How do you recognize bone mets?
Yesterday I had an email from a woman whom I knew a couple of years ago when she went through adjuvant treatment (surgery, radiation, and chemotherapy) for breast cancer. Since then, I have heard from her from time to time, and she has been doing well and making some very positive changes in her life. Her note yesterday, however, was less cheerful. She has been experiencing pain in her back for a while and is, of course, scared that it might represent a bone met, spread of the cancer to her back. She mentioned that she had tried to find some information about this on my blog and had not been able to do so. After responding directly to her, I decided that this would be an important topic to address here.
First and most important, remember that most aches and pains are just that: aches and pains, not cancer-related. This is a time that the "two week rule" applies. This means that you don't need to call your doctor unless a symptom persists for longer than two weeks. Most don't. Clearly, this does not apply to possible emergency situations! If you are having chest pain, call the doctor and get to an ER asap. It does apply to aches, pains, coughs, other minor but irritating and, in our situation, worrisome symptoms.
How do you know if a pain is cancer in the bone of due to any number of other things? Bottom line: you can't. Cancer bone pain generally is not 100% persistent in the beginning, may seem to come and go, or at least to wax and wane in intensity. Over time, it gets worse. May seem worse at night, may awaken you, and may be worse if you use the bone (e.g. if it is your leg and you take a long walk). Since bones are the most common site of a first spread of breast cancer, we do have to take this seriously. If you have pain that lasts for more than two weeks, is in the same spots, and maybe seems to be getting worse, call your doctor. Tell yourself when you make the call that it is probable that this won't be cancer, but you need to find out--hopefully to put your mind at rest.
Your doctor may first suggest that you take two advil, with milk, 3-4 times a day for a week. This could help determine if the pain is due to some kind of inflammation. Or, s/he may have another strategy to try before ordering a bone scan.
If the advil does not help or if your doctor does not suggest trying something like that first, it is likely that a bone scan will be ordered.. Occasionally other tests are part of the process, but the bone scan is the standard first response. You may have bloods drawn, too, to check the cancer markers (CEA and CA 25-27)--whichmay or may not be elevated whatever the bone situation is. Those markers are not completely accurate and reliable. A bone biopsy is not usually necessary.
Please remember, if you find yourself in this situation, that almost all of us experience at least one scare within the first few years after breast cancer. Most of the time, it is just that, a scare. If it does turn out to be metastatic breast cancer, you will be back on treatment, but you can plan to live your life for a very long time.