Metastatic Breast Cancer Awareness Day: Living With Stage 4 in October
October 13 is Metastatic Breast Cancer Awareness Day, set aside for people whose breast cancer has spread to other parts of the body.
Most of what you'll see this month is about finding breast cancer early and getting through treatment. Our earlier post this month covered screening, and all of it still stands. October 13 is for people whose breast cancer has spread beyond the breast and nearby lymph nodes, and who will be in treatment for the rest of their lives. I'm that person. I'm living with metastatic breast cancer.
What stage 4 means
Stage 4, or metastatic, breast cancer has spread to other parts of the body, most often the bones, liver, lungs or brain. The American Cancer Society describes it as very difficult to cure and says treatment continues for the rest of a person's life. It also says many people live for years with treatment.
About 6% of invasive breast cancers are already stage 4 when they are first diagnosed. Most metastatic breast cancer shows up later, as a recurrence in someone first treated for an earlier stage. National cancer registries record the stage at first diagnosis and don't track those later recurrences, so there is no official yearly count of how many people in the US are living with it.
Stage 4 at diagnosis
How many breast cancers are already stage 4 when they're first found
Women in the US diagnosed with invasive breast cancer
breast cancers have already spread to other parts of the body by the time they are first found. Each dark square is one of those 6.
This count only includes cancers that were stage 4 the first time they were found. Most people living with stage 4 were first treated for an earlier stage, and their cancer came back and spread later. National records don't count that larger group.
National Cancer Institute, SEER Cancer Stat Facts: Female Breast Cancer; Metastatic Breast Cancer Network, Statistics for Metastatic Breast Cancer.
Women are living longer with it
The most recent national estimate comes from a 2017 study by researchers at the National Cancer Institute. It found that more than 150,000 women in the US were living with metastatic breast cancer at the start of that year, and that the number was growing. The researchers said this was likely due to the aging of the US population and improvements in treatment.
Among women first diagnosed at stage 4 between the ages of 15 and 49, the share still alive five years later doubled, from 18% of those diagnosed in 1992 to 1994 to 36% of those diagnosed in 2005 to 2012. About a third of the women living with metastatic breast cancer in 2017 had already lived with it for five years or more.
Living longer
Women diagnosed at stage 4 are living longer than they used to
Women in the US whose breast cancer was already stage 4 when it was first found
How long women typically lived after a stage 4 diagnosis
Typical means the middle point. Half of the women lived longer than this, and half lived less.
| Age at diagnosis | Diagnosed 1992 to 1994 | Diagnosed 2005 to 2012 |
|---|---|---|
| 15 to 49 | 22.3 months | 38.7 months |
| 50 to 64 | 19.1 months | 29.7 months |
These numbers stop with women diagnosed in 2012, before most of the newer treatments described below were available.
Mariotto AB et al., Cancer Epidemiology, Biomarkers & Prevention, 2017; National Cancer Institute press release, May 2017.
More recent numbers point the same way. At an international medical conference on advanced breast cancer in November 2025, researchers presented US health-record data on more than 60,000 people treated for metastatic breast cancer since 2011. Average survival from the start of treatment rose from 27.5 months for people treated in 2011 to 2013 to 34.3 months for those treated in 2020 to 2022. The gains were largest for HER2-positive breast cancer. Triple-negative breast cancer improved the least. The chart below shows each type, and the box above it explains the names.
Breast cancer types, in plain words
- Hormone-positive
- The cancer uses the hormones estrogen or progesterone to grow. Doctors often write this as HR-positive or ER-positive. It is the most common type.
- HER2-positive
- The cancer makes too much of a protein called HER2, which helps it grow. Some drugs target HER2 directly.
- Triple-negative
- The cancer is not driven by hormones or by HER2, so hormone and HER2 drugs don't work on it.
- ESR1 mutation
- A change in a gene that can make hormone therapy stop working for hormone-positive cancer. A blood test can find it.
