When breast cancer spreads beyond the breast, we speak of metastatic disease — a reality that affects a significant number of women in the Maghreb and in Africa. In Tunisia, 29.5% of patients present with metastases at the initial diagnosis, and these metastases affect roughly 20 to 30% of patients initially treated for localized breast cancer. They lodge, in order of frequency, in the bones, the liver, the lungs and the brain. Recognizing the warning signs early and gaining access to innovative treatments — hormone therapy, targeted chemotherapy, targeted therapies — remains decisive for care.
Metastatic breast cancer in telling figures
In Tunisia, breast cancer mainly affects young women, with an average age of 51, and 29.5% of patients present with metastases at the initial diagnosis. Algeria, for its part, records 15,000 new cases each year with 3,500 deaths, while in Morocco breast cancer accounts for 19.2% of all cancers.
These metastases affect roughly 20 to 30% of patients initially treated for localized breast cancer. Yet the reality is even more worrying: in Africa, between 60% and 70% of women are diagnosed at an advanced stage, and only one woman in two survives five years after diagnosis.
How cancer cells orchestrate their escape
The metastatic process begins when cancer cells acquire remarkable capacities for escape. Initially settled in the breast’s milk ducts, they gradually develop enzymes that break down the basement membrane separating them from neighboring tissues.
This transformation is accompanied by several alarming phenomena. First, the tumor cells create their own blood vessels, thereby securing their supply of oxygen and nutrients. Then they skillfully exploit the lymphatic system to spread, which explains why examination of the axillary lymph nodes remains crucial.
A troubling fact: 27HC, a cholesterol metabolite, increases the metastatic capacities of cancer cells, which explains why high cholesterol promotes their dissemination.
Breast cancer metastasis: the preferred sites revealed
Cancer cells do not colonize just anywhere. They follow a well-established order of preference:
The bones come first, particularly affected by hormone-sensitive cancers. In Tunisia, bone metastases account for 13.3% of cases diagnosed by scintigraphy, with a predilection for the axial skeleton.
The liver is the second favorite destination, notably for cancers without hormone receptors.
The lungs follow closely, often associated with aggressive forms.
The brain remains particularly threatened by cancers overexpressing HER2.
This distribution varies according to the type of breast cancer. Lobular cancers favor the stomach and the ovaries, whereas hormone-dependent forms preferentially target the bones.
| Metastatic site | Frequency / rank | Associated cancer profile |
|---|---|---|
| Bones | 1st rank | Hormone-sensitive cancers; axial skeleton; 13.3% of cases diagnosed by scintigraphy in Tunisia |
| Liver | 2nd rank | Cancers without hormone receptors |
| Lungs | 3rd rank | Aggressive forms |
| Brain | Particular threat | Cancers overexpressing HER2 |
| Stomach and ovaries | Specific distribution | Lobular cancers |
Warning signs: when the body sounds the alarm
Certain symptoms should alert you immediately, in particular:
- Persistent back pain, resistant to standard painkillers
- The appearance of a lump in the opposite breast or of a swollen lymph node
- Unexplained digestive troubles: loss of appetite, nausea, aversion to food
- New respiratory problems: chronic cough, chest pain, shortness of breath
- Neurological signs: headaches, dizziness, visual disturbances
These manifestations call for a prompt consultation. Do not forget: in Algeria, the majority of deaths are linked to late diagnosis, with patients arriving at stages 3 and 4.
Tests to confirm breast cancer metastasis
Diagnosis rests on several essential complementary examinations:
- Blood work with measurement of tumor markers
- Thoraco-abdominal CT scan to visualize visceral metastases
- Bone scintigraphy, still the reference examination for bone metastases
- PET scan when a precise assessment is required
- MRI, particularly useful for bone and brain locations
In Morocco, the interval between the first consultation and diagnosis exceeds three months in 52% of cases, underscoring the importance of an optimized care pathway.
Groundbreaking treatments against metastases
Fortunately, care is evolving rapidly thanks to therapeutic advances. Metastatic breast cancer is gradually becoming a controllable chronic disease.
Hormone therapy as first-line treatment
It remains the treatment of choice for all metastatic cancers with positive hormone receptors.
Targeted chemotherapy
Favored for rapidly progressing cancers with few hormone receptors.
Innovative targeted therapies
Trastuzumab deruxtecan is revolutionizing the management of HER2-positive cancers. Recent studies show a response rate of 53.5% with a median progression-free survival of 9.4 months.
Trodelvy (sacituzumab govitecan) offers new hope for triple-negative cancers that have failed treatment.
Keytruda (pembrolizumab) in combination with chemotherapy increases median overall survival from 16 to 23 months in triple-negative cancers.
Surgery and adjunct radiotherapy
Sometimes, surgery for liver or lung metastases remains an option after medical treatment. Cementoplasty also holds an important place in the management of osteolytic bone metastases.
Prognosis and hope: encouraging figures
While high-income countries report five-year survival rates above 90%, Africa still lags considerably behind. Nevertheless, median survival now reaches 2 to 3 years for metastatic breast cancer, with some patients living more than 10 years after diagnosis.
Specific challenges in the Maghreb and Africa
Infrastructure remains inadequate: Algeria has only three cancer-care centers for 48 provinces, Morocco six state centers, and Tunisia a single anti-cancer center, the Salah Azaiez Institute.
This situation explains why many Algerians seek treatment in Morocco, Tunisia and France, for 3,500 to 5,000 euros.
Regional reference bodies
- Tunisia: Salah Azaiez Institute, National Institute of Public Health (INSP)
- Algeria: Pierre-et-Marie-Curie Centers (Algiers, Oran, Blida), Algerian Society of Medical Oncology
- Morocco: Mohammed VI Center for the Treatment of Cancers, Lalla Salma Foundation
The fight against breast cancer metastasis demands a collective mobilization. Despite the infrastructure challenges, therapeutic advances offer encouraging prospects. What matters most remains early diagnosis and equitable access to innovative treatments for all African women.
