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

Pavani Chalasani, MD, MPH;  Stefania Morganti, MD


January 23, 2023

Following diagnosis of bone metastases, the NCCN guidelines recommend adding denosumab, zoledronic acid, or pamidronate — with calcium and vitamin D supplementation — to chemotherapy or endocrine therapy in patients with adequate renal function and expected survival of ≥ 3 months.

Breast surgery is not routinely indicated in patients with metastatic breast cancer.

According to international guidelines, there is no indication for radiation therapy to treat asymptomatic lesions, only sites causing pain or at risk for fracture. In this patient, radiation therapy may be considered to treat symptomatic lesions not improved after initiation of systemic therapy, but not as treatment for all metastatic sites.

In patients with bone metastases, a baseline bone density assessment is not routinely recommended.

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