Skill Checkup: A 64-Year-Old Woman With a Breast Mass and Back and Hip Pain

Maurie Markman, MD

Disclosures

September 08, 2021

Correct Answer: D. Bone

Of the approximately 200,000 cases of incident breast cancer diagnosed in the United States each year, 1 in 3 will have a distant metastasis. Women with breast cancer are most prone to bone metastases, which is often the first detectable distant site. However, the first location of distant metastasis varies by subtype; in those with HR-positive/HER-negative breast cancer, it spreads to the bone in about 70% of cases. Other common sites are the lungs and the liver, but breast cancer can spread to almost any other part of the body, including the brain and skin.

Traditionally, high-risk patients were screened for occult metastases using bone scintigraphy, chest radiography, and abdominal ultrasound or bone scintigraphy and CT of the chest, abdomen, and pelvis. However, conventional imaging frequently detects bone disease and visceral metastases only in later stages, which are associated with poorer outcomes. Moreover, these methods often fail to demonstrate the heterogeneity of the tumor biology, leading to delays in the opportunity for therapeutic modifications. More modern methods of investigating metastases involve combinations of techniques, such as PET/CT.

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