Prognosis and survival for breast cancer
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.
The doctor will look at certain characteristics of the person and aspects of the cancer, such as its stage and grade and the size of the tumour. These are called
Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type, stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and the chances of survival.
Doctors use different prognostic and predictive factors for newly diagnosed and recurrent breast cancers.
Newly diagnosed breast cancer @(Model.HeadingTag)>
The following are prognostic and predictive factors for breast cancer when it is first diagnosed.
The stage is the main prognostic factor for breast cancer. It describes how much cancer is in the body, where it is and how far it has spread.
Early-stage breast cancer is less likely to come back (recur), so it has a more favourable prognosis. Breast cancer that is diagnosed at a later stage has a greater risk of recurrence, so it has a less favourable prognosis.
When using the stage to estimate prognosis, doctors will consider if cancer has spread to
Cancer in the lymph nodes @(Model.HeadingTag)>
Breast cancer that has spread to lymph nodes has a higher risk of coming back and a less favourable prognosis than breast cancer that has not spread to any lymph nodes.
The number of lymph nodes that contain cancer (called positive lymph nodes, or
Size of the tumour @(Model.HeadingTag)>
Tumour size will affect prognosis no matter how many lymph nodes have cancer in them.
Breast tumours that are 5 cm or larger are more likely to come back after treatment than smaller tumours. If a breast tumour is smaller than 1 cm and the cancer hasn't spread to any lymph nodes, the prognosis is usually very favourable.
The grade is a description of how the cancer cells look compared to normal cells. Low grade means the cancer cells look a lot like normal cells. High grade means the cancer cells look more abnormal.
Low-grade tumours have a better prognosis because they grow slower and are less likely to spread than high-grade tumours.
Hormone receptor status @(Model.HeadingTag)>
Estrogen and progesterone can help some breast cancer cells grow. Some types of breast cancer cells have estrogen receptors (ERs) and progesterone receptors (PRs) on their surface or inside them. These receptors are where the hormones attach to the cells. Once they attach, the hormones can affect the behaviour or growth of the cells.
Breast cancer cells that have ERs and PRs need these hormones to grow and divide. Knowing the hormone receptor status of the tumour helps doctors predict how well hormone therapy will work and what other treatments may be effective.
Hormone receptor–positive tumours have ERs, PRs or both. They are usually less aggressive than hormone receptor–negative tumours (which don't have ERs or PRs). This means that they grow more slowly, are lower grade and have a lower risk of spreading. As a result, hormone receptor–positive tumours generally have a better prognosis in the short term than hormone receptor–negative tumours. However, hormone receptor–positive tumours sometimes recur years after treatment has finished.
Find out more about hormone receptor status testing.
HER2 status @(Model.HeadingTag)>
The HER2 gene controls a protein on the surface of cells that promotes their growth. HER2-positive breast cancer means that the cancer cells make too many copies of, or overexpress, the HER2 gene.
HER2-positive breast cancer is more aggressive than HER2-negative breast cancer. This means that it is more likely to grow, spread and come back after treatment.
HER2-positive cancer has a better chance of responding to treatment that includes drugs that target the HER2 protein. But it still has a less favourable prognosis than HER2-negative breast cancer.
Find out more about HER2 status testing.
Age at diagnosis @(Model.HeadingTag)>
The risk for breast cancer increases with age. Breast cancer is most often found in people who are older than 55 years of age.
People younger than 35 years of age tend to be diagnosed with more aggressive, higher grade tumours. Their breast cancer is often more advanced at the time of diagnosis. This means that younger women have a greater risk that their breast cancer will recur and a poorer overall prognosis than
Recurrent breast cancer @(Model.HeadingTag)>
Doctors will consider the following prognostic factors for breast cancer that comes back after treatment.
Length of time before the cancer recurs @(Model.HeadingTag)>
The longer the period of time before breast cancer comes back, the better the prognosis. If breast cancer comes back more than 5 years after diagnosis, the outcome is usually better than when it recurs less than 2 years after diagnosis.
Where the cancer recurs @(Model.HeadingTag)>
Cancer that comes back in the same breast is called a local
A regional recurrence is when cancer has come back in nearby
Distant recurrence is when breast cancer has spread (
Distant recurrence will be treated like chronic disease. This means that your healthcare team will offer treatments to slow the cancer's spread and manage symptoms, rather than try to cure the cancer itself.
Kathryn Isaac, MD, FRCSC, MPH
Melinda Musgrave , MD, FRCPC, PhD
Pan H, Gray R, Braybrooke J, et al. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. New England Journal of Medicine. 2017: 379(19):1836–46..
National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. National Institutes of Health; 2022: https://www.cancer.gov/.
American Society of Clinical Oncology (ASCO). Cancer.net: Breast Cancer Statistics. 2022: https://www.cancer.net/.
American Cancer Society. Survival Rates for Breast Cancer. 2022: https://www.cancer.org/.
Fabiano V, Mando P, Rizzo M, et al. Breast cancer in young women presents with more aggressive pathologic characteristics: retrospective analysis from an Argentine national database. JCO Global Oncology. 2020: 6:639–646..
Jagsir R, King TA, Lehman C, Morrow M, Harris JR, Burstein HJ. Malignant tumors of the breast. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 79:1269–1317.