Breast Cancer Metastases Presenting as Musculoskeletal Complaints

Breast cancer often metastasizes to the bone, leading to musculoskeletal symptoms that may mimic benign conditions. Patients with undiagnosed or recurrent malignancies may initially present to first-contact providers, including chiropractors, with non-specific spinal or musculoskeletal pain. Here, we extend the series with two additional cases, highlighting risks of delayed diagnosis, the role of imaging, and chiropractic care. In Case 1, a 62-year-old woman with a history of breast carcinoma presented with progressive left-sided sciatica-like symptoms (pain radiating from the sacroiliac region to the lower extremity), revealing progressive metastases on MRI (e.g., L5 vertebral collapse with retropulsion and severe stenosis) and PET/CT (e.g., new intraspinal extensions at C2, T2, and T4). Multidisciplinary intervention, including radiotherapy, targeted therapy (letrozole, palbociclib, denosumab), and conservative chiropractic management, reduced Visual Analog Scale (VAS) pain scores from 7/10 to 3/10 and improved quality of life from 58/100 to 86/100. In Case 2, a 44-year-old woman presented with constant lumbar pain (7/10 intensity), leading to the discovery of multilevel vertebral collapses (e.g., C7, T3, T5, T8, and L2) and abnormal marrow signals on MRI, confirmed as invasive ductal carcinoma via biopsy and PET/CT. These cases underscore the need for vigilance in patients with an oncologic history presenting with musculoskeletal pain. These clinical outcomes highlight the synergy of an interdisciplinary management model, where primary oncology therapies (radiotherapy and systemic targeted agents) successfully achieve metabolic and structural stabilization of the metastatic lesions, while concurrent, low-force supportive chiropractic care safely focuses on mechanical symptom mitigation and preserving the patient's quality of life.