Researchers have found that asymptomatic brain metastases may be more common in patients with stage IV breast cancer than previously understood, according to a recent study published by Ahmed et al in Neuro-Oncology. The findings suggest that physicians may need to reconsider current screening guidelines for detecting brain metastases in asymptomatic patients.
Study Methods and Results
Researchers used magnetic resonance imaging (MRI) surveillance to check for brain metastases in 101 asymptomatic patients diagnosed with stage IV breast cancer—including those with triple-negative, HER2-positive, and hormone receptor–positive/HER2-negative disease. The patients underwent follow-up MRI after 6 months if the initial scan was negative for signs of metastasis.
Among the patients who completed the initial MRI scan, 14% of them presented with brain metastases. The rates of brain metastasis by subtype were: 18% in triple-negative breast cancer, 15% in HER2-positive disease, and 10% in hormone receptor–positive/HER2-negative disease.
Following the second MRI, the proportion of patients with brain metastases increased to about 25% in each subtype. Patients with MRI scans positive for brain metastases received early treatment, including changes in systemic therapy and local therapies.
Conclusions
“Our study suggests that asymptomatic brain metastasis is quite common in [patients with] stage IV breast cancer,” emphasized lead study author Kamran Ahmed, MD, an associate member and Section Chief for Breast Radiation Oncology at the Moffitt Cancer Center. “Although larger studies are needed to confirm our findings, given the improvements in systemic and local therapies for breast cancer brain metastasis, the time may be appropriate to reconsider current guidelines that recommend against routine MRI surveillance in late-stage breast cancer,” he concluded.
Disclosure: The research in this study was supported by the Florida Breast Cancer Foundation. For full disclosures of the study authors, visit academic.oup.com.
