Breast Cancer Prognosis: Tumor Profile and Risk Factors - Verywell Health
:max_bytes(150000):strip_icc()/GettyImages-1170994066-eae512718d8943bbb070e5ece11bf291.jpg)
Over a quarter of a million people are diagnosed with breast cancer annually. Other than skin cancer, It is the most common type of cancer but not the most deadly. If you or a loved one has a diagnosis of breast cancer, you may be wondering about their prognosis—the survival rates and other outcomes.
Multiple factors determine the prognosis or outlook for a breast cancer diagnosis. The factors determining how deadly breast cancer is include 1) how far cancer has spread when it is first discovered, 2) how large the tumor is, 3) how the cancer cells look under the microscope, and 4) differences in which genes and proteins are in the cancer cells.
kali9 / Getty Images
Breast cancer survival has greatly improved due to new developments in treatment approaches and screening technologies that make it easier to catch cancer early. The death rate has decreased by about 1.3% each year between 2011 and 2020, and the outlook for most breast cancer cases is generally good.
This article explains the factors that affect a female breast cancer prognosis and what that means for survival and treatment.
Terminology
Breast cancer statistics are reported by the Surveillance, Epidemiology, and End Results (SEER) database and the American Cancer Society as female or male breast cancer. Their terminology is used when citing these statistics.
Female breast cancer is that reported in a person assigned female at birth. Male breast cancer is that reported in a person assigned male at birth. The American Cancer Society statistics use the term women for people with female breast cancer and men for people with male breast cancer.
Tumor Profile
The factors that inform a breast cancer prognosis include the size of the tumor, where it has spread, and how the cells look in a microscope. These descriptions comprise the tumor profile, usually determined after surgery or a biopsy (a sample of the tumor is removed and analyzed in the lab).
Additional testing for specific proteins on the surface of the cancer cells and genes expressed by the cancer cells can also inform a prognosis and give you an idea of how likely the cancer is to come back after treatment.
Signs Breast Cancer Has Spread
Some signs that breast cancer has spread (metastasized) include nonspecific symptoms like fatigue and unexplained weight loss. These may be so bad that it is hard to do daily tasks. Other signs depend on the location of the new tumors:
- Bone cancer may cause pain or broken bones.
- Tumors in the brain may cause headaches, seizures, or dizziness.
- Lung tumors may cause shortness of breath.
- Tumors in the liver may cause yellowed skin and eyes or a swollen belly.
Your healthcare provider considers all of these details during the staging process, which is how healthcare providers assign cancer a "stage." This process gives them a better idea of how to determine treatment options and gives them a good idea of the potential outcomes of the disease.
Stages range from 1 to 4. The higher the stage, the more deadly the cancer is.
Invasive or Noninvasive
Stage 0 breast cancer is only inside the milk duct and has not invaded tissues nearby. Ductal carcinoma in situ (DCIS) is a stage 0 breast tumor. However, this tumor has the potential to become invasive if it isn't removed and treated. It is highly curable.
There are two types of invasive breast cancer:
- Invasive or infiltrating ductal carcinoma makes up about 80% of invasive breast cancers. These cancers start in the cells lining the ducts of the breast, where milk flows during lactation. It becomes invasive if it breaks through the duct wall and spreads to other tissues in the breast.
- Invasive lobular carcinoma makes up about 10% of invasive breast cancers. They start in the mammary glands that make milk. They become invasive if they spread to other tissues in the breast.
Just because breast cancer is invasive doesn't mean it has spread to other parts of the body. But invasive breast cancer is more likely to spread to local lymph nodes, the chest wall, or other organs (which would then be metastatic breast cancer).
The more cancer has spread, the higher the cancer is staged and the worse the prognosis.
Tumor Size
The tumor size plays a big role in the prognosis of breast cancer. Generally, the larger the original tumor, the higher the cancer is staged and the worse the prognosis is. How size is ranked in staging includes:
- Tumors smaller than 2 centimeters (cm) are T1.
