![]() ![]() 7 Metastatic recurrence is a significant problem in patients with breast cancer, the most frequently diagnosed malignancy and the second leading cause of cancer-related death among women worldwide. However, it is most often the result of relapse (recurrence), where metastases manifest after definitive treatment. 5, 6 Metastatic disease can occur de novo, in which metastases are present at the original diagnosis, the cancer having already spread prior to detection. This process is responsible for >90% of tumour-related deaths, often due to the impairment of vital organ function. 2 Metastasis is the dissemination of tumour cells from the primary neoplasm to secondary sites in a multistep process that is often depicted as a simple series of sequential events: 3, 4 escape from the primary tumour and local invasion, intravasation and survival in the circulation and extravasation and metastatic seeding (Fig. ![]() With a total of 18,989,634 new cases and 10,052,507 associated deaths estimated to occur in 2020, 1 cancer remains a major health problem worldwide. ![]()
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