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It's a serious and scary condition, but doctors say there's reason for patients to be optimistic. 

Amanda MacMillan
May 31, 2017

Singer and actress Olivia Newton-John, 68, announced yesterday that she’s been diagnosed with breast cancer that has spread to her back. The Grease star had previously postponed the first half of her concert tour scheduled for this month, citing severe back pain.

Newton-John first battled breast cancer in 1992, and has since been an advocate for cancer research. She also lost her mother and her sister to cancer.

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But according to a source close to the Grammy winner, Newton-John’s prognosis is good. “She plans to be touring in August,” the source told People on Tuesday. “[She and her family are] all very positive.”

Breast cancer recurrence—especially when it spreads to other organs—is a scary and serious diagnosis. But patients do have reason to be optimistic, says Sagar Sardesai, MBBS, a breast medical oncologist at The Ohio State University Comprehensive Cancer Center. While Dr. Sardesai has not treated Newton-John, he does have some insight into what a condition like hers involves.

What is metastatic breast cancer?

Newton-John has metastatic breast cancer, which means her cancer began in the breast but then spread (or metastasized) to other organs—in this case, her sacrum, or lower spine. Metastatic cancer is also referred to as Stage IV cancer, the most advanced stage.

Cancer is difficult to treat once it spreads. But the number of women surviving this advanced stage of the disease is rising: A study published this month in Cancer Epidemiology, Biomarkers & Prevention found that the five-year survival rate for women initially diagnosed with metastatic breast cancer doubled from 18% in the early 1990s to 36% in the last decade or so. The study authors estimated that, as of January 1, 2017, more than 150,000 women in the United States were living with metastatic breast cancer.

They calculated the median survival time after diagnosis to be about 39 months for women diagnosed between ages 15 and 49, and about 30 months for women diagnosed between ages 50 and 64. But they also note that a "small but meaningful number of women" live many years after an initial diagnosis, reported the National Cancer Institute. (According to the American Cancer Society, the five-year survival rate for metastatic breast cancer is about 22%.)

“We’re now starting to think about metastatic breast cancer as a chronic disease,” says Dr. Sardesai. “We talk to patients about living with cancer, and living with treatments that can help prevent symptoms and improve quality of life, so you can do the things you want to do.”

Some metastatic breast cancer patients are able to travel and live active lives, says Dr. Sardesai. And as drugs therapies become more advanced, they have more options—and more flexibility with treatment schedules—than ever before.

According to the National Cancer Institute, breast cancer most commonly spreads to the bone, brain, liver, or lungs. Dr. Sardesai says it’s not uncommon for breast cancer to return 10 or 20 years after an initial diagnosis, and then spread to the bone.

 

What are the symptoms?

When Newton John postponed her tour earlier this month, she cited a “long-running issue with sciatica,” noting on social media that she planned to take some time off to “rest and deal this very painful condition.”

This week, a new post announced that her sciatica had turned out to be cancer. When cancer spreads to the bones in the spine, it can indeed cause back pain, as well as swelling and fractures. (If it spreads to other organs, symptoms can vary.)

That doesn’t mean that anyone with sudden back pain should think of cancer as a probable cause. “Everyone is going to have back pain, just like everyone is going to have sore throats and chills and muscle aches,” says Dr. Sardesai. “But if you’re a cancer survivor, it’s normal to jump to conclusions that your cancer might be coming back.”

Dr. Sardesai tells his patients that anytime they experience an unexplained symptom for longer than two weeks—like back pain, shortness of breath, nausea, or loss of appetite—they should get it checked out. “I’m not saying it’s cancer, but at that point we want to investigate further to see if it might be related,” he says.

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How is metastatic breast cancer treated?

The type of medical care offered for metastatic breast cancer depends on where it has spread. For hard-to-treat areas like the spine, doctors will usually go with radiation. Surgery isn't typically helpful for metastatic breast cancer, says Dr. Sardesai, since the cancer has entered the circulatory system and has the potential to come back elsewhere if it's not treated systemically.

According to Newton-John’s statement, the entertainer will undergo a “short course of photon radiation therapy,” along with natural wellness therapies.

Depending on the type of metastatic breast cancer a patient has, other options may also be available. Breast tumors that are HER2 positive—meaning that they have high levels of a protein called HER2—often respond to targeted medications, sometimes known as “smart bombs,” like Herceptin.

“These therapies can attack cancer cells spreading through healthy tissues,” says Dr. Sardesai. “But unlike chemotherapy, they won’t kill the healthy cells, and they often don’t have as many side effects either.”

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What else can metastatic breast cancer patients do?

When Newton-John had breast cancer in the 1990s, People reports that star “did massage and meditation and yoga” to help “keep my spirit positive.” And research has shown that these mind-body strategies may help relieve some symptoms of the disease.

Dr. Sardesai says that, in addition to keeping up with their treatment plan, living a healthy lifestyle can help patients feel their best. “Eating lots of fruits and vegetables, limiting fat intake, and being physically active—as much as they are able—is equally important for women with metastatic breast cancer as it is for women without the disease,” he says.