How advances in metastatic breast cancer care offer hope for longer, fuller lives
Personalised treatments transform outlook for women with metastatic breast cancer
For a woman living with metastatic breast cancer, a successful treatment can mean months or years of disease control, with work, family responsibilities and personal plans continuing between appointments. Advances in medicine are making that possible for more patients. They are also giving doctors and women more to consider when choosing treatment, including its effects on energy, independence, emotional well-being and the routines that make life familiar.
Metastatic breast cancer has spread to distant parts of the body and remains generally incurable. Treatment aims to extend survival, slow progression and relieve symptoms, with outcomes varying considerably between patients.
A changing outlook
The expanding range of medicines reflects a better understanding of the biological differences between breast cancers.
“Advances in targeted therapies, immunotherapy and personalised medicine have transformed the management of metastatic breast cancer,” says Dr Pranab K, Consultant Medical Oncology, Aster Hospital, Qusais. “While generally not curable, the disease can increasingly be controlled for longer periods in many patients.”
Dr Tariq Alhamid, Specialist Medical Oncology, Burjeel Cancer Institute, explains that hormone receptor-positive cancers have benefited from endocrine therapy combined with CDK4/6 inhibitors. Median survival has reached five years or more in some large studies, although these figures cannot predict an individual patient’s outcome.
HER2-positive disease has also seen substantial progress. Antibody-drug conjugates have expanded treatment possibilities, including for eligible patients with HER2-low expression. Triple-negative disease remains more challenging, despite improvements with immunotherapy and newer medicines.
“Patients should ensure their tumour is fully profiled, discuss treatment goals with their oncologist, and understand that more treatment options are now available,” he says.
Testing for alterations such as BRCA, PIK3CA and ESR1 can guide treatment. A biopsy of a metastatic site may sometimes help because tumour characteristics can change.
Decisions shaped by daily life
A medicine’s effectiveness is considered alongside the patient’s fitness, organ function, previous treatments and ability to tolerate side effects. The speed of progression matters too: rapidly advancing disease threatening an organ may need a faster response.
Personal priorities bring another dimension. One woman may want to continue working; another may place greater importance on fewer hospital visits or maintaining childcare responsibilities.
“Treatment decisions are highly personalized and take into account the biology of the cancer, the extent of the disease, previous treatments, the patient’s overall health, and their personal goals,” says Dr Stephen Grobmyer, Institute Chief, Cancer Institute, Cleveland Clinic Abu Dhabi.
Dr. Farhat Arsalan, Consultant General and Laparoscopic Surgeon – Zulekha Hospital Sharjah, says patients need a meaningful role in these discussions.
“Her concerns about surgery, body image, recovery, work, family responsibilities and emotional well-being all matter,” she says. “Most importantly, patients should be actively involved in these discussions so they understand their options and feel confident about the decisions being made.”
Breast conservation and reconstruction can support selected patients across breast cancer care. Systemic medicines remain central in metastatic disease, with surgery serving selected purposes.
The effects that accumulate
Longer periods of treatment can bring persistent symptoms that gradually interfere with daily activities. Fatigue may continue despite rest, while bone pain, joint discomfort, digestive problems and skin changes can affect movement, sleep and confidence.
“Because treatment may continue for long periods, even relatively mild side effects can affect quality of life over months or years,” says Dr Alhamid.
Hormonal treatments can cause hot flushes and vaginal dryness. Chemotherapy may cause nausea, hair loss or hand-foot syndrome, while targeted medicines can affect blood counts. Changes in weight, sexuality and fertility also deserve discussion.
Uncertainty adds its own demands. Anxiety before scans, financial pressures and worries about children can persist during otherwise stable periods.
“Addressing these challenges through continuous medical, psychological and emotional support is essential to comprehensive cancer care,” says Dr Pranab.
Dr. Sukrit Shetty, Specialist Surgical Oncology – Zulekha Hospital Sharjah, highlights counselling and peer support alongside advances in treatment and reconstructive techniques.
“Emotional support is an essential component of cancer care. Multidisciplinary teams comprising oncology specialists, counsellors and support groups have raised the standard of holistic care,” he says.
Some patients later help lead support groups, using their experiences to guide others through prolonged treatment.
Hormones and reproductive health
For younger women, treatment may also disrupt menstrual cycles and future reproductive plans. Chemotherapy can temporarily or permanently affect ovarian function, while hormonal therapies can influence sleep, sexual health and menopausal symptoms.
