['lizbeth]

I would infer synchronous with stage IV from initial diagnosis from reading this:

http://annonc.oxfordjournals.org/con...nc.mdq301.full

Data from the Surveillance, Epidemiology, and End Results (SEER) program and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project indicate that ∼6% of women newly diagnosed with breast cancer have stage IV disease, representing ∼12 600 new cases per year in the United States in 2005 [1, 2]. The 5-year overall survival (OS) rate among such patients rarely exceeds 20% [3]. Survival can be improved by endocrine therapy, chemotherapy, and biological therapy [4, 5]. Local treatment is often recommended to prevent or relieve symptoms but is traditionally considered to have no noteworthy impact on survival [4, 5]. However, several recent observational studies have shown that 35%–60% of breast cancer patients with stage IV disease at diagnosis receive treatment of the primary tumor and that this treatment is associated with a survival advantage [6–18]. The impact of treatments targeting regional lymphatics is unclear, and the patient subgroups most likely to benefit from treatment of the primary tumor remain to be identified. Two prospective studies are currently examining the benefits of locoregional therapy compared with systemic therapy alone in this setting. The main objective of this review is to highlight current issues regarding treatment of the primary tumor in breast cancer patients with synchronous metastases in order to highlight clinicians in their therapeutic decision.