancy, for a short or long while, the cells become active and start growing in the distant organ.

Although Stage 4 breast cancer is not curable, it is usually treatable. Current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, Stage 4 breast cancer may respond to a number of treatment options that can extend life for several years.

This is especially true for those whose cancer cells are ER+, PR+, and HER2-.  CDK4/6 inhibitors are a relatively new classification of drugs that have become a game changer resulting in many women years, even decades, in harmony with their Stage 4 breast cancer.

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Table of contents

• Stage 4 breast cancer symptoms
• Stage 4 breast cancer survival rates
• Breast cancer Stage 4 prognosis
• Diagnosing Stage 4 breast cancer
• Treatment options for Stage 4 breast cancer
• Palliative care for Stage 4 breast cancer
• FAQs
• Stage 4 breast cancer stories of hope

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Stage 4 breast cancer signs and symptoms

The symptoms of Stage 4 breast cancer may be different depending on what part of the body the breast cancer has spread to. The most common areas for breast cancer to spread to are the bones, lungs, liver, or brain. If the cancer cells are invasive lobular carcinoma (ILC), those cells may travel to additional organs, such as the uterus, ovaries, stomach, or colon.

Not all breast cancer may cause signs or symptoms that can be observed or felt. However, if you experience any of the following symptoms, you should contact your healthcare provider or oncologist right away.

Symptoms of Stage 4 breast cancer in the bones

The bones, particularly the spine, pelvis, and thigh bones, is the most common place for breast cancer to spread to, affecting approximately 70% of Stage 4 patients. 

Not all Stage 4 breast cancer has observable signs or symptoms. But if breast cancer has spread to the bones, the following signs and symptoms may be felt:

• Severe, progressive bone pain, particularly in the spine, ribs, pelvis, or long bones in the arms and legs
• Swelling of joints within the skeletal system
• Weak or fragile bones, not as a result of osteoporosis 
• Weakness in the arms or legs
• High levels of calcium in the blood (hypercalcemia) 

Symptoms of Stage 4 breast cancer in the lungs

After bones, the lungs are the second most common area of the body for breast cancer to spread to, affecting approximately 60% of Stage 4 breast cancer patients. 

Lung metastasis may not produce signs or symptoms. But if signs and symptoms are present, the following may indicate metastasis to the lungs:

• Chronic cough
• Shortness of breath, particularly after physical exertion
• Pain or discomfort in the chest area

Symptoms of Stage 4 breast cancer in the liver

Approximately 50% of individuals with Stage 4 breast cancer will develop liver metastases at some point. 

Stage 4 breast cancer in the liver rarely produces symptoms. But if symptoms do occur, they can include:

• Jaundice (yellowing of the skin and whites of the eyes)
• Itchy skin or rash
• High liver enzyme levels determined through a blood test
• Abdominal pain, particularly on the right side
• Weakness
• Loss of appetite
• Nausea and vomiting
• Light gray stool color
• Weight loss

Stage 4 breast cancer symptoms in the brain

Brain metastasis occurs in approximately 10-15% of women with Stage 4 breast cancer. Research studies are underway to determine if this percentage is actually higher than currently reported. This is due to the methods used to diagnose it. Medical oncologists usually wait for symptoms to appear before scanning the brain. This means that some individuals may have brain metastasis without having notable symptoms.

Metastasis of Stage 4 breast cancer in the brain may cause a variety of symptoms: 

• Persistent and progressively worsening headaches or pressure in the head
• Memory loss
• Vision disturbances (blurred vision, double vision, loss of vision, etc.)
• Slurred speech
• Dizziness or balance problems
• Weakness or paralysis on one side of the body
• Numbness or tingling in the extremities
• Nausea or vomiting
• Seizures or stroke
• Mood, personality, or behavioral changes
• Impaired judgment

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Stage 4 breast cancer survival rate

Stage 4 breast cancer is the most advanced stage of breast cancer with the lowest survival rate of the breast cancer stages. Survival rates for breast cancer are calculated by the National Cancer Institute (NCI) using a 5-year relative survival rate. This rate compares women with the same type and stage of breast cancer to women in the general population.

It is important to remember that while survival rates are estimates based on previous patient outcomes, they cannot accurately predict what will happen in each unique individual’s case. These statistics may be confusing or discouraging, leading you to have more questions. Please reach out to your healthcare team for more information and details about how these statistics may apply to your unique situation.

According to the American Cancer Society, the 5-year relative survival rate for Stage 4 breast cancer in women is 31%. This means 31% of women with Stage 4 breast cancer will still be living 5 years after diagnosis.

However, with advancements in treatment options for Stage 4 breast cancer, its survival rate is expected to rise. Approximately 70% of Stage 4 breast cancer patients have HR+, HER2-negative metastatic disease, and are candidates to receive a new classification of drugs called CDK4/6 inhibitors. These patients are therefore able to have their cancer treated as a chronic illness. However, patients whose metastatic disease is triple negative (ER-, PR-, HER2-negative) are not yet seeing higher survival rates.

The table below shows the survival rates for all levels of breast cancer, including Stage 4, which is considered distant breast cancer.

Breast cancer survival rates by SEER* stage

SEER stage	5-year relative survival rate
Localized: There is no sign that cancer has spread outside of the breast. Includes only invasive breast cancer, not DCIS.	99%
Regional: The cancer has spread outside of the breast to nearby structures or lymph nodes.	86%
Distant: The cancer has spread to different parts of the body, such as the bones, lungs, liver, or brain.	31%
All SEER stages combined	91%

Stage 4 breast cancer survival rate for men

While rare, men can also develop Stage 4 breast cancer. The 5-year relative survival rate for Stage 4 breast cancer in men is 20%, according to the American Cancer Society. 

This lower survival rate in men is largely due to men not attributing a lump or other irregularity in their breast tissue as potentially being cancerous. Therefore, men are less likely to see a doctor and are often diagnosed at later stages when cancer is harder to treat.

Stage 4 breast cancer survival rate by age

Many people want to know if Stage 4 breast cancer survival rates can be calculated by age. However, it is difficult to quantify survival rates based on age without considering the initial age and health status of the patient when first diagnosed.

If a 40-year-old woman is diagnosed with Stage 4 breast cancer, the likelihood of Stage 4 breast cancer causing her death is high because of the relatively young age at which she was diagnosed. But if a 75-year-old woman is diagnosed with Stage 4 breast cancer, her eventual death may be more likely to be caused by other factors, such as older age, health status at diagnosis, or other comorbidity factors (the existence of more than one condition within the body at the same time), such as heart disease, hypertension, diabetes, etc.

Stage 4 breast cancer survival rate by area of metastasis

Currently, there is not much data on survival rates based on the area of breast cancer metastasis. However, if the cancer is limited to just the bones, the disease tends to be easier to manage, giving these patients the longest survival time.

Stage 4 breast cancer survival rate by cancer type

Different types of breast cancer have different characteristics, including differing survival rates:

Stage 4 inflammatory breast cancer (IBC) survival rate

Inflammatory breast cancer (IBC) is rare, accounting for only 1-5% of breast cancer diagnoses. IBC is considered Stage 3 breast cancer upon diagnosis because it involves the metastasis (spread) of cancer to the skin of the breast. If IBC spreads beyond the breast tissue and breast skin to other organs of the body, it is considered Stage 4 inflammatory breast cancer. 

According to the American Cancer Society, the 5-year relative survival rate for Stage 4 inflammatory breast cancer is 19%.

Stage 4 triple negative breast cancer (TNBC) survival rate

Triple negative breast cancer (TNBC) is an aggressive form of breast cancer that typically grows quickly, making it harder to catch in the early stages. Because of this, the survival rate for Stage 4 triple negative breast cancer is lower than other types of Stage 4 breast cancers.

According to the American Cancer Society, the 5-year relative survival rate for Stage 4 triple negative breast cancer is 12%.

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Stage 4 breast cancer life expectancy and prognosis

Every person is different and will respond to cancer and treatments differently. Therefore, there is no guaranteed number for Stage 4 breast cancer life expectancy. Depending on the severity of the diagnosis, treatments undertaken, and other contributing health factors, some women live only 1 to 2 years after a diagnosis, while others may live up to 10 years or more with Stage 4 breast cancer.

Due to advancements in treatments, more and more women are living longer by treating the disease as a chronic illness through continuous treatment and monitoring, with a focus on quality of life as a primary goal.

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Stage 4 breast cancer diagnosis

How is Stage 4 breast cancer usually diagnosed?

Stage 4 breast cancer is often initially investigated based on symptoms the patient may be experiencing. If a patient is experiencing symptoms of Stage 4 breast cancer, their healthcare provider may perform a staging workup.

A staging workup for Stage 4 breast cancer may include:

• Blood tests, including tumor markers in some patients. Blood tests may also include:
  • Complete blood count (CBC) to assess the body’s bone marrow function
  • Liver enzymes to check for liver metastasis
  • Calcium levels to check for bones metastasis
• Whole-body bone scan, with or without x-rays of specific bones
• MRI (magnetic resonance imaging) of the spine or brain
• CT (computer tomography) scan of the chest, abdomen, pelvis, or brain
• PET (positron emission tomography) scan 
• X-ray or ultrasound of the abdomen or chest
• Bronchoscopy, if there is a persistent cough or trouble breathing
• Biopsy of any suspicious areas found on a PET/CT scan
• Tap: Removal of fluid from the area with symptoms to check for cancer cells
  • Pleural tap (thoracentesis): Removes fluid between the lung and chest wall
  • Spinal tap (lumbar puncture): Removes fluid from around the spinal cord
  • Abdominal tap (paracentesis): Removes fluid from the abdominal cavity
• Your doctor may ask questions about the patient’s health and family history, including if they have had cancer previously, if any of their relatives have a history of cancer, and other questions about their overall health.
• Personal history of breast cancer and its treatment

If Stage 4 breast cancer is suspected, your doctor may recommend genetic testing to see if the patient has a mutation in a breast cancer gene (BRCA1 or BRCA2) that increases the likelihood of developing breast cancer, as well as the likelihood of close family members developing breast cancer.

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Treating Stage 4 breast cancer

Since Stage 4 breast cancer will be part of a patient’s life for the rest of their life, the goal of Stage 4 breast cancer treatment differs from the treatment goals of other stages of breast cancer. Because it is incurable, the focus of Stage 4 breast cancer treatment is to control the disease through continuous treatment and monitoring, with a focus on the patient’s quality of life as a primary goal.

As you begin treatment for Stage 4 breast cancer, talking with your treatment team about yourself, beyond your diagnosis, can be very important and is something your care team can take into consideration.

Below are examples of things to let your treatment team know about so that they can create a treatment plan that takes your personality, family, goals, and hopes for the future into account:

• Family status: Are you married? Do you have children? Grandchildren?
• Likes and hobbies: What do you do for work? Do you enjoy outdoor activities, such as hiking or swimming? Do you enjoy knitting, watching movies, or have any other hobbies? What 3 things bring you joy? This type of information can help your care team tailor your treatment to help keep you enjoying the things that you love.
• Goals: What upcoming milestones do you have, such as family weddings or graduations, that you need to feel well enough to attend?

Stage 4 breast cancer treatment options

Stage 4 breast cancer treatment usually consists of systemic therapies. Systemic therapies are drug therapies that work throughout the entire body, rather than focusing on one specific area of the body. Systemic therapies commonly used to treat Stage 4 breast cancer include:

• Hormonal therapy: A type of drug therapy that keeps breast cancer cells from receiving or using the natural female hormones in the body (estrogen and progesterone) which they need to grow. Hormonal therapy also blocks the ability of healthy breast cells to receive hormones that could stimulate breast cancer cells to regrow. These drugs are commonly combined with CDK4/6 inhibitor therapy.
• Chemotherapy: A treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells. Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body.
• Targeted therapy: A treatment method that uses drugs to target specific proteins on cancer cells that may help them grow or spread. Targeted drugs work to destroy or slow down cancerous cell growth and are most commonly used to treat cancer cells that are HER2-positive.
• Immunotherapy: A relatively new form of treatment for women with Stage 4 metastatic breast cancer, which uses the patient’s immune system to fight the cancer.

In some cases, local (non-systemic) treatments may also be used to treat Stage 4 breast cancer and its symptoms. Local treatments for Stage 4 breast cancer may include radiation therapy and/or surgery. 

What should a person with Stage 4 breast cancer expect from treatment?

In addition to monthly support group meetings, NBCF hosts free metastatic breast cancer retreats for those living with Stage 4 breast cancer and their caregivers. These retreats are a time for Stage 4 patients to come together, along with their caregivers, to offer one another support, hope, and encouragement for what lies ahead.

Sessions include the opportunity to ask questions of a breast medical oncologist, discussions of what may lie ahead, ways to regain control of your life during times of uncertainty, stress management classes, networking with others in the same situation, opportunities for patients to express their hopes and fears, yoga, meditation, mindfulness, laughter sessions, and card selections for children and grandchildren for when they reach future milestones. Email [email protected] for more information on NBCF metastatic breast cancer retreats.

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Palliative care for Stage 4 breast cancer

Many patients diagnosed with Stage 4 breast cancer choose to begin palliative care, either immediately upon diagnosis or if symptoms or treatment side effects begin to affect their quality of life. Palliative care is not a treatment for metastatic breast cancer, nor is it hospice care.

Instead, palliative care is supportive care that focuses on the management of symptoms or side effects that are disruptive to a patient’s quality of life. Palliative care may include specialized pain management options, drug therapy to alleviate nausea and increase appetite, emotional care from trained professionals, and more. The goal of palliative care is quality of life preservation or restoration.

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Stage 4 breast cancer FAQs

Can Stage 4 breast cancer go into remission?

There is no cure for Stage 4 breast cancer, but it is possible for Stage 4 breast cancer to go into remission. This is also called “no evidence of disease,” or NED. When Stage 4 breast cancer is NED, it means that the cancer is not visible on imaging or other tests, but is likely still in the body at a level that is too small to detect.

How serious is Stage 4 breast cancer?

Stage 4 breast cancer is the most advanced and most life-threatening stage of breast cancer. There is no known cure for Stage 4 breast cancer, with the focus of treatment being quality of life for the patient.

Can Stage 4 breast cancer go undetected?

It is not uncommon for all stages of breast cancer, including Stage 4, to produce no noticeable symptoms when the cancer first develops. However, as Stage 4 breast cancer progresses and spreads, symptoms will begin to appear. It is important to report any and all symptoms of Stage 4 breast cancer to your doctor or oncologist as soon as you are aware of them.

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Stage 4 breast cancer stories of hope

No matter the stage of breast cancer, NBCF is here to offer help and hope. The NBCF blog, The Hope Nook, offers several hopeful and encouraging stories from women facing Stage 4 breast cancer:

Confessions of an 18-Year Metastatic Breast Cancer Thriver
Spoiler Alert: She Lives
Marianne’s Story of Finding Hope with Metastatic Breast Cancer

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