After a double mastectomy, followed by chemotherapy, Hannah Gardner was confident that she’d beaten breast cancer. Even when cancer was detected in her chest wall four years later, she wasn’t overly worried.
‘It was an unmistakable pea-sized lump in the breast which I’d had reconstructed,’ says 38-year-old Hannah, a clinical trials manager who lives in Twickenham – and a scan confirmed the worst.
‘I was treated at the Royal Marsden Hospital [in London], and after surgery to remove more tissue, chemotherapy and radiotherapy, I was assured that I had a very good chance of living cancer-free.’
Hannah, who was 26 when she was first diagnosed in 2013, felt so reassured that she and her husband Peter, a firefighter, decided to start a family. A daughter, Lilah, was born in July 2020.
So Hannah was blindsided when a routine scan a few months later, in November 2020, revealed cancer cells in the lymph nodes under her arm.
‘The only sign had been a strange throbbing sensation in my armpit which had started a few weeks earlier,’ she says.
After radiotherapy, Hannah once again dared to hope for the best. But two years later, a routine scan revealed the cancer was back. This time it had spread to her liver.
‘The oncologist made it very clear: this was secondary cancer and there was no cure,’ she says. ‘It was my worst nightmare.’
After a double mastectomy, followed by chemotherapy, Hannah Gardner was confident that she’d beaten breast cancer
Hannah is one of an estimated 57,000 women in the UK living with secondary breast cancer, according to a study of NHS admissions in 2021 – a figure that’s been rising year on year since 2018. Between 10 and 40 per cent of UK patients diagnosed with primary breast cancer go on to develop secondary breast cancer.
The good news is that while secondary breast cancer remains incurable, treatments have improved dramatically.
‘Secondary breast cancer is no longer a death sentence – it’s very treatable,’ explains Russell Burcombe, a clinical oncologist at Maidstone and Tunbridge Wells NHS Trust.
‘For decades, the overall survival rate remained at two to three years. But there have been such exciting advances in treatment that the average expectation is now five years – and many will live longer than this.’
On average, 67 per cent of women live one year after a secondary breast cancer diagnosis; 26 per cent live five years and 11 per cent live for at least ten years.
‘One of the biggest things scientists are working on is turning breast cancer into a chronic disease that patients live with, not die from,’ adds Dr Burcombe.
‘The biggest change has been the use of drugs called CDK4/6 inhibitors – tablets that enhance the effectiveness of hormone therapy, which works to stop or slow down the growth of cancer cells. We now have patients taking a hormone tablet with one of these drugs for ten or more years.
‘Then we have immunotherapy, which uses the immune system to fight cancer and is usually delivered by intravenous injection. It is particularly successful at treating patients with the aggressive triple negative breast cancer who used to fare particularly badly if their cancer recurred.’
Hannah is now on a clinical trial involving immunotherapy. ‘I’m on treatment for the rest of my life,’ she says. ‘It’s not a walk in the park, but at least it’s buying me time.
‘No one wants to think about cancer coming back. I certainly didn’t. But there’s no point burying your head in the sand.
‘The earlier you seek a diagnosis and start treatment, then the better your chances.’
The most common site for secondary breast cancer is in the bone, followed by the lungs, liver, skin and brain
Hannah is one of an estimated 57,000 women in the UK living with secondary breast cancer, according to a study of NHS admissions in 2021 – a figure that’s been rising year on year since 2018
Looking back, Natalie Gibbs, 48, knows she should have reported her symptoms earlier. The Pilates teacher and energetic mother of two regarded herself as too fit and healthy to bother medics after she fell, cracking a rib. She’d also been enduring back pain for several months, which she’d put down to a chest infection.
It was only in January 2020 – two months after the fall – that Natalie decided she could no longer ignore the puckering skin on both her breasts and booked an appointment at the breast care centre of KIMS, a private hospital in Maidstone, Kent.
Scans and biopsies revealed secondary breast cancer, which had spread to her bones and ovaries. She had no idea that the cracked rib was a symptom.
In fact, when breast cancer spreads outside the breast through the lymphatic or blood system, it most commonly goes first to the bones, making them brittle and prone to breakage.
‘I was in total shock,’ says Natalie, who lives in Canterbury, Kent, with her husband Alfie, 55, a surveyor, and their children George, 19, and Olivia, 16.
‘I’d noticed the changes in my breasts over many months, but I had buried my head in the sand because I was too scared to acknowledge it could be cancer,’ she says. ‘Discovering it had already spread was devastating.’
While most women are aware of the symptoms of breast cancer, which include lumps and skin puckering, alarmingly few know the signs of secondary, or stage 4, breast cancer. Even fewer know the encouraging news that it is now very treatable.
The most common site for secondary breast cancer is in the bone, followed by the lungs, liver, skin and brain.
Yet a survey by GenesisCare, a specialist cancer care provider, found that 72 per cent of women who’d previously had a cancer diagnosis didn’t know where in the body it’s likely to appear.
After a six-month programme of chemotherapy, as well as bone-strengthening drugs, Natalie is back to her active self. ‘I thought it was a death sentence, but the drugs have kept the cancer at bay for four years,’ she says.
‘Sadly, in July 2023 I started suffering crippling headaches, and scans showed that the cancer had spread to my brain.
‘I had radiotherapy on my brain and now take immunotherapy tablets every day and chemotherapy tablets 14 days out of 21 every month.
‘For my family’s sake I can’t let cancer dominate my life. I believe in cracking on. I’ve got so much to do – like preparing George for university last year and Olivia for boarding school.’
A worrying number of women would also not think to mention their breast cancer history to their GP for new, seemingly unrelated symptoms.
According to research by GenesisCare, 80 per cent of women with a previous diagnosis wouldn’t link excess tiredness, feeling sick or loss of appetite with cancer – yet all these symptoms can be connected to secondary breast cancer in the liver.
And 78 per cent wouldn’t mention their history if they were experiencing a cough or breathlessness, yet both these are symptoms of secondary breast cancer in the lung.
Unsurprisingly, the highest risk of recurrence is in the first few years after treatment. Risk factors include the type of breast cancer, the stage when it was diagnosed, the size of the tumour, how many lymph nodes, if any, were involved and factors such as obesity and alcohol consumption.
‘No tool can guarantee cancer will not return,’ says Nicola Roche, a consultant breast surgeon at the Royal Marsden.
‘But making healthy lifestyle choices is important. There is a link between high levels of oestrogen in the blood and breast cancer recurrence. A diet high in fat and calories can increase circulating oestrogen.’
Dr Burcombe adds: ‘I understand that patients want to forget they had cancer, but I always tell them that even if they were diagnosed 15 years ago, they are not out of the woods.
‘Most GPs will be alert to a recurrence, but if you have a symptom such as a cough or an ache that’s new, prolonged and unusual, then you should always see your GP and point out your cancer history – even if you think it’s unrelated.’
Hannah and Natalie are taking part in a campaign by GenesisCare to drive awareness of secondary breast cancer. For more information on the symptoms to look out for, go to genesiscare.com/uk/second-chance.
