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If you have a newly diagnosed metastatic breast cancer, should you have a biopsy of the metastases? Should your treatment be based on the biomarker status of the primary or the metastatic cancer? These guidelines instruct your doctors how to treat your metastatic breast cancer.

The American Society of Clinical Oncology (ASCO) has put out new guidelines about how to treat women diagnosed with metastatic breast cancer.  These guidelines are important because it has not been clear how to handle patients who are first diagnosed with metastasis while being treated for a primary cancer.  For example, it hasn’t been clear whether the metastatic cancer should be biopsied to see if its characteristics are the same as the primary cancer’s characteristics.  If the characteristics of the mestastatic cancer are different than the primary cancer, different treatments may be required.
The guidelines say:
1.  People with newly diagnosed metastatic breast cancer should be offered a biopsy of the metastatic cancer to determine whether it is estrogen-receptor positive or negative, progesterone-receptor positive or negative, and to determine its HER-2 status.
2.  If the metastatic cancer has different hormone-receptor HER-2 status than the primary cancer and the person is still being treated for the primary cancer, doctors should tell the woman that it’s not clear if results are better if treatment is based on the biomarkers in the primary cancer or the metastatic cancer.  Still, the expert panel that developed the guidelines felt that doctors should base treatment on the characteristics of the metastatic cancer as long as the treatments aligned with the person’s choices.