- Tumors between 2 cm and 5 cm are stage T2.
- Tumors larger than 5 cm are stage T3.
The larger the tumor, the higher the T stage and the worse the prognosis is.
Cancer Grade
A physician specializing in laboratory and anatomical medicine (pathologist) determines cancer's grade by examining the cells from a biopsy or tissue from surgery under a microscope. The grade is a way to measure how "wild" the cells in the tumor sample look.
The more "normal" the cells look, the lower the grade and the better the prognosis. Higher-grade tumors have a worse prognosis. The grade can give an idea of how fast cancer will likely grow and how likely it is to spread; it also impacts treatment decisions.
Female breast cancer has one of three grades:
- Grade 1: Also called low-grade or well-differentiated cancers, grade 1 cancers look relatively normal. They grow slowly, are less likely to spread, and have a better prognosis.
- Grade 2: Middle-grade cancers fall between 1 and 3.
- Grade 3: Also called high-grade or poorly differentiated, grade 3 cancers look wild under the microscope and have a worse prognosis.
Biomarkers
Biomarkers are biological signs from the body or cancer cells that can tell a healthcare provider more about how to treat cancer or how it might grow, spread, or come back. New breast cancer drugs that take advantage of these biomarkers have revolutionized breast cancer treatment.
Three major biomarkers play an essential role in breast cancer prognosis and treatment.
Hormone Receptors
Hormone receptors, including receptors for estrogen and progesterone, can be found outside some breast cancer cells. These hormone receptors send signals to the cancer cells to grow in the presence of hormones. Cancer cells with hormone receptors are typically slow growing and respond well to treatments that block the hormone signals.
Hormone receptor-negative cancers have a worse prognosis because they do not respond to hormone therapies. They also typically grow faster than hormone receptor-positive cancers and return quickly after treatment. Hormone receptor-positive breast cancers can also come back but usually many years after treatment.
HER2 Status
Another biomarker that is important in breast cancer prognosis is human epidermal growth factor receptor 2 (HER2). HER2 is a growth-promoting protein expressed by some breast cancers.
HER2-positive breast cancers grow and spread quicker, but there are treatments explicitly targeted to HER2-positive breast cancers, giving these people more treatment options.
Generally, healthcare providers consider HER2-positive cancers to have a worse prognosis than HER2-negative cancers. However, this is changing with the successful development of targeted therapies against HER2.
Gene Expression Profile
In addition to these biomarkers, many genetic signals can tell a healthcare provider more about your breast cancer and give you an idea of your prognosis and the likelihood of recurrence. These breast cancer gene expression tests are a type of personalized medicine.
Gene expression tests include Oncotype DX, MammaPrint, and Prosigna. They are most useful for early stage cancers.
They look at what genes the cancer cells express and use that information to get an idea of how likely the cancer is to return after treatment. If the cancer is more likely to return, the healthcare provider may recommend chemotherapy to reduce that risk.
Survival Rates by Stage
When diagnosing breast cancer, healthcare providers include many of these factors in the staging process. Staging includes information about the size of the tumor; if it has spread to other tissues, lymph nodes, or organs; how the cells look under the microscope; and what its genetic characteristics are.
On the simplest side, stages can be broken down into localized, regional, and distant, the three stages that the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database uses.
Localized female breast cancer is still contained within the breast. Regional breast cancer may have spread to other chest tissues or local lymph nodes. Distant breast cancers may have spread to other organs like the lungs or bones.
Survival rates are worse for cancers that have spread. Luckily, regular screening recommendations and advanced technologies have made it so that many breast cancers are caught early, at the localized stage, when they're most treatable.
| Female Breast Cancer Survival Rate By Stage | ||
|---|---|---|
| Stage | Percent of Cases | 5-Year Survival Rate |
| Localized | 64% | 99.1% |
| Regional | 29% | 86.1% |
| Distant | 6% | 30.0% |
| Unknown | 2% | 60.0% |
| All | 100% | 90.6% |
Prognosis Based on Race
In the overall population, the death rate per year for female breast cancer is highest in non-Hispanic Black people (27.6 per 100,000 compared to 19.6 per 100,000 for people of any race). Black women are less likely to be diagnosed with breast cancer than White women and their death rate per year from breast cancer is 41% higher.