Living longer, by type
On average, people are living longer after starting treatment
More than 60,000 people in the US treated for stage 4 breast cancer. Each type compares people who started treatment in 2011 to 2013 with people who started in 2020 to 2022.
| Type | Started 2011 to 2013 | Started 2020 to 2022 |
|---|---|---|
| All types together | 27.5 months | 34.3 months |
| Hormone-positive and HER2-positive | 42 months | 53.1 months |
| HER2-positive, not hormone-positive | 33.4 months | 52 months |
| Hormone-positive, HER2-negative | 31.7 months | 39.2 months |
| Triple-negative | 11.2 months | 13.2 months |
These are averages for large groups of people. They can't tell any one person how long they will live. The results were presented at a medical conference in November 2025 by researchers from the ABC Global Alliance and the drugmaker Roche.
Sanglier T, Cardoso F et al., presented at ABC8, Lisbon, November 6, 2025, as reported by ecancer and Oncology Central.
Where the research is now
The treatment options for metastatic breast cancer have changed quickly over the last few years. Most of the new drugs fall into two groups.
New hormone-targeting pills. Hormone-positive breast cancer can develop a change in the ESR1 gene that lets it keep growing despite standard hormone therapy. A blood test can find that change. Several pills now target it directly, and in May 2026 the FDA approved vepdegestrant, the first approved drug of its kind, which works by breaking down the estrogen receptor. Researchers are also testing whether checking the blood regularly and switching treatment as soon as the ESR1 change appears can slow the cancer down.
Antibody-drug conjugates. These drugs attach chemotherapy to an antibody that seeks out cancer cells, so more of the drug reaches the tumor. In May 2026 the FDA approved datopotamab deruxtecan for metastatic triple-negative breast cancer in people who can't receive immunotherapy. In the study behind that approval, half of the people on the new drug lived longer than 23.7 months, compared with 18.7 months for people on standard chemotherapy. In December 2025, trastuzumab deruxtecan with pertuzumab became a new first treatment option for HER2-positive metastatic breast cancer, the first new first treatment for that group in more than ten years.
Recent FDA approvals
New treatments the FDA has approved for stage 4 breast cancer
A selection since 2023, listed by date. Each one is for a specific type of breast cancer, so your oncologist can tell you which, if any, fit yours.
- 2023Elacestrant (Orserdu)For hormone-positive, HER2-negative cancer with an ESR1 mutation
- 2025Imlunestrant (Inluriyo)For hormone-positive, HER2-negative cancer with an ESR1 mutation
- 2025Datopotamab deruxtecan (Datroway)For hormone-positive, HER2-negative cancer
- December 2025Trastuzumab deruxtecan (Enhertu) with pertuzumabA new first treatment for HER2-positive cancer
- May 2026Vepdegestrant (Veppanu)For hormone-positive, HER2-negative cancer with an ESR1 mutation, after at least one hormone therapy has been tried
- May 2026Datopotamab deruxtecan (Datroway)For triple-negative cancer, when immunotherapy isn't an option
US Food and Drug Administration; Living Beyond Breast Cancer, SABCS 2025 research update; FORCE, FDA breast cancer update, June 2026; AJMC, May 2026.
Many more drugs are in clinical trials, including ones meant for when current treatments stop working. Ask your oncologist whether a trial might fit you, and whether you've had biomarker testing, the tests on your tumor or blood that show which treatments might work. The National Cancer Institute's Cancer Information Service can help you search for trials at 1‑800‑4‑CANCER.
The day has its own ribbon, which adds two colors to the pink. The US Senate first designated October 13 as National Metastatic Breast Cancer Awareness Day in 2009.
October 13
The metastatic breast cancer ribbon
Pink, teal and green, each with its own meaning
- PinkFor where the cancer started, in the breast.
- TealFor healing and spirituality.
- GreenFor spring over winter and life over death, and for renewal and hope.
Shauna Martin Metastatic Breast Cancer Foundation, MBC ribbon colors.
What my life looks like right now
My life right now is full. I'm building Gilgal Home Care & Registry, and the business is growing. My daughter is healthy and busy with her activities and her friends, and I get to watch her become her own person. I'm in treatment through all of it. I feel blessed.
Living well with stage 4 takes upkeep. The scans and labs are on my calendar and I keep them. So are the appointments that have nothing to do with cancer. I've started eating healthier, and I'm more conscientious about what I eat and what I bring into my home. I also use Gilgal's own direct care workers for support at home, week to week. I built this business to give families that kind of help, and I use it the same way a client would.
