What Jackie Collins's Story Can Help Us Understand About Breast Cancer

Six and a half years, quietly

Jackie Collins wrote 32 novels, all of which reached the New York Times bestseller list. She died on 19 September 2015, aged 77. Her family said the cause was breast cancer.

BBC News reported, citing People magazine, that she had been diagnosed with stage 4 breast cancer six and a half years earlier. She told People, in an interview on 14 September, that she had told few people beyond her three daughters.

"I've written five books since the diagnosis, I've lived my life, I've travelled all over the world, I have not turned down book tours and no-one has ever known until now when I feel as though I should come out with it."

She had been in the UK on a book tour less than two weeks before she died.

That combination, stage 4 disease and six and a half working years, is what makes this story medically worth writing about. It is not the exception people assume it to be.

What stage 4 actually means

NCI defines metastatic cancer as cancer that has spread from where it started to a distant part of the body. For many cancers it is also called stage 4.

The naming trips people up, so it is worth being precise. Breast cancer that spreads to the lung is metastatic breast cancer, not lung cancer. Under a microscope the cells still look like breast cancer cells, and that is how doctors know where they came from. It is treated as stage 4 breast cancer.

NCI lists bone, brain, liver, and lung as the main sites breast cancer spreads to. Bone, liver, and lung are the most common destinations across cancers generally.

One detail explains a lot about the biology. NCI notes that metastatic cancer cells can stay inactive at a distant site for many years before they start growing again, if they ever do. Our page on metastatic cancer covers the mechanics of how spread happens.

Controlled, not cured

This is the part that has changed most in public understanding, and NCI states it without hedging.

There are treatments for most types of metastatic cancer. Often the goal is to control it, by stopping or slowing its growth. NCI adds, plainly, that some people can live for years with metastatic cancer that is well controlled.

Which treatment depends on the type of primary cancer, where it has spread, what treatments came before, and the person's general health.

Palliative care sits alongside that, not after it. NCI describes it as care to relieve symptoms and improve quality of life, and is explicit that it can be given at any point during cancer treatment. It is not a synonym for end-of-life care. Our page on palliative care explains what it involves.

When to get checked

Metastatic cancer does not always cause symptoms. When it does, the symptoms follow the location. NCI's list is short and specific:

• Pain and fractures, when cancer has spread to bone
• Headache, seizures, or dizziness, when it has spread to the brain
• Shortness of breath, when it has spread to the lung
• Jaundice or swelling in the belly, when it has spread to the liver

For anyone with a past breast cancer diagnosis, new persistent bone pain, a first seizure, or breathlessness that will not settle should be reported rather than waited out.

For everyone else, the checks are earlier in the story. A lump in or near the breast or under the arm, a change in breast size or shape, nipple discharge that is not milk, a nipple that flattens or turns inward, or skin that dimples, puckers, reddens, or scales are all reasons to be seen. Our page on mammograms covers what screening does and does not catch.

The numbers behind six and a half years

SEER puts five-year relative survival for female breast cancer at 91.9 percent across all stages, for cases from 2016 to 2022. For distant disease, it is 33.8 percent.

About 6 percent of breast cancers are already distant at diagnosis. That is a small share of a very common cancer, which still adds up to a large number of people.

Two things follow. A third of people with distant breast cancer were alive five years on, in a cohort treated with what existed several years ago. And a five-year figure says nothing about the people beyond it. Six and a half years is not an anomaly in that distribution.

These figures also pool receptor subtypes that behave very differently. Hormone receptor-positive disease, the most common kind, has notably better distant-stage survival than triple-negative disease.

Privacy is a medical decision too

Collins told almost nobody. She gave interviews about her final book without mentioning the diagnosis. She said she had no regrets.

That is worth stating without judgment, because the opposite framing is common. Public disclosure is often described as brave and privacy as denial. Neither description is medicine.

What does matter clinically is that the people providing care know, and that someone close knows enough to help in a crisis. Beyond that, who is told is a personal choice with no correct answer. Our page on emotions and cancer covers the range of ways people respond.

What this story cannot tell you

Six and a half years with stage 4 breast cancer is a real outcome and it was hers. It is not a forecast, and it is not a benchmark anyone should measure themselves against.

The reports do not say what receptor subtype she had, where the cancer had spread, or what treatments she received. Those are the facts that would determine how her course compares to anyone else's, and they were never public.

What generalizes is narrower. Stage 4 is not the same as untreatable. Treatment aimed at control rather than cure is real treatment. And people living with metastatic cancer are often doing ordinary work in ordinary weeks, which is exactly why you rarely notice them.

Sources

• NBC News, Best-Selling Novelist Jackie Collins Dies of Breast Cancer at Age 77 — https://www.nbcnews.com/pop-culture/books/novelist-jackie-collins-dies-breast-cancer-age-77-n430411
• BBC News, Novelist Jackie Collins dies aged 77 — https://www.bbc.com/news/entertainment-arts-34305950
• NPR, Best-Selling Novelist Jackie Collins Dies At 77 — https://www.npr.org/sections/thetwo-way/2015/09/19/441839033/best-selling-novelist-jackie-collins-dies-at-77
• NCI, Metastatic Cancer: When Cancer Spreads — https://www.cancer.gov/types/metastatic-cancer
• NCI, Breast Cancer Signs and Symptoms — https://www.cancer.gov/types/breast/symptoms
• SEER Cancer Stat Facts, Female Breast Cancer — https://seer.cancer.gov/statfacts/html/breast.html
• SEER Cancer Stat Facts, Female Breast Cancer Subtypes — https://seer.cancer.gov/statfacts/html/breast-subtypes.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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