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Sclerotic Bone Response — SCE Medical Oncology MCQ

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ModerateBreast CancerSclerotic Bone ResponseSCE Medical Oncology

A 58-year-old woman with ER+/HER2- metastatic breast cancer has bone-only metastatic disease. After 6 months on first-line AI + CDK4/6 inhibitor, CT shows sclerotic changes at known bone metastatic sites with no new lesions. CEA and CA15-3 are declining. What does sclerotic change at bone metastases indicate?

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Correct answer: B — Healing/treatment response

Sclerotic change at previously lytic bone metastatic sites during endocrine therapy represents osteoblastic healing (treatment response), not progression. This can be misinterpreted as new bone disease by clinicians unfamiliar with this pattern. Response assessment in bone-dominant metastatic breast cancer requires clinical correlation (symptoms, markers) alongside imaging. PET-CT can help distinguish healing sclerosis (low metabolic activity) from progressive sclerotic disease (high metabolic activity).

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer