breast cancer recurrence/bone metastases

In 1988, at the age of 33, my mother had breast cancer; surgery which removed the breast and ovaries followed, plus 12 sessions of chemotherapy and 5 years on tamoxifen. Last week, 18 years later, she was diagnosed with bone metastases (osteolytic, 7 different locations). Is it possible that the disease is recent - do you know of any such cases - or is it likely that she's had it for a while. What does this mean in terms of life expectancy?

She is currently on Bonefos IV (1500 mg/day; 5x5 mL ampul at a time, once a month; which I think is the maximum possible dose?) until Aredia become available to her next month. She also started chemo immediately (Taxotere) and the doctor said they will continue for 6 sessions before they decide how better to proceed. How long is the treatment with Aredia recommended to continue for? Are there other treatments that should be considered?

Can we expect the cancer to spread to other organs too and when/how is it possible to tell if she is responding to treatment? And, in such late case (compared to when the primary cancer was treated) what kind of response can we expect?

Are bone fractures or the disease's spread to other organs the reason for high death incidence in patients with bone metastases?

Any other advice or information that might apply in this case is much appreciated.

[CCF-RN,MSN-rf]

Dear mon75:  It is not possible to know how long the disease has been present.  Although it is not common, it is well documented that breast cancer can recur many years after the primary diagnosis.  Life expectancy is impossible to predict at this point.  What we can generally say is that this disease is not curable but it is treatable.

Aredia is part of a class of drugs called bisphosphonates.  These medications are commonly used in the presence of bone metastasis to build up bone.  This can be a long term treatment.

If the only disease that is present is in her bones, it may be difficult to determine how well the cancer is responding to chemotherapy.  It is much easier to measure chemotherapy effectiveness if the disease is in another place (such as the lung or liver), thought it is better if it is in fewer places, prognosis wise.  It is possible that the disease could spread to other organs but we have no way of knowing whether or when this might happen.