Factors that Affect Prognosis and Treatment
Read our blog, 6 Ways Your Care Team Learns About Your Breast Cancer.
This section has information on factors that affect prognosis (chances for survival) and treatment of early and locally advanced breast cancer.
Learn about factors that guide treatment for metastatic breast cancer.
Information learned from your biopsy
If a biopsy finds breast cancer, it’s important to understand the factors related to your diagnosis. These factors help you and your health care team make treatment decisions.
Tests are done on the tumor and any lymph nodes removed during surgery. The results of these tests help inform your prognosis and guide your treatment.
Some tests can be done on the small amount of tissue removed during a needle biopsy. Others need a larger amount of tissue removed during surgery.
Watch our video of Former Komen Chief Scientific Advisor Dr. George Sledge who talks about the tests that are done on tissue to help guide breast cancer treatment.
Early and locally advanced breast cancer
Factors related to the tumor are considered together to inform prognosis and guide treatment for early and locally advanced breast cancer. They include:
- Hormone receptor status (estrogen and progesterone receptor status)
- HER2 status
- Lymph node status
- Tumor size
- Tumor grade
- Type of tumor (how the cancers cells look under a microscope)
- Proliferation rate
- Tumor profiling score:
Summary table of factors that affect prognosis and treatment
Factors that Affect Prognosis and Treatment for Early and Locally Advanced Breast Cancer | |||
Factor |
What is assessed? |
What does it show? |
How is it assessed? |
Hormone receptor status (estrogen and progesterone receptor status) |
Amount of hormone receptors present within the cancer cells. |
Hormone receptor-positive tumors can be treated with hormone therapies such as tamoxifen, aromatase inhibitors and ovarian suppression. Hormone receptor-negative tumors (those with few or no hormone receptors) can’t be treated with hormone therapies and tend to have higher rates of recurrence. | Immunohistochemistry (IHC). IHC is a pathology test. |
Amount of HER2 protein on the surface of cancer cells (IHC) or the number of copies of the HER2 gene in the cancer cells (FISH). |
HER2-positive tumors can be treated with trastuzumab (Herceptin) and other HER2-targeted therapies. |
IHC. Fluorescence in situ hybridization (FISH). FISH is a pathology test. |
|
Whether or not lymph nodes in the underarm area contain cancer. Number of lymph nodes with cancer (if any nodes with cancer are found). |
Important factor related to breast cancer recurrence and survival. When the lymph nodes contain cancer, prognosis (chance of survival) is poorer. |
Physical exam and breast ultrasound. Pathologist’s exam of nodes (removed during surgery) under a microscope. This is the most accurate method. |
|
Size of the tumor. |
Important factor related to breast cancer recurrence and survival. Larger tumors often have a poorer prognosis than smaller tumors. |
Physical exam. Imaging (breast ultrasound, mammography). Pathologist’s exam of the tumor (removed during surgery) under a microscope. This is the most accurate method. |
|
How similar the cancer cells are to normal cells. The more abnormal the cells, the higher the grade. |
Higher grade tumors are more likely than lower grade tumors to spread to lymph nodes and other parts of the body. Higher grade tumors usually have a poorer prognosis than lower grade tumors. |
Pathologist’s exam of tissue or cells under a microscope. |
|
Tumor profiling tests (genomic testing, molecular profiling, genetic signature testing), such as Oncotype DX® and MammaPrint® |
Patterns of expression for a set of genes in a sample of the tumor. |
Test results show the risk of metastases for some breast cancers to help guide treatment. A test result showing a low risk of metastases helps some people avoid chemotherapy. | Ribonucleic Acid (RNA). Tumor profiling tests look at the RNA of the genes in the cancer cells. |
Type(s) of cancer cells that make up a tumor. |
Prognosis varies by type of tumor. |
Pathologist’s exam of tissue or cells under a microscope. |
|
Percentage of cancer cells with Ki-67 proliferative antigen in their nuclei. |
Tumors with a lot of Ki67-positive cells are fast-growing and fast-dividing. This increases the chances the cancer will spread to lymph nodes and other parts of the body. | IHC. Though Ki-67 is assessed at some medical centers, it’s not standard. Ki-67 is not routinely used by all oncologists to make treatment decisions. |
|
Adapted from selected sources [12,18]. |
|||
Which factors best inform prognosis and predict response to treatment for early and locally advanced breast cancer is under study. A factor only becomes a part of the standard of care after a lot of research has shown it’s accurate and reliable.
Learn about factors that guide treatment for metastatic breast cancer.
Breast cancer staging
Breast cancer stage is the most important factor for prognosis. In general, the earlier the stage, the better the prognosis will be.
Ductal carcinoma in situ (DCIS) is stage 0 (non-invasive) breast cancer and has the best prognosis.
There are 4 main stages of invasive breast cancer, stages I-IV (1-4). The lower the breast cancer stage, the better the prognosis tends to be.
Breast cancer stage is determined by:
- Lymph node status
- Tumor size
- Presence or absence of metastases
- Tumor grade
- Estrogen receptor status
- Progesterone receptor status
- HER2 status
Oncotype DX® score is also part of breast cancer staging for some estrogen receptor-positive, lymph node-negative tumors.
If you were diagnosed before 2018, your breast cancer was staged using only lymph node status, tumor size and the presence or absence of metastases.
Learn more about staging.
Genetic testing after a breast cancer diagnosis
If you’ve been diagnosed with breast cancer, genetic testing may help guide your treatment. For example, some breast cancer treatments are only given to people who have certain inherited gene mutations.
Genetic testing looks for gene mutations in the hereditary genes of a person.
Learn more about genetic testing after a breast cancer diagnosis.
Updated 03/10/25
This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.
