In a courageous and candid interview with ABC News, actress Shannen Doherty, celebrated for her iconic roles in “Beverly Hills, 90210” and “Charmed,” revealed the return of her breast cancer as stage IV. This announcement not only brought personal news into the public sphere but also shone a spotlight on the complexities of breast cancer, particularly the journey from an original diagnosis to metastatic stages. Doherty’s initial battle with cancer and her current diagnosis offer a poignant case study for understanding the nuances of breast cancer, including types like triple negative, and the realities of living with metastatic disease.
Doherty’s first encounter with breast cancer began in March 2015. At the time of her original cancer diagnosis, it was identified as invasive breast cancer that had metastasized to at least one lymph node. This initial diagnosis led to an intensive treatment plan that included a mastectomy, chemotherapy, and radiation, followed by reconstructive surgery. Sharing her experiences openly on social media, Doherty became an advocate and a symbol of resilience for many facing similar health challenges. By 2017, she was in remission, marking a significant victory in her fight against cancer.
However, approximately a year before her public announcement of stage IV cancer, while filming the “90210” reboot, Doherty experienced unusual pain that prompted a medical re-evaluation. This led to the devastating diagnosis of recurrent breast cancer. This time, she chose to keep her health battle private, navigating demanding 16-hour filming days while confiding only in co-star Brian Austin Green. This period underscores the personal struggles faced by individuals dealing with serious illnesses while maintaining professional and personal lives.
Doherty decided to come forward with her stage IV diagnosis because of pending legal actions against State Farm Insurance related to damage to her home from the 2018 Woolsey fire. The ensuing court documents would inevitably reveal her health status. In her interview, she expressed a preference to control the narrative and share her story directly, stating, “I don’t want it to be twisted. I don’t want it to be a court document.” This decision highlights the added layer of complexity celebrities face when personal health matters intersect with public life and legal proceedings.
When Amy Robach, herself a breast cancer survivor, inquired about how Doherty was coping with this second diagnosis, Doherty’s response was raw and honest. “I don’t think that I’ve processed it,” she admitted, describing the news as “a bitter pill to swallow.” She further articulated the emotional turmoil, saying, “I’m petrified; I’m pretty scared…. There are definitely days where I say, ‘Why me?’ And then I go, ‘Why not me? Who else?’ Who else besides me deserves this? None of us do.” Her words resonate with the universal struggle of grappling with a life-threatening illness, the questioning, and the search for meaning amidst adversity.
Understanding Stage IV and Metastatic Breast Cancer
Stage IV breast cancer is synonymous with metastatic breast cancer (MBC). This advanced stage indicates that the cancer has spread beyond the breast and nearby lymph nodes to distant parts of the body. Common sites for metastasis include the bones, lungs, liver, and brain. Approximately 6% of women are diagnosed with MBC at the time of their initial breast cancer diagnosis, known as de novo metastatic breast cancer. Furthermore, about 30% of women initially diagnosed at earlier stages will experience a recurrence with metastatic spread at some point.
The symptoms of MBC are diverse, varying based on the affected organs. Key symptoms associated with metastasis to different sites include:
- Bone Metastases: Often characterized by the sudden onset of new pain, most commonly in the ribs, spine, pelvis, and long bones.
- Lung Metastases: May present as pain or discomfort in the lungs, shortness of breath, and a persistent cough.
- Brain Metastases: Symptoms can include headaches, changes in speech or vision, and memory problems.
- Liver Metastases: Can manifest as pain or discomfort in the midsection, fatigue and weakness, and unexplained weight loss or poor appetite.
The Evolving Prognosis of Metastatic Breast Cancer
While metastatic breast cancer remains a challenging diagnosis without a definitive cure, significant advancements in treatment have dramatically improved both survival rates and quality of life for many patients. Historically, median survival was reported to be between 18 to 24 months. However, contemporary treatments have extended survival considerably for many, with some patients achieving long-term survival.
A notable 2017 study highlighted this positive trend. Researchers from leading institutions like the National Cancer Institute and the Metastatic Breast Cancer Alliance found that not only is the population of women living with MBC in the U.S. growing, but survival rates are also improving, particularly among younger women.
The study revealed a doubling of the 5-year relative survival rate for women initially diagnosed with MBC between ages 15-49, from 18% in 1992-1994 to 36% in 2005-2012. Median survival time for this age group increased from 22.3 months to 38.7 months during the same periods. Similar improvements were observed for women diagnosed between 50 and 64 years old, with median survival increasing from 19.1 months to 29.7 months. Importantly, the research also indicated that a meaningful proportion of women are living for a decade or more post-MBC diagnosis.
Treatment Landscape for Metastatic Breast Cancer
The progress in survival rates is largely attributable to the development and introduction of novel systemic treatments. Personalized treatment strategies, guided by tumor biology and individual patient factors, are crucial in managing MBC.
Molecular marker testing is essential in determining the most effective treatment approach. Biopsies of suspected metastatic lesions are analyzed for estrogen receptor (ER), progesterone receptor (PR), and HER2 (human epidermal growth factor receptor 2) overexpression. Additional molecular assessments, such as tropomyosin receptor kinase mutations and microsatellite instability, along with germline testing for BRCA1 and BRCA2 mutations, further refine treatment decisions. The potential for receptor status discordance between primary and metastatic tumors underscores the importance of re-biopsy to guide therapy accurately.
Treatment for metastatic breast cancer is primarily palliative, aimed at prolonging life and enhancing quality of life. Treatment strategies are often categorized by the molecular characteristics of the cancer.
Triple Negative Breast Cancer Considerations
While the original article does not explicitly state Shannen Doherty’s breast cancer subtype as triple negative, it’s important to understand this aggressive form of breast cancer, as it is often associated with recurrence and metastasis. Triple-negative breast cancer is defined by the absence of estrogen receptors (ER), progesterone receptors (PR), and HER2 protein overexpression. This lack of receptors means that it does not respond to hormone therapies or HER2-targeted therapies, leaving chemotherapy as the mainstay of systemic treatment for many years.
However, advancements are being made in treating triple-negative breast cancer as well. For instance, immunotherapy, particularly with agents like atezolizumab in combination with chemotherapy, has shown promise in improving outcomes for patients with advanced triple-negative breast cancer.
Hope and Resilience in the Face of Stage IV Cancer
Shannen Doherty’s journey with breast cancer, from her original diagnosis to her current stage IV status, is a powerful reminder of the complexities of this disease and the importance of ongoing research and advancements in treatment. Her openness in sharing her story helps to destigmatize cancer, raises awareness about metastatic breast cancer, and provides hope to others facing similar battles. While stage IV breast cancer is a serious diagnosis, the progress in treatment and the increasing number of long-term survivors offer a message of hope and resilience.
