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Metastatic Breast Cancer

Breast cancer that spreads to other parts of the body -- most commonly the lungs, liver, bone, or brain -- is called metastatic breast cancer or stage IV breast cancer. While this type of breast cancer is often not curable, the right combination of treatments can substantially prolong and improve your quality of life. Duke experts in metastatic breast cancer help you make informed decisions about your care. Our goals are to:

Help relieve the symptoms caused by metastatic breast cancer.
Improve your quality of life.
Keep your cancer under control for as long as possible.
Extend your life with optimal treatments.

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Newly Diagnosed or Seeking a Second Opinion

Seeking care from specialists in metastatic breast cancer is important whether you are newly diagnosed or are in the middle of your treatment. As a comprehensive cancer center, we use the latest treatments and can enroll you in clinical trials that are testing new therapies. Our team has helped develop many of the drugs for metastatic breast cancer used today.

We also offer you a wealth of resources to help you cope with your diagnosis and its effect on you and your family. Support groups, medical family therapy, palliative care specialists, and financial counselors can support you every step of the way.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Diagnosing Metastatic Breast Cancer

While it is possible for metastatic breast cancer to be found at your initial diagnosis, it is more common for breast cancer to return years after you’ve completed treatment. In either case, a variety of tests help us identify how extensively cancer has spread. They also provide information on the subtype of breast cancer in the metastases and possibly the underlying genomic alterations (changes in genes) in the tumor. We use this information to recommend the best treatments for you.

Imaging Tests

You may undergo several types of imaging tests, such as X-ray, MRI, and PET, CT, or bone scans. They help us identify the secondary site (such as the liver, bones, lung) where breast cancer has spread.

Biopsy

A biopsy removes cell and tissue samples from the secondary site for evaluation under a microscope. This helps us determine if there are any differences between your original and current breast cancer diagnosis.

Additional Lab Tests

Blood work and tissue samples may be studied to determine the subtype of breast cancer. For example, we test for:

Hormones such as estrogen and progesterone that may be responsible for tumor growth. These types of breast cancer are called ER-positive and PR-positive (or hormone receptor-positive). They respond initially to endocrine therapy-based treatments.
A protein called human epidermal growth factor receptor 2 (HER2), which is found in HER2-positive breast cancer. This aggressive cancer responds well to certain treatments.

When tests for ER/PR and HER2 protein are negative, the cancer is called triple-negative breast cancer. New medications such as immunotherapy are proving promising for some patients with this subtype.

Genomic Molecular Profiling

Blood work and tissue analysis may be performed to identify the genetic makeup of the tumor. These tests can identify vulnerabilities that may be treated with targeted therapies.

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Metastatic Breast Cancer Treatment

The type of treatment you receive will depend on the type of breast cancer with which you are diagnosed. In general, the following treatments are used to treat metastatic (stage IV) breast cancer.

Endocrine Therapy

If you are diagnosed with hormone-receptor-positive breast cancer (ER-positive or PR-positive breast cancer), medications called endocrine therapy drugs block, damage, or lower the production of the hormones to stop them from directing the cancer cells to grow and multiply. Targeted therapies are often added to endocrine therapy and have been shown to further slow the spread of growth and extend life.

Targeted Therapy for HER2-Positive Breast Cancer

Drugs that target the HER2 protein can help stop the cancer cells from growing. These drugs may be given in pill or IV form, sometimes in conjunction with chemotherapy. Many newer HER2 targeted agents are proving to be very effective.

Chemotherapy

Chemotherapy may be recommended at some point in your care for any breast cancer subtype.

Immunotherapy

Immunotherapy relies on the body’s immune system to recognize and destroy cancer cells. It can be used to treat some types of metastatic breast cancer, such as triple-negative, and may be used with chemotherapy.

Surgery

Surgery is not often used in the treatment of metastatic breast cancer but may be necessary to remove tumors causing pain.

Radiation Therapy

External beam radiation therapy may be recommended as a palliative treatment to relieve symptoms, such as pain caused by tumors.

Additional Treatments

Depending on where cancer has spread, additional treatments may be recommended to manage symptoms such as pain, seizures, memory problems, trouble speaking, bone weakness or breaks, and loss of strength or mobility.

Breast Cancer Clinical Trials at Duke

Our metastatic breast cancer clinical trials give you access to new therapies and new ways to treat breast cancer long before FDA approval. You may be screened for clinical trials by making an appointment.

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Why Choose Duke

We Are an NCI-Designated Comprehensive Cancer Center
At National Cancer Institute-Designated Comprehensive Cancer Centers like Duke Health, you’ll work with breast cancer specialists whose level of expertise can only be found at a few cancer centers across the country. Our breast cancer specialists have years of experience treating metastatic breast cancer and other types of breast cancer, including rare forms.

Our Metastatic and Molecular Tumor Boards Review Patients' Care
Duke breast medical oncologists hold weekly meetings called “tumor boards” for our metastatic breast cancer patients. They discuss and review our patients’ care, identify optimal treatments, and screen for clinical trials. The molecular tumor board also meets weekly to review specific genetic abnormalities within all tumor types and evaluate optimal targeted therapies.

We Provide Second Opinions and Work with Your Local Doctor
If your home is not close to one of our cancer centers, we can provide a second opinion to review your cancer diagnosis and treatment options and relay this information to your local doctors to carry out.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

Coordinated Care for Breast Cancer That Has Spread to the Bone
If breast cancer has spread to the bone, you can work with our team of experts who provide comprehensive care. The team includes interventional radiologists, radiologists, radiation oncologists, and surgical oncologists.

Treatments Extend Hope When Cancer Spreads to Brain
When breast cancer has spread to the brain, it is typically considered advanced and may be life-threatening. Duke specialists in brain and spine metastasis offer new treatments and access to clinical trials that may make it possible for you to live longer with a better quality of life.

Our Support Services Follow You Through Your Journey
You’ll have access to the full range of services to help minimize the side effects of treatment and support you and your loved ones through your cancer journey. Our financial coordinators help you navigate ways to help you pay for your care. View our support care services to learn more.

Palliative Care Helps You Find Relief
The debilitating effects of serious illness are often magnified by physical, mental, and spiritual pain and suffering. Our palliative care experts partner with you, your family, and your medical team to help you find relief.

This page was medically reviewed on 07/28/2025 by

Carey K. Anders, MD | Medical Oncologist