Survival statistics for people diagnosed with female breast cancer also show a racial disparity.
| Female Breast Cancer Survival Rate by Race/Ethnicity | |
|---|---|
| All Races | 90.4% |
| White (includes Hispanic) | 82.8% |
| Black (includes Hispanic) | 91.4% |
Multiple factors are at play in this disparity. Black people assigned female at birth are more likely to develop inflammatory breast cancer or triple-negative breast cancer, which have fewer treatment options and grow and spread faster than other breast cancers.
Black people are also subject to structural racism and systematic discrimination and bias. These lead to inequalities in the social determinants of health and cause socioeconomic differences, resulting in these people having less access to quality health care. A lack of access means their cancer is often diagnosed at more advanced stages, with a poorer prognosis.
| Female Breast Cancer by Race/Ethnicity | ||
|---|---|---|
| Race/Ethnicity | New Case Rate | Death Rate |
| All Races | 128.3 | 19.6 |
| Non-Hispanic White | 137.6 | 19.7 |
| Non-Hispanic Black | 129.6 | 27.6 |
| Non-Hispanic Asian/Pacific Islander | 106.9 | 11.7 |
| Non-Hispanic American Indian/Alaska Native | 111.3 | 17.6 |
| Hispanic | 99.9 | 13.7 |
Prognosis Based on Age
Middle-aged and older people are the most commonly diagnosed with female breast cancer. People who are older at diagnosis are more likely to die than younger people. People aged 65 to 74 are the most likely to die from female breast cancer if they're diagnosed with it. The median age at death from breast cancer is 70.
| Female Breast Cancer by Age | ||
|---|---|---|
| Age | Percent of New Cases | Percent of Deaths |
| <20 | 0 | 0 |
| 20-34 | 2.0% | 1.0% |
| 35-44 | 8.3% | 4.4% |
| 45-54 | 18.8% | 11.3% |
| 55-64 | 25.6% | 20.9% |
| 65-74 | 26.5% | 24.4% |
| 75-84 | 13.7% | 20.6% |
| >84 | 5.2% | 17.4% |
When you look at the five-year survival rate for people with female breast cancer, the rate is lower (86%) before age 40. The survival rate is lower in this group because cancers in young people are rarer—and they are typically more advanced at diagnosis because they're rare.
| Female Breast Cancer Survival Rate by Age | |
|---|---|
| Age Group | 5-Year Relative Survival |
| 15–39 | 86% |
| 40–64 | 91.1% |
| 65–74 | 92.7% |
| 75+ | 86.1% |
Summary
Many factors affect breast cancer prognosis, outlook, and survival rate. These factors include:
- How far the cancer has spread
- How large the tumor is
- How the cancer cells look in the lab
- What genes and proteins are in the cancer cells
- The race of the patient
- The age of the patient
Invasive breast cancers have a worse outlook than those that are noninvasive. People with larger tumors tend to fare worse than those with smaller tumors. Tumors with a higher grade are typically faster growing and more likely to spread.
Tumors with hormone receptors are more treatable. Those with HER2 are more aggressive, though they also have more treatment options. Tumors with favorable genetic profiles have better outcomes. They need less aggressive treatment and are less likely to recur.
Cancer's stage determines prognosis—the five-year relative survival rate for breast cancer drops in more advanced cancer.
A racial disparity is seen with female breast cancer. Black people are more likely to die from female breast cancer than those of other races and are more likely to have types of breast cancer that are aggressive or harder to treat.
A Word From Verywell
Female breast cancer is one of the most common cancer diagnoses—and one of the most treatable. While there's no cure for cancer, breast cancer has a high survival rate, and many people go on to live full lives free of cancer for many, many years.
Comments
Post a Comment