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Breast cancer and bone health

Breast cancer is the most common malignancy and second leading cause of death amongst women in the United States. The Centers for Disease Control and Prevention estimate that 2013 saw 180,000 newly diagnosed cases of breast cancer with all but 2,240 of them occurring in women.

Breast cancer has the ability to spread to distant sites in the body in a process called metastasis. During this process, tumor cells break free from the original site of the cancer and travel through the blood stream to distant sites in the body where they can grow and multiply. The human skeleton (bone) is the most common site for these metastatic lesions.

At Greater Rochester Orthopaedics, we take a complete medical history or update an existing one for every patient encounter so that we are aware of any conditions that may be affecting your health. For patients who have a breast cancer history or for patients who are newly diagnosed, this history can alert us to the potential that cancer may have spread to the skeleton and can aid in determining a course of treatment.

Metastatic breast cancer most commonly occurs in women over age forty. Patients who have had metastatic disease to their bones are frequently in greater need of orthopaedic care than those who have not experienced such spread. These treatments may include surgery, radiation therapy, chemotherapy, or some combination of these three to treat the cancer and any complications that may occur.

Breast cancer that metastasizes to bone can and often does weaken bone. Patients undergoing treatment for breast cancer may experience rapid bone loss, particularly if metastatic lesions exist. Over time, these bony changes may lead to localized pain and fracture at the site of a metastatic lesion.

Pain is the most common presenting symptom for patients with metastatic disease. The incidence of pathologic fracture through a metastatic lesion is generally uncommon without several weeks or months of increasing localized pain. In some cases patients may try to ignore or deny these symptoms. In other cases a painful lesion may be initially diagnosed as a muscle pull or sprain. This can result in a temporary delay in the diagnosis of metastatic disease while a patient is treated with pain medications.

When surgery is indicated, research reveals that patients that have prophylactic skeletal stabilization, surgery to stabilize the bone before a fracture occurs, fare better than those that have surgery after a fracture has occurred. Hospitalizations are shorter and patients tend to be discharged to home as opposed to rehabilitation facilities, return more rapidly to previous activities, have improved survival, and have fewer surgical complications compared to patients whose bone(s) fracture. Prophylactic surgical stabilization also allows the medical oncologist and the surgeon to coordinate surgical treatment and systemic chemotherapy.

The decision to pursue surgical intervention is individualized to each and every patient. Orthopaedic surgeons consider a number of factors in order to determine whether or not a bone is at risk for fracture including degree of pain, location and size of the lesion, and the appearance of the bone on diagnostic imaging modalities.

Since patients with metastatic lesions tend to be less healthy than a typical patient undergoing an elective orthopaedic surgical procedure and the surgery itself is often more complex, there is an increased risk of complications including infection, bleeding, blood clots, and damage to nerves, arteries, or veins. Accordingly, the patient and their family, the surgeon, and the oncologist must all come together and make an informed decision as to whether or not to pursue surgical intervention.

The current standard of care for patients diagnosed with metastatic breast cancer require a multidisciplinary team approach that can include surgery, radiotherapy, and chemotherapy. At Greater Rochester Orthopaedics, our surgeons play an active role in this multidisciplinary effort. We work in concert with referring physicians, oncologists, radiation therapists, and orthopaedic oncologists to search for and apply improved materials and techniques that can help patients live longer and with an improved quality of life.