The Diagnosis And Treatment Of Bone Metastases In Breast Cancer

Allan Lipton, MD

Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA

Abstract: Bone metastases from breast cancer can cause clinically relevant skeletal morbidity. These skeletal-related events (SREs) can undermine patient quality of life and functional independence. Early diagnosis of bone metastases could provide important benefits to patients. Although there is no clear consensus, some guidelines suggest bone scans for patients with advanced breast cancer. Skeletal scintigraphy should be the first choice for screening, and confirmation of diagnosis should be made with plain radiography, computed tomography, or magnetic resonance imaging. All patients with advanced metastatic disease should receive systemic anticancer therapy. Furthermore, supplementation of systemic anticancer therapy with bisphosphonates or other therapeutic approaches is suggested for prevention of SREs. Bisphosphonates have demonstrated significant reductions in the risk of SREs in patients with bone metastases from breast cancer. Zoledronic acid has demonstrated benefits beyond those of pamidronate in patients receiving cytotoxic or hormonal therapy for advanced breast cancer. Other palliative therapies and other therapies that reduce skeletal morbidity associated with malignant bone lesions are also discussed. Considering the increasing survival of patients with breast cancer achieved with emerging therapies, monitoring for, and treatment of, bone metastases to maintain the quality of patient survival are critical.

Keywords: bisphosphonates, bone metastases, breast cancer, screening, skeletal-related events, zoledronic acid

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