What is metastatic breast cancer, the type Olivia Newton-John had?

The death of Australian superstar Olivia Newton-John has drawn attention to an often misunderstood stage of breast cancer—metastatic breast cancer.

Newton-John was first diagnosed with breast cancer in the 1990s and spent 25 years in remission. When the cancer returned in 2017, this time in her spine, she fostered greater public awareness of the disease’s stages as she began canceling tour dates.

While it is uncommon for cancer to return after more than two decades in remission, it’s possible, which is why it is important for women and anyone who has had cancer before to keep up with routine screenings, said Pat Halpin-Murphy, president and founder of the PA Breast Cancer Coalition.

“People think that if you’re five years out, you’re sort of over the hump,” Halpin-Murphy said. But as Newton-John’s case shows, “you’re vulnerable at any time.”

Here’s what to know about metastatic breast cancer:

What is metastatic breast cancer?

“Metastatic” means cancer that has spread from the breast to other parts of the body, such as bones, liver, and lungs. Metastatic breast cancer, also known as stage IV cancer, cannot be cured, though treatments may help slow the spread.

How is metastatic breast cancer treated?

It depends on the type of breast cancer and where it has spread, said Melissa McShane, an assistant professor at Fox Chase Cancer Center, who specializes in breast cancer. Chemotherapy, immunotherapy, surgery to remove tumors, and a mastectomy, when the breast is removed, are all common treatments for breast cancer.

When deciding which treatment approach is best, doctors also consider patients’ overall health, their lifestyle, and their goals. For instance, some patients may want to pursue aggressive treatment while others may decide the side effects and time commitment of treatment are too much.

Who is at risk for metastatic breast cancer?

Both women and men can develop metastatic breast cancer. About 30% of people diagnosed with early stage breast cancer will eventually develop metastatic breast cancer, according to Breastcancer.org. About 4% of breast cancers are metastatic at the initial diagnosis.

Can you get metastatic breast cancer if you’ve had a mastectomy?

Yes. A mastectomy, when the breast is surgically removed, reduces the risk of the cancer coming back in the same place, but metastatic breast cancer by definition means breast cancer that has spread beyond the breast. People may develop metastatic breast cancer months or even years after their initial early-stage diagnosis.

How long can you live with metastatic breast cancer?

It depends on the type of cancer, where it has spread, what treatment patients receive, and how their body responds to treatment, McShane said. The five-year survival rate for metastatic breast cancer is 29%, meaning people diagnosed with metastatic breast cancer are about 29% as likely as those who don’t have that cancer to live for at least 5 years after diagnosis, according to the American Cancer Society. But with more advanced treatment options, people are increasingly living longer with metastatic breast cancer.

Is metastatic breast cancer preventable?

No. But routine screening for breast cancer can increase the chances of catching cancer at an earlier stage, when it easier to treat. Routine mammograms are recommended for women over age 40. Private health insurance, Medicare, and Medicaid are required to cover mammograms for people who are eligible without cost sharing.