Should Doctors Regularly Screen for Breast Cancer Brain Metastases?
Brain metastases that don’t cause symptoms are more common in people with metastatic breast cancer than previously believed, according to a study. The results suggest that doctors may need to rethink current guidelines, which don’t recommend regular screening for brain metastases in people with metastatic breast cancer.
The study was published in Neuro-Oncology.
Key takeaways
Among 101 people diagnosed with metastatic breast cancer, MRI screening found brain metastases in 14%, even though they had no symptoms.
When the MRI scans of the brain were repeated six months later, the percentage of people with brain metastases had increased to 24% and they still had no symptoms.
The rates of brain metastases were similar among all breast cancer subtypes.
What the results mean for you
This study strongly suggests that brain metastases that cause no symptoms are common in people diagnosed with metastatic breast cancer. Current National Comprehensive Cancer Center (NCCN) guidelines don’t recommend routine screening for brain metastases for people with metastatic breast cancer who don’t have any neurological symptoms.
The researchers said these guidelines should be reviewed, especially since new treatments, such as Enhertu (chemical name: fam-trastuzumab-deruxtecan-nxki) and Tukysa (chemical name: tucatinib), have been found to effectively treat certain brain metastases.
Why do the study?
Researchers estimate that 15% to 30% of people diagnosed with metastatic breast cancer will develop brain metastases. Compared to other areas where metastatic breast cancer can spread, studies show that people with brain metastases have worse outcomes.
National guidelines recommend screening MRIs to look for brain metastases in people with stage II or higher non-small cell lung cancer and stage IIIB to stage IV melanoma because studies have shown these two types of cancer frequently metastasize to the brain. But NCCN guidelines only recommend screening brain MRIs for people with metastatic breast cancer if they have neurological symptoms, such as headaches, dizziness, slurred speech, or seizures. According to the researchers, this is likely because rates of brain metastases in people with metastatic breast cancer haven’t been well documented.
About the study
The study included 101 people — 100 women and one man — diagnosed with metastatic breast cancer. Most of the people — 86% — were white. They ranged in age from 29 to 87.
40 people had hormone receptor-positive, HER2-negative disease
28 had triple-negative disease
33 had HER2-positive disease
None of the people had symptoms of brain metastases.
Between January 2022 and December 2023, all the people had a baseline MRI brain scan. Six months later, 66 people had a second brain MRI. (The decline in participation was due to people dropping out of the study or dying over the course of the study.)
Detailed results
The results of the first brain MRI showed that 14 people (14%) had brain metastases. Rates of brain metastases by subtype were:
18% in people with triple-negative breast cancer
15% in people with HER2-positive breast cancer
10% in people with hormone receptor-positive, HER2-negative breast cancer
After the second brain MRI, the results showed 10 more people had brain metastases. The rates of brain metastases by subtype were:
25% in people with triple-negative breast cancer
24% in people with HER2-positive breast cancer
23% in people with hormone receptor-positive, HER2-negative breast cancer
After being diagnosed with brain metastases, most people received early treatment, including changes in systemic treatments, such as targeted therapies and chemotherapy, and local treatments, such as stereotactic radiation and surgery.
“Our study suggests that asymptomatic brain metastasis is quite common in stage IV breast cancer,” principal investigator Kamran Ahmed, MD, said in a statement. Ahmed is associate member and section chief for Breast Radiation Oncology at the Moffitt Cancer Center. “Although larger studies are needed to confirm our findings, given the improvements in systemic and local therapies for breast cancer brain metastasis, the time may be appropriate to reconsider current guidelines that recommend against routine MRI surveillance in late-stage breast cancer.”
— Last updated on July 1, 2025 at 8:39 PM