Skill Checkup: A 56-Year-Old Woman With a History of Breast Cancer and Pain in Her Ribs and Spine

Pavani Chalasani, MD, MPH


January 14, 2022

Women with breast cancer are most prone to bone metastases, which are often the first detectable distant site. In the current patient, the elevated alkaline phosphatase level was a clue to bone involvement.

The first location of distant metastasis varies by subtype; in patients with HR-positive/HER2-negative breast cancer, it spreads to the bone in up to 85% of cases. Other common sites are the lungs and the liver, but breast cancer can also spread to almost any other part of the body, including the brain and skin.

Bone scan or PET/CT is used to detect bone metastases. PET/CT is a more sensitive method for detecting bone metastases.


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