Caring for yourself while living with it
Metastatic breast cancer is treated over years, so the habits that help are the ones you can keep up. These come from national guidelines and from what helps in daily life. Check any change in diet, exercise or supplements with your care team first, since your treatment may affect what's safe for you.
- Keep every appointmentScans, labs and infusions, plus the dentist, the eye doctor and your primary care visit. Keep them all on one calendar.
- Ask about palliative care earlyPalliative care treats pain, fatigue, nausea, anxiety and other symptoms, and you can have it alongside the rest of your treatment. ASCO recommends referral early in treatment for people with advanced cancer.ASCO palliative care guideline, 2024
- Move as much as you safely canFor cancer survivors, the American Cancer Society suggests working toward 150 to 300 minutes of moderate activity a week, plus strength exercises two or more days a week. Start slowly and adjust to how treatment leaves you feeling.ACS guideline for cancer survivors
- Eat for strengthBuild meals around vegetables, fruit, whole grains, beans, fish and poultry, and limit processed meat, sugary drinks and highly processed food. Ask for a referral to a registered dietitian, especially if you're losing weight. ASCO found too little evidence to recommend keto, fasting or other special diets during treatment.ACS guideline for cancer survivors; ASCO, 2022
- Limit alcoholThe American Cancer Society says avoiding it is the best choice. During treatment it can also worsen mouth sores and interact with some medicines.ACS guideline for cancer survivors
- Ask about testing and trialsAsk whether your tumor or blood has been tested for changes like ESR1 or HER2-low, and whether a clinical trial could fit you. These questions can open up treatment options.
- Tell your team how you're feelingAnxiety, low mood and trouble sleeping are common and treatable. Many cancer centers have social workers, counselors and support groups, and the Metastatic Breast Cancer Network and METAvivor focus on people living with stage 4.
- Let people help, and be specificA meal on a treatment day, a ride to an appointment, a few hours at home with someone else there. People usually want to help and don't know what to offer.
- Look at your benefits earlyDo it before there's a crisis. There are federal and Pennsylvania programs written with this diagnosis in mind, and our post later this month walks through them.
If someone you love is living with it
Stage 4 is long-term. The family caregivers around someone with metastatic breast cancer may be doing this for years, so set up help you can keep going. That might mean a standing block of home care each week, a rotation among siblings, or both. Your own appointments and rest count too.
If you don't have a diagnosis
Get screened. The national guidance now starts at age 40, with a mammogram every other year through 74. Our earlier post on screening has the details, including free screening in Pennsylvania if you're uninsured.
Support at home during cancer care and recovery
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Whether the support is for you or for someone you love, tell us what the week looks like. We'll talk through what would help and plan it around treatment days. You can also read more about our cancer care and recovery support.
Sources
- American Cancer Society, Treatment of Stage IV (Metastatic) Breast Cancer
- National Cancer Institute, SEER Cancer Stat Facts: Female Breast Cancer
- Metastatic Breast Cancer Network, Statistics for Metastatic Breast Cancer
- Mariotto AB et al., Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States, Cancer Epidemiology, Biomarkers & Prevention, 2017, and the National Cancer Institute press release
- ecancer, Advanced breast cancer patients living longer, and Oncology Central, on ABC8 results, November 2025
- Living Beyond Breast Cancer, What's next for metastatic breast cancer treatments? SABCS 2025
- US Food and Drug Administration, datopotamab deruxtecan approval for triple-negative breast cancer, May 22, 2026
- AJMC, FDA Approves Vepdegestrant for ESR1-Mutated, ER-Positive, HER2-Negative Advanced Breast Cancer, May 2026
- FORCE, New breast cancer drug approvals increase treatment options, June 2026
- American Cancer Society, Guideline for Diet and Physical Activity for Cancer Survivors
- ASCO guideline on exercise, diet and weight management during cancer treatment, 2022, as summarized by Breastcancer.org
- The ASCO Post, ASCO Guideline Update Highlights the Importance of Early Integration of Palliative Care, 2024
- US Senate, S.Res.295 (111th Congress), designating October 13, 2009, as National Metastatic Breast Cancer Awareness Day
- Shauna Martin Metastatic Breast Cancer Foundation, MBC Ribbon Colors
- Metastatic Breast Cancer Network and METAvivor
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