Prognosis is an estimate of the likely course and outcome of a disease, such as the likelihood of it coming back (recurrence) and the person’s life expectancy.
After a diagnosis of breast cancer, people often worry about their prognosis but vary in how much information they want. Some would rather not ask while others want to know as much as possible. It's up to each person to decide how much information they want. Talking to family, friends and your specialist team may help you decide what information is most helpful for you.
How prognosis is estimated
Prognosis is estimated by looking at what happened over many years to large groups of people diagnosed with a similar cancer. But, everyone’s case is different so no one can say for certain what will happen to you. Also, treatments and survival rates are constantly improving, which affects the accuracy of estimates about people being treated today.
Prognosis can be put into words (such as excellent, good, poor) or numbers. It’s often expressed as a five- or ten-year survival rate, which is an estimate of how many people are likely to be alive five or ten years after diagnosis.
A 90% five-year survival rate means that out of 100 people diagnosed with breast cancer, 90 are likely to be alive after five years. It doesn’t mean that these people will only live for five years; it just reflects how many people are likely to be alive at that point in time.
Cancer Research UK has general statistics on five- and ten-year breast cancer survival rates on their website. Remember, these statistics are based on large groups of patients and won’t be able to tell you what will happen in your individual case.
Cancer ‘cure’ and ‘all clear’
You may hear words like ‘cure’ and ‘all clear’ in the media but these probably won’t be used by your specialist team. This is because it’s not possible to be sure that a breast cancer will never come back.
Many people who have cancer want to know if they are cured. The term ‘cured’ means there’s no chance of the breast cancer coming back. The term ‘all clear’ is also used sometimes. This means there’s no obvious sign of cancer but only at that point in time.
Treatment for breast cancer will be successful for most people, and the risk of recurrence gets less as time goes on. But recurrence can happen even many years after treatment, which is why no one can say that you’re definitely cured.
In order to be as clear and honest as possible, your specialist team is more likely to talk about your survival over time or the possibility of remaining free of breast cancer in the future.
What affects prognosis?
There are a number of factors about your breast cancer that affect prognosis. These factors include:
- the type of breast cancer you have
- the grade of the breast cancer
- the size of the breast cancer
- lymph node status
- ER status
- HER2 status.
Other factors that may affect your prognosis include your age, menopausal status (whether you have been through the menopause or not) and your general health.
Each person’s breast cancer has a different combination of factors, some of which are thought of as good, others less so. For example, someone might have a small breast cancer that has not spread to the lymph nodes (good), but is high grade (less good).
All of these factors will be considered in estimating your prognosis and in deciding what treatment you’re offered.
If your breast cancer has spread to other parts of your body (known as secondary breast cancer) this will affect your prognosis. Secondary breast cancer can be treated, sometimes for many years, but not cured. Find out more about secondary breast cancer.
Ways to estimate prognosis
Doctors sometimes use online programs, such as Predict NHS, to estimate prognosis. These use information about the person and their breast cancer alongside data from large research studies. The results are often presented as a percentage survival rate at five and/or ten years after diagnosis.
Some programs also estimate the survival benefit from treatments such as chemotherapy or hormone therapy. Your doctor may show you a graph of this information to help with decisions about whether to have these treatments.
Nottingham Prognostic Index (NPI)
This is a scoring system using various factors such as the grade and size of the breast cancer and whether there are any breast cancer cells in the lymph nodes. The prognosis is categorised as excellent, good, moderate or poor, depending on the score. For each category there are estimates of the number of people alive five years after diagnosis.
Some tests analyse groups of genes found in breast cancer to provide information about the risk of recurrence.
One of these is called Oncotype DX. It can also help indicate whether you would benefit from having chemotherapy as part of your treatment. It’s available on the NHS across the UK, although it’s not suitable for everyone.
There are others tests you may hear about such as EndoPredict and Prosigna, but the ones above are most widely available and commonly used.
How your prognosis might affect you
It can be difficult to take in and make sense of information about your prognosis. Having a good prognosis may reassure you, although you may still worry. If your prognosis is less good, you may feel anxious about the future. However you feel, there’s no evidence that people’s attitude to having cancer alters their prognosis.
No tests can tell you with complete certainty what will happen to you. Sometimes people with a poor prognosis live for a long time. Equally, breast cancer can come back in people with a seemingly excellent prognosis.
It’s normal to want to make plans for the future and the uncertainty about a diagnosis of breast cancer can be hard to live with. Most people find that it gets easier over time but sometimes you may need more support. This can come in all sorts of ways: from your friends or family, your breast care nurse, specialist or GP (local doctor). You can also be referred to a counsellor who is trained to talk to people about adjusting to the feelings that can come with breast cancer.
Whatever challenges or concerns you are facing, Breast Cancer Care is here to support you. Whether you want to speak to our nurses, join a support group or connect with volunteers who have faced what you are facing now, we can help you feel more in control.
For more information, visit our support for you section.