Consider the possibility of metastatic breast cancer if the patient has a symptom that persists over several weeks, tending to get worse rather than better and is otherwise unexplained.

Some cases of metastatic disease will be detected at the same time as presentation with the initial primary breast cancer (‘de novo metastatic disease’).

Signs and symptoms will depend on the type of cancer initially diagnosed and the location of metastatic disease. They may be discovered by the patient or by surveillance in the post-treatment period. Symptoms can often present as bone pain (most common), shortness of breath or cough, weight loss, abdominal symptoms or jaundice.

Other patients may present with symptoms of recurrent disease after a previous cancer diagnosis. Patients can present with symptoms of recurrent disease in the locoregional area, or at distant sites, or both. This may include a breast mass, skin nodules, enlarged lymph nodes or inflammatory cancer symptoms. Some local recurrence is detected at follow-up imaging only.

Some cases of recurrent disease will be detected by routine follow-up in a patient who is asymptomatic.

All cases should undergo investigation (staging scans) to establish the extent of disease and be rebiopsied if possible; biopsies should have receptor status re-evaluated.

Access to the best available therapies, including clinical trials, as well as treatment overseen by a multidisciplinary team, are crucial to achieving the best outcomes for anyone with metastatic or recurrent disease.