Breast Cancer and Spine Surgery

With October designated as Breast Cancer Awareness Month, it is the perfect time to talk about breast cancer and spine surgery.

Breast cancer is by far the most common disease in women. Metastatic breast cancer remains an incurable disease, with the spinal column one of the most likely areas to be affected by metastases. And a significantly prolonged patient survival is the direct result of great advances in modern oncologic treatment options over the last decade. Therefore, surgical treatment of vertebral metastases has become an increasing focus for spine surgeons. Crucial to proper treatment is the correct estimate of expected survival time in relation to the invasiveness of the therapy or intervention recommended in relation to a metastatic spine surgery.  

Breast cancer is one of the most common cancer diseases metastasizing to the spine, and the second leading cause of death in woman related to cancer[1]. Modern treatment and diagnostic concepts, along with considerably longer survival times and a reduced rate of skeletal complications[2-4] are all factors to take into consideration before, during and following treatment. In fact, until 2015, the survival time was 27 months whereas actual studies reported survival extended to 55 months. However, this extended lifespan includes an 85% incidence of spinal metastases[2-15]. Therefore, there is an increased need for surgical treatment of any complications then related to spinal metastases as well.

Visceral, skeletal or cervical spine metastases, surgical complications and advanced patient age are not necessarily negatives[13] when deciding to move forward with spine surgery as part of your cancer treatment. Furthermore, a patient’s preference, symptoms, biological age, intrinsic breast cancer subtype, tumor burden (number of metastasized organs) and prior therapies all need to be taken into account[4] when determining if and what type of surgery to discuss and pursue with your spine care specialist.

For instance, pathologic or iatrogenic symptomatic spinal lesions are common in metastatic breast cancer. Given the longer overall survival rates courtesy of modern oncologic therapies, a prompt and effective treatment of such lesions may have a significant impact on a patient's quality of life, with pain improvement and the prevention of the deterioration of neurologic function.

A retrospective review was conducted on patients with breast cancer operated to the spine between 2005 and 2013. The series includes 41 patients and 57 vertebral levels treated (4 cervical, 35 dorsal, and 18 lumbar). There were 28 patients who received palliative surgery and 13 who received excisional surgery, according to their clinical condition.

Of the 41 patients, 38 presented with a median survival of 50 months and a retained the ability to ambulate independently. The median overall survival after the first spine surgery was also 50 months, suggesting that in the patient group, a reasonable quality of life was preserved almost to the end of their clinical history. In patients treated with palliative surgery, the median survival was 37 months. In those treated with complex surgery, it was 57 months.

Major excisional surgery, albeit associated with an increased length of hospital stay, did result in prolonged survival rates, when compared with less aggressive types of surgery. However, kyphoplasty techniques have expanded indications for palliative surgery and have increased the number of patients who may benefit from rapid and sustained pain relief, preservation of neurologic function, and early mobilization.

Treatment of breast cancer extends to so many doctors, sometimes it is difficult to keep track! And, when you hear the words “metastatic breast cancer” fear sets in. Engaging a spine care specialist early in treatment can add significant survival time. Every surgical treatment should be considered carefully and discussed fully. Talk to your spine surgeon about the surgical – minimally invasive and major excisional surgery-- options, present and future.