Bone pain vs bone metastasis: how to tell the difference

After breast cancer, it is natural to worry that every ache means the cancer has spread to bone. Most aches and pains are not cancer. They often come from hormone therapy, which commonly causes joint and muscle pain, from arthritis, strain, poor posture or low vitamin D. Pain from bone metastasis tends to have a different pattern: it is usually in one place, gets steadily worse over weeks, is present at rest and at night, and does not improve with the usual measures. Only tests can confirm the cause, so pain with these warning features should always be reported. Reporting early is not an overreaction; it leads either to reassurance or to treatment at the right time.

Pain that is less likely to be cancer

Aches in several joints, stiffness worst in the morning that eases with movement, pain after unusual activity that settles with rest, and aches that began soon after starting hormone tablets.

Pain that should be checked

New pain in one bone that lasts more than a couple of weeks, worsens over time, wakes you at night, or comes with other symptoms such as weight loss or tiredness.

Symptoms that need urgent help

Back pain with new weakness or numbness in the legs, difficulty walking, or problems controlling the bladder or bowels need emergency assessment, as they can signal pressure on the spinal cord.

The tests chosen depend on your symptoms, history and what your doctor finds when examining you.

Examination and blood tests

Your doctor checks the painful area, your strength and reflexes, and may order blood tests including calcium, alkaline phosphatase and vitamin D.

X-rays

Useful for arthritis and fractures, though early metastases may not show on X-ray.

Bone scan, CT or PET-CT

These show whether there are areas of abnormal bone activity elsewhere in the skeleton.

MRI

The best test for the spine and for pain with nerve symptoms. It is used urgently when spinal cord compression is suspected.

A clear description helps your doctor decide quickly whether tests are needed and which ones will be most useful.

Where and how it feels

Point to the exact place, and describe whether the pain is aching, sharp, burning or throbbing, and whether it spreads anywhere, such as down a leg or around the ribs.

When it happens

Explain whether it is constant or comes and goes, whether it is worse at night or when lying down, and whether movement, coughing or standing makes it worse.

What you have tried

Mention pain relief, rest or exercise you have used and how much they helped.

Other changes

Tell your doctor about weight loss, tiredness, thirst, constipation, confusion, or any weakness or numbness, as these can point to different causes.