What Breast Cancer Specialists Want Patients to Understand

Breast cancer survivor and OB-GYN Dr. Thaïs Aliabadi, along with breast oncologist Dr. Elizabeth Comen, discuss what recurrence means, why it happens, and what people with metastatic disease should know.

Need to know

• Dr. Thaïs Aliabadi describes how she navigated her own breast cancer diagnosis, treatment, and efforts to advocate for her care
• Metastatic breast cancer can often be managed as a chronic condition with treatment plans tailored to the individual
• Doctors advise patients to trust their instincts, keep asking questions, and get another opinion if something feels off

Looking back on her breast cancer diagnosis, Dr. Thaïs Aliabadi says one thing is clear: she believed she was doing everything she was supposed to do.

At 48, the OB-GYN and SHE MD podcast co-host had a routine mammogram that found atypical cells, but not cancer. Even without a family history or known genetic mutation, she had dense breasts and other risk factors that worried her enough to pursue a preventive double mastectomy. Getting that operation, however, was not simple.

“I was told I was too healthy, too anxious, too aggressive,” Aliabadi recalls.

Roughly six months later, she found a surgeon. Days after the procedure, she learned she had stage 1 invasive breast cancer in the breast doctors had been less concerned about.

Then came another shock. After surgery, Aliabadi felt breast tissue she believed should not have been there. Her MRI had been read as clear, and a second radiologist agreed. She kept pushing for another review. A breast surgeon ultimately confirmed her concern, and she later underwent a second double mastectomy.

“I had a medical degree, the knowledge and the access, and I still had to fight to be heard,” she says. “I think every day about the women who don’t have those things.”

That experience now shapes the guidance she gives patients, especially those facing the possibility of recurrence or a metastatic breast cancer diagnosis.

What does metastatic breast cancer mean?

Metastatic breast cancer, also known as stage 4 breast cancer, happens when breast cancer cells spread beyond the breast and nearby lymph nodes to distant parts of the body, including the bones, liver, lungs or brain. Even when it shows up in another organ, it is still breast cancer.

“It’s not that you have breast cancer that then becomes lung cancer,” says Dr. Elizabeth Comen, a breast oncologist and co-director of the Mignone Women’s Health Collaborative at NYU Langone Health. “It is breast cancer that has spread to the lung.”

That distinction matters because treatment is guided by the biology of the breast cancer cells, not simply the organ where they are found.

Cancer can return even when you did everything right

One of the hardest parts of recurrence is the question many patients understandably ask: how can this happen if they followed every recommendation?

Comen says some breast cancer cells may have already traveled outside the breast before the original cancer was diagnosed. Surgery, radiation, chemotherapy or hormonal therapy can treat the known cancer, while microscopic cells that have already spread may remain inactive and later grow.

“Recurrence is not a failure. It is the biology of cancer,” Aliabadi says. And although recurrence is frightening, it does not automatically mean someone is nearing the end of life.

A metastatic diagnosis is not necessarily an immediate death sentence

Comen says one of the biggest misconceptions she sees is the assumption that a stage 4 diagnosis means an immediate decline.

“Not all stage 4 cancers are alike,” she says. “Stage 4 pancreatic cancer is different from stage 4 breast cancer.”

Treatment for metastatic breast cancer has also advanced significantly as researchers have learned more about the biology of individual tumors. Doctors can use that information to match therapy to the features of a patient’s cancer.

“Metastatic is really geography,” Comen explains. “It’s where the cancer is.”

For some patients, metastatic breast cancer can be managed as a chronic disease, with treatment continuing for years while quality of life remains good. Comen says many people are able to live “full, beautiful lives” while receiving care.

That does not make the diagnosis easy, and it does not allow doctors to predict exactly how any one person’s cancer will behave. But it does show that stage 4 breast cancer is not just one story.

A biopsy can reveal more about what doctors are treating

If breast cancer comes back or is found elsewhere in the body, Comen says doctors will often do a biopsy to confirm that it originated in the breast and to learn more about its current features.

That matters because the biology of a recurrent or metastatic tumor can sometimes differ from the original cancer.

Knowing those changes can help doctors decide which treatments may be the best fit.

Keep advocating for yourself

Aliabadi’s own experience has made her especially passionate about encouraging patients to trust themselves when something feels wrong. She urges women to learn their personal breast cancer risk, find out whether they have dense breasts, ask about their individualized screening plan and seek further evaluation when something does not seem right.

A normal imaging result does not always mean a new or ongoing symptom should be ignored. In her view, asking for another opinion can be appropriate when concern remains.

“As an OB-GYN and a breast cancer survivor, I want women to stop apologizing for asking questions,” she says. “So many women stay quiet because they don’t want to seem dramatic. I was told I was being too anxious, and I’m a doctor.”

If you are living with metastatic breast cancer, you deserve support, not blame

For Aliabadi, perhaps the most important takeaway is that recurrence is not something a patient should blame herself for. Breast cancer does not always follow a straight line, even when someone has been careful about screening and treatment.

For people living with metastatic disease, Comen says there is still reason for hope as researchers continue developing more targeted therapies. Patients can remain on treatment for years while keeping a good quality of life.

Aliabadi puts it even more simply: “Every woman with metastatic disease deserves compassion, support and better treatments.”