“Today, women have several fertility preservation options, including egg and embryo freezing before starting cancer treatment,” says Dr. Maya Alwan, Specialist Obstetrician & Gynaecologist at Medcare Medical Centres – Motor City. “In certain cases, medications that temporarily suppress ovarian function during chemotherapy may also help protect fertility.”
Early discussion allows specialist assessment before treatment begins. Future pregnancy in metastatic disease requires particular care because treatment is often ongoing. Gynaecological support also helps manage menstrual irregularities and menopausal changes.
Understanding hormonal exposure is important across breast health. Dr. Fathima Thasneem, Specialist Obstetrician & Gynaecologist at Medcare Women & Children Hospital, explains:
“Research shows that breastfeeding can help lower breast cancer risk, while starting menstruation at an early age or experiencing menopause later in life may slightly increase it.”
Hormonal contraceptives carry a small increase during current or recent use. Menopausal hormone therapy requires assessment of formulation, duration and personal history. Combined systemic therapy can increase breast cancer risk; oestrogen-only and local preparations require separate consideration, particularly after breast cancer.
Gut health under investigation
Questions about food and supplements often accompany treatment. The gut microbiome influences immunity, inflammation, metabolism and hormone processing, making it an area of research interest.
“We cannot yet establish a direct cause-and-effect relationship between gut health and breast cancer,” says Dr. Thasneem Mohamad Nour Abu El Fuol, Specialist General & Laparoscopic Surgery General, Medcare Hospital Sharjah – Sheikh Saqr Al Qasimi Street.
Researchers are studying younger women, responses to chemotherapy and immunotherapy, and digestive side effects. Gut bacteria produce short-chain fatty acids from fibre and influence oestrogen recycling, although the clinical significance remains under investigation.
Dietary variety, hydration and suitable fibre-rich foods can support gut health. Fermented foods may suit some patients, with adjustments for appetite, symptoms and immune status. Sleep, activity, stress, smoking, alcohol and antibiotic exposure also influence the microbiome.
“There is currently no conclusive evidence that probiotic supplements can prevent breast cancer or replace established cancer treatments,” she says.
Different bacterial strains have different effects, and supplements need medical advice. Prescribed antibiotics should never be delayed over microbiome concerns.
Screening and sustained support
Screening serves a separate purpose from monitoring metastatic cancer. Dr. Arun Thomas, Specialist Radiology, Medcare Royal Speciality Hospital, explains that 3D mammography creates thin images from multiple angles, helping distinguish abnormalities from overlapping tissue.
“This can be particularly beneficial for women with dense breasts, where overlapping tissue may make certain abnormalities more difficult to identify on conventional mammograms,” he says.
Detection and recall rates can improve in some settings. Expert interpretation, risk assessment and appropriate follow-up remain essential.
“A normal mammogram should not be used to dismiss a new or persistent symptom,” he adds.
Across care, coordination helps ensure that symptoms and concerns receive attention. Dr Manuelita Mazza, Section Head, Medical Oncology, Cancer Institute, Cleveland Clinic Abu Dhabi, values specialists working closely around the same patients.
“Having breast surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, and other specialists working closely together makes an enormous difference,” she says.
Structured tumour boards support decisions. Her approach also incorporates physical activity, nutrition and weight management, alongside recognition of inherited, reproductive and tumour-related factors.
Outside hospital, flexible working arrangements, help at home and coordinated rehabilitation can reduce strain. Palliative care can begin alongside treatment to manage symptoms, while counselling and community support help address uncertainty.
“There should be no pressure to appear strong or to return to normal before they are ready,” says Dr Arsalan.
That understanding gives women room to describe what they are experiencing and ask for assistance. Treatment planning can then account for an important family occasion, a demanding working week or the need for more rest, with practical support changing as their circumstances do.
Dedicated breast care
Launched on October 1, 2026, during Breast Cancer Awareness Month, the Aster Breast Clinic at Aster Hospital, Al Qusais, brings together specialists to support screening, diagnosis, treatment and recovery.
Located on the hospital’s first floor, the clinic offers mammography, breast ultrasound, MRI and biopsies. Services include assessment and management of benign breast conditions and high-risk concerns, providing women with a coordinated pathway to specialist advice.
For patients requiring treatment, breast surgery, medical oncology, radiology, and plastic and reconstructive surgery specialists collaborate on personalised plans that consider clinical needs alongside physical and emotional concerns.
Dedicated Breast Care Nurses provide guidance and follow-up support, while Concierge Services assist with appointments and hospital navigation.
The clinic stresses compassionate communication, personal attention and continuity of care, helping women understand their options and participate in decisions. Its focus is on making comprehensive breast care accessible and supporting patients and families throughout assessment, treatment and recovery.
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