gynecology and obstetrics
Breast Cancer
Prognosis for Breast Cancer
Long-term prognosis depends on tumor stage. Nodal status (including number and location of nodes) correlates with disease-free and overall survival better than any other prognostic factor. The 5-year survival rate (from the National Cancer Institute'sSurveillance, Epidemiology, and End Results (SEER) Program)depends on cancer stage: Localized (confined to primary site): 99.0% Regional (confined to regional lymph nodes): 85.8% Distant (metastasized): 29.0% Unknown: 57.8% Poorer prognosisis associated with the following other factors: Young age:Prognosis appears worse for patients diagnosed with breast cancer during their 20s and 30s than for patients diagnosed during middle age. Breast cancer death rates from 2015 to 2019 were higher in the United States in non-Hispanic Black females (28 per 100,000) than in non-Hispanic White females (19.9 per 100,000 [ Prognosis references ]). Black women are diagnosed at a younger age compared with White women (median 60 versus 63 years) and are more likely to have triple negative disease ( Larger primary tumor:Larger tumors are more likely to be node-positive, but they also confer a worse prognosis independent of nodal status. High-grade tumor:Patients with poorly differentiated tumors have a worse prognosis. Absence ofestrogenandprogesteronereceptors:Patients with ER+tumors have a somewhat better prognosis and are more likely to benefit from endocrine therapy. Patients withprogesteronereceptors on a tumor may also have a better prognosis. Patients with bothestrogenandprogesteronereceptors on a tumor may have a better prognosis than those who have only one of these receptors, but this benefit is not clear. Presence of HER2 protein:When theHER2gene (HER2/neu[erb-b2]) is amplified, HER2 is overexpressed, increasing cell growth and reproduction and often resulting in more aggressive tumor cells. Overexpression of HER2 is an independent risk factor for a poor prognosis; it may also be associated with high histologic grade, ER− tumors, greater proliferation, and larger tumor size, which are all poor prognostic factors. Presence ofBRCAgene mutations:For any given stage, patients with theBRCA1gene mutation appear to have a worse prognosis than those with sporadic tumors, perhaps because they have a higher proportion of high-grade, hormone receptor–negative cancers. Patients with theBRCA2gene mutation probably have the same prognosis as those without the mutation if the tumors have similar characteristics. With either gene mutation, risk of a 2nd cancer in remaining breast tissue is increased (to perhaps as high as 40%). For patients with metastatic breast cancer, quality of life may deteriorate, and the chances that further treatment will prolong life may be small. Palliation may eventually become more important than prolongation of life. Cancer Pain can be adequately controlled with appropriate medications, including Psychologic and spiritual counseling should be offered. Patients with metastatic breast cancer should be encouraged to prepare Advance Directives , indicating the type of care they desire in case they are no longer able to make such decisions. 1.American Cancer Society: Cancer Facts & Figures or African American/Black People 2022-2024. Accessed May 4, 2023. 2.American Cancer Society: Key Statistics for Breast Cancer. Accessed May 4, 2023. 