Prognosis

After a diagnosis of breast cancer, many people will naturally start to think about what their prognosis (outlook) might be. People vary greatly as to how much information they want to know; some would rather not think about it while others would like to know as much as possible.

If you would rather not see information about how your prognosis may be affected then you may prefer not to read on. 

There are a number of ways that doctors can estimate your prognosis although it is important to remember that your situation is unique. No one can accurately predict what will happen to you.

Your prognosis can be estimated by looking at what happened to people in a similar situation to you. However, data is usually taken from people treated many years ago (to allow them to be followed-up for a period of time). Because survival rates are constantly improving it is difficult to give truly accurate figures that reflect what someone being treated today might expect.

Prognosis can be expressed differently: in words (excellent, good, poor) or in numbers. It is often expressed in the form of 5 or 10 year survival. An 80 per cent 5 year survival rate means that out of 100 women diagnosed with breast cancer, 80 remain alive after 5 years. It does not mean that people only lived for 5 years; it is purely a snapshot of how many people were alive at that point in time.

It is difficult to talk in terms of a ‘cure‘. Many people will be cured of breast cancer following their treatment and the risk of experiencing a recurrence decreases as the years pass after diagnosis. But because it is possible to experience a recurrence of breast cancer many years after the initial diagnosis, one cannot usually say that you are definitely cured.

There are a number of factors which are thought to affect prognosis. These include:

• grade
• size
• lymph node status
• ER status
• HER2 status
• what type of breast cancer you have been diagnosed with.

For more information about these factors you may want to read our Understanding your pathology report booklet or visit our pathology report page.

For many people their breast cancer has combination of factors, some of which are thought of as good, others perhaps less so. For example, you might have a small breast cancer that has not spread to the lymph nodes, which is a high grade. All of these factors can be taken into account when considering your prognosis and they may also affect what adjuvant (additional) treatment you are offered.

Ways to estimate prognosis

Computer programmes

One of the common tools that doctors use to estimate prognosis are computer programmes, such Adjuvant! Online or Predict. These programmes use individual information about the patient and their breast cancer alongside data from large research studies to make a prognosis prediction for that patient.

Prognosis is often presented in the form of a percentage survival rate at 10 years after diagnosis. The programmes often estimate what benefit you might expect to get from treatments such as chemotherapy or hormone therapy. Your doctor may show you a graph with this information on it.

Nottingham Prognostic Index

This is a scoring system which uses various prognostic factors (for example, grade, size and lymph node involvement). You are then given a score which puts you into a prognostic category. Five year survival is then estimated depending on which category you are placed in.

Oncotype DX

New tests have recently become available that analyse a sample of your breast cancer to check its ’genetic fingerprint‘. One such test is called Oncotype DX. Although it is not suitable for everyone, the results of Oncotype DX can offer an estimate of how likely a patient’s cancer is to return and provide additional guidance beyond standard measurements (such as the grade of your breast cancer and whether lymph nodes are affected). It can also help to indicate whether a patient would benefit from chemotherapy, in addition to hormone therapy.

For information on this test, visit our page on Oncotype DX.

How your prognosis affects you

Receiving information about your prognosis can be difficult to take in and make sense of. Having a good prognosis may make you feel encouraged and hopeful. If your prognosis is less good, you may feel anxious about the future.

Although learning about your prognosis may provide you with some helpful information about your breast cancer and what you might expect, nothing can tell you with any certainty what will happen to you. Sometimes people can live for a very long time even with a poor prognosis. But equally, even with an apparently excellent outlook, a minority of people do not do so well and experience a recurrence of breast cancer despite the statistics for their situation looking very positive.

Ideally it’s probably best to take one day at a time, but this can be very difficult. It’s normal to want to make plans for the future and the uncertainty around a diagnosis of breast cancer can be hard to learn to live with. Most people find that it does get easier over time but sometimes you may feel you need more support. This can come in all sorts of forms: from your friends or family, your breast care nurse, specialist or GP. Or from a counsellor who is trained to talk to people about adjusting to the feelings that breast cancer can bring up.

Breast Cancer Care also has a range of services that can help. For more information, visit our services section.