How to Answer Questions About MBC

Keep it as simple as you can. Explain that breast cancer has four stages, and you have Stage IV, which is also called metastatic breast cancer. This means that you were diagnosed with breast cancer that hasmetastasized, or traveled, to other parts of your body. Consider being upfront with the fact that this kind of cancer is treatable but not curable. It’s totally up to you whether you’d like to share additional details, such as which organs are affected.

No, but it is treatable, and treatments can keep it under control for periods of time. Repeatedly explaining, “No, MBC is not curable,” can be painful. Always feel free to end conversations at any point. If having the same conversations about your condition over and over is difficult, consider delegating a friend or family member as a single point of contact, Dr. Spiegel suggests. If you’re comfortable sharing routine updates online, social media or an online health journal likeCaringBridge.comare also options.

Ouch. That’s a tough one, so it’s good to be prepared for it (although here’s hoping acquaintances have enough common sense not to ask it). “I don’t know, and I’d rather not talk about it” is a fair answer. However, you can explain that there’s a difference between metastatic breast cancer, which is treatable, and terminal cancer, when treatment turns primarily to providing comfort. Though uncurable, MBC is not an immediate death sentence. The five-year survival rate for people diagnosed with MBC is 27%, but it varies widely depending on the type of cancer.

Never. Think of it as a marathon, rather than a sprint. The rest of your life will likely be a series of medical treatments, perhaps with some breaks if the cancer is under control. You can explain that a common pattern with metastatic breast cancer is to use a treatment until it stops controlling the cancer or the side effects become unbearable, and then try something else. Depending on your type of cancer, treatment options may include different chemotherapy regimens, radiation, endocrine (hormone-blocking) therapy, targeted drugs, or immunotherapy.

People like to help. When they ask if you’ve tried different treatments, however, it may come across like they’re questioning what you are doing or are suggesting you’re missing something. “You can assure the asker that you feel confident that your healthcare team has chosen the right course of treatment for you,” says Dr. Spiegel. “You can say, ‘I have an excellent team of physicians and have real faith in them. They’re keeping me informed about the best treatments for me.’”

Reply options:

• “Yes. I’m in one.”
• “No. I’m confident my healthcare team is following the right course of treatment for me, which doesn’t include a clinical trial.”
• “Maybe at some point.” “Clinical trials are one of our biggest advancements in the treatment of cancers,” says Fauzia Riaz, M.D., clinical assistant professor, medicine-oncology, at Stanford University School of Medicine. “I encourage people to ask their doctors about them. Just asking doesn’t mean you’re obligated to participate, and you can always opt out.”

There are many ways to treat metastatic breast cancer—including radiation, endocrine (hormone-blocking) therapy, targeted drugs, and immunotherapy—beyond chemotherapy, which typically is the cause of hair loss. “Every treatment has varying side effects,” says Dr. Riaz. And even under the chemotherapy medicine umbrella, some drugs make all your hair fall out, some thin your hair or change the texture, and some have no effect on your hair. “Our goal is to find treatments where people are able to maintain some sort of normalcy,” says Dr. Riaz. “We want to optimize how patients are spending their time.”

If your breast cancer has spread to your lungs, be prepared to have people ask you if you ever smoked. Simply say that metastatic breast cancer is not caused by smoking. In fact, it’s also not “lung cancer,” rather it’s breast cancer that has traveled to the lungs. This is another situation where you can keep in mind that you always have the option to end a conversation by saying, “I don’t want to talk about it. Let’s talk about something else.”

People mean well when they ask about your health, but when you have metastatic breast cancer, answering questions can be draining. “People will understand if there are things you don’t want to deal with or discuss,” says Dr. Spiegel. Here are some polite ways to end conversations:

• “I know you mean well. I appreciate the suggestion.”
• “I’ve got plenty I’m dealing with right now. Thank you for your concern.”
• “Now isn’t a good time. We can find a time to talk later.”