The terrifying rise of ‘secondary’ breast cancer – and the little-known sign that thousands of women could be missing

After a double mastectomy followed by chemotherapy, Hannah Gardner was convinced she had defeated breast cancer. Even when cancer was discovered in her chest wall four years later, she wasn’t too concerned.

‘It was an unmistakable pea-sized lump in the breast that I had reconstructed,’ says 38-year-old Hannah, a clinical trial manager living in Twickenham – and a scan confirmed the worst.

‘I was treated at the Royal Marsden Hospital (in London) and after surgery to remove more tissue, chemotherapy and radiotherapy I was reassured that I had a very good chance of living cancer-free.’

Hannah, who was 26 when she was first diagnosed in 2013, felt so reassured that she and her husband Peter, a firefighter, decided to start a family. A daughter, Lilah, was born in July 2020.

So Hannah was blindsided when a routine scan a few months later, in November 2020, revealed cancer cells in the lymph nodes under her arm.

“The only sign was a strange throbbing sensation in my armpit, which had started a few weeks earlier,” she says.

After radiotherapy, Hannah dared to hope for the best again. But two years later a routine scan revealed the cancer had returned. This time it had spread to her liver.

“The oncologist made it very clear: this was secondary cancer and there was no cure,” she says. ‘It was my worst nightmare.’

Hannah is one of an estimated 57,000 women in Britain living with secondary breast cancer, according to a study of NHS admissions in 2021 – a figure that has been rising year on year since 2018. Between 10 and 40 percent of British patients diagnosed with primary breast cancer will develop secondary breast cancer.

The good news is that while secondary breast cancer remains incurable, treatments have improved dramatically.

‘Secondary breast cancer is no longer a death sentence; it is very treatable,” explains Russell Burcombe, a clinical oncologist at Maidstone and Tunbridge Wells NHS Trust.

“For decades, the overall survival rate remained two to three years. But there are such exciting developments in treatment that the average expectancy is now five years – and many will live longer than this.’

On average, 67 percent of women live one year after the diagnosis of secondary breast cancer; 26 percent live five years and 11 percent live at least ten years.

“One of the biggest things scientists are working on is turning breast cancer into a chronic disease that patients live with and don’t die from,” adds Dr. Burcombe.

‘The biggest change has been the use of drugs called CDK4/6 inhibitors – tablets that increase the effectiveness of hormone therapy, which stops or slows the growth of cancer cells. We now have patients who have been taking a hormone tablet containing one of these medications for ten years or more.

‘Then we have immunotherapy, which uses the immune system to fight cancer and is usually given by intravenous injection. It is particularly successful in treating patients with aggressive triple negative breast cancer, who used to be in particularly bad shape when their cancer returned.”

Hannah is now in a clinical trial of immunotherapy. “I’ll be in treatment for the rest of my life,” she says. ‘It’s not a walk in the park, but at least it buys me time.

‘Nobody wants to think about cancer coming back. I certainly didn’t. But there’s no point in burying your head in the sand.

“The sooner you diagnose and start treatment, the better your chances.”

Looking back, Natalie Gibbs (48) knows she should have reported her symptoms earlier. The Pilates teacher and energetic mother of two considered herself too fit and healthy to bother doctors after she fell and broke a rib. She had also suffered from back pain for several months, which she attributed to a respiratory infection.

It wasn’t until January 2020 – two months after the fall – that Natalie decided she could no longer ignore the wrinkling skin on both her breasts and booked an appointment at the breast care center at KIMS, a private hospital in Maidstone, Kent.

Scans and biopsies revealed secondary breast cancer, which had spread to her bones and ovaries. She had no idea the broken rib was a symptom.

When breast cancer spreads beyond the breast through the lymph or blood systems, it usually goes to the bones first, making them brittle and prone to fractures.

“I was completely shocked,” says Natalie, who lives in Canterbury, Kent, with her husband Alfie, 55, a surveyor, and their children George, 19, and Olivia, 16.

‘I had noticed the changes in my breasts for many months, but I had buried my head in the sand because I was too scared to acknowledge that it could be cancer,’ she says. “It was devastating to find it had already spread.”

Although most women are aware of the symptoms of breast cancer, including lumps and wrinkles in the skin, alarmingly few know the signs of secondary or stage 4 breast cancer. Even fewer people know the encouraging news that the disease is now easily treatable.

The most common site for secondary breast cancer is in the bone, followed by the lungs, liver, skin and brain.

Yet a survey by GenesisCare, a specialist cancer care provider, found that 72 percent of women who had previously been diagnosed with cancer did not know where in the body it was likely to occur.

After a six-month chemotherapy program and bone-strengthening medications, Natalie is back to her active self. “I thought it was a death sentence, but the drugs kept the cancer at bay for four years,” she says.

‘Unfortunately, in July 2023 I suffered crippling headaches, and scans showed the cancer had spread to my brain.

‘I have had radiotherapy to my brain and now take immunotherapy tablets every day and chemotherapy tablets 14 out of 21 days a month.

‘For the sake of my family, I cannot let cancer dominate my life. I believe in perseverance. I have so much to do, like getting George ready for college last year and Olivia for boarding school.”

A worrying number of women would also hesitate to mention their history of breast cancer to their GP because of new, seemingly unrelated symptoms.

According to research from GenesisCare, 80 percent of women with a previous diagnosis would not link excessive fatigue, nausea or loss of appetite with cancer – yet all of these symptoms could be linked to secondary breast cancer in the liver.

And 78 percent would not mention their history if they had a cough or shortness of breath, but these are both symptoms of secondary breast cancer in the lungs.

It is not surprising that the greatest risk of recurrence occurs in the first years after treatment. Risk factors include the type of breast cancer, the stage at which it was diagnosed, the size of the tumor, how many lymph nodes, if any, were involved, and factors such as obesity and alcohol consumption.

‘No tool can guarantee that cancer will not return,’ says Nicola Roche, a breast surgeon at Royal Marsden.

‘But making healthy lifestyle choices is important. There is a link between high levels of estrogen in the blood and the recurrence of breast cancer. A diet high in fat and calories can increase circulating estrogen.”

Dr. Burcombe added: ‘I understand patients want to forget they had cancer, but I always tell them that even if they were diagnosed 15 years ago, they are not out of the woods.

‘Most GPs will be alert to a recurrence, but if you have a symptom such as coughing or pain that is new, long-lasting and unusual, you should always go to your GP and point out your cancer history – even if you think it may be have nothing to do with each other. .’

Hannah and Natalie are participating in a GenesisCare campaign to raise awareness of secondary breast cancer. To learn more about the symptoms to look out for, visit genesiscare.com/uk/secondchans.