Breast Cancer and the Brain:
Staying on Top of Neurologic Symptoms Is Key

May Abdo-Matkiwsky, DO

With new advances in breast cancer care, Stage IV breast cancer patients are living longer than ever before. However, even when the disease is controlled systemically, patients and survivors are at risk of the cancer metastasizing in the brain. Medical oncologist May Abdo-Matkiwsky, DO, explains why monitoring neurologic symptoms is critical and how new treatments are preserving patients’ quality of life.

Is the prevalence of metastatic breast cancer in the brain increasing?

Thanks to the development of more therapeutic options for women and men with metastatic breast cancer, patients are living longer. With longer survival and systemic control of the disease, we are seeing a slight increase in incidence. The overall incidence of brain metastases in metastatic breast cancer is approximately 10 to 30%.

How does the type of breast cancer a patient has impact the spread to the brain?

The subtype of breast cancer does play a role in its likelihood to metastasize to the brain. Triple-negative breast cancers are typically aggressive and most likely to metastasize to the brain, followed by HER2-positive breast cancers and hormone-positive breast cancers.

Can brain metastases develop after patients are cured?

Patients and caregivers always need to keep in mind the possibility that the disease will progress. An individual’s tumor type, stage and receptor status play a role in how likely, or unlikely, it is that the cancer will metastasize to the brain. For example, earlier stage breast cancers are typically less likely to metastasize to the brain. Post-diagnosis surgery and completion of the recommended therapy can help reduce this risk.

What are some of the warning signs of brain metastases?

Some of the warning signs include visual changes, difficulty with balance, severe headaches, personality changes or unexplained nausea or vomiting. It is important that patients be diligent about their follow-ups as well as comfortable talking with their oncologist about potential symptoms they are experiencing. I tell my patients to inform me of any new sign or symptom, even if they do not believe it is related to the underlying breast cancer diagnosis.

What are some of the latest advances in treating breast cancer that has metastasized to the brain?

We feel more confident about treating patients with metastatic breast cancer to the brain in the setting of targeted therapies. These are intravenous therapies that have been proven to improve brain metastases by crossing the blood-brain barrier.

Radiation has been a standard of care to treat brain metastases. In addition to whole-brain radiation, which is used to treat multiple brain metastases, CyberKnife® radiation can be used if only a few lesions are detected. This highly targeted form of radiation can preserve healthy brain tissue and reduce toxicities while maximizing performance status and quality of life.

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