The Who, What, Where, When and Sometimes, Why.

Factors that Affect Prognosis and Treatment

This section covers information on factors that affect prognosis and treatment of early 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 provider make treatment decisions that are right for you.

Tests are done on the tumor (and any lymph nodes removed during surgery). The results of these tests help determine 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 from tissue removed during surgery.

Early and locally advanced breast cancer

Factors that affect prognosis and treatment for early and locally advanced breast cancer are considered in combination (rather than alone). They include:

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?

Lymph node status

Whether or not lymph nodes in the underarm area contain cancer.

Number of nodes with cancer (if any are found).

Important factor related to breast cancer recurrence and survival.

When the lymph nodes contain cancer, prognosis is poorer.

Physical exam.

Pathologist’s exam of node(s) (removed during surgery) under a microscope. This is the most accurate method since a physical exam can be misleading.

Tumor size

Size of the tumor.

Important factor related to