October is Breast Cancer Awareness Month, so you'll soon be hearing a lot about the disease—but probably not much about the metastatic kind. Metastatic means the cancer has spread to another part of the body, usually the lungs, liver, bones, or brain. It's also known as stage IV cancer. Women initially diagnosed with stage II breast cancer have a five-year survival rate of about 93 percent; with stage III, it's about 72 percent. In stage IV, the rate drops to about 22 percent. Most breast cancer deaths are due to metastasis; it kills roughly 40,000 Americans each year.

Now, the good news. Though there's no cure for metastatic breast cancer (MBC), it can be treated—with chemo, surgery, radiation, and, increasingly, targeted drugs. When a drug regimen is effective, a patient stays on it until it stops working, and then she tries a different medication. In January, the FDA expanded these life-lengthening options when it approved a new class of drugs for breast cancer called PARP inhibitors, which can slow the progression of the disease in stage IV patients with BRCA mutations. "This shows we're moving in the right direction for improving survival," says Marc Hurlbert, PhD, chief mission officer at the Breast Cancer Research Foundation.

April Doyle, 40, a cancer blogger in California's Central Valley, is well acquainted with the ins and outs of MBC treatment. Diagnosed with breast cancer at age 31, Doyle was told she was cured at 36—only to find out the same day that the doctor had spoken too soon: She had metastatic breast cancer in her bones. But while the median life expectancy for MBC patients is three years, she's been living—and working, traveling, and parenting—with it for four. We asked Doyle for her advice to women who share her diagnosis.

Make sure your oncologist will go out of her way for you.
"We are at the mercy of our disease, so we need to feel like our doctors are doing everything they can to extend our lives for as long as possible. Look for someone you trust and don't be afraid to ask questions, push for answers, and say what's on your mind. It took me a few tries, but my current oncologist is amazing. He takes the time to explain everything to me."

Don't suffer through the pain.
"My cancer makes my whole body hurt, and the pain in my hips, especially, can hold me back from yoga, gardening, and riding bikes with my son. The cancer meds also make my joints ache. So I'll pop a painkiller when I need one. I also take a lot of Epsom salt baths—I love a good soak."

Find your people.
"Those in the same situation get what you're going through like no one else. But whether they're women you met in cancer support groups or longtime friends, connect with the ones you can be you with. My friends let me cry, scream, and drag them on trips to New Orleans or St. Thomas."

Live in the moment.
"From the day of my MBC diagnosis four years ago, when my son was 3, my life has revolved around making memories with him. I don't know whether I'll be here when he has children, gets married, or even starts high school, so I do everything I can to make sure he'll remember how much I love him and the fun we had together. It's not always a big deal; sometimes we're just playing board games or with Legos. I also love to travel, and the idea of my son remembering going somewhere with his mom fills my heart. I take lots of pictures and videos and overshare on social media. One day that's all he'll have of me."

Think about what the future will hold for those who depend on you.
"My son's dad and I are divorced, but I want them to have a strong bond—ditto my ex's parents—so my son will be well cared for if I'm not here someday. I make sure he spends quality time with them, even though it hurts to stay home without him."

Always have something to look forward to.
"I try not to let my life revolve around cancer. For example, I'm having radiation to help relieve some pain, but a week after I'm done, I'm going to Lake Tahoe. It's difficult some days, but I'm here now, and I believe in living like I'll be around for a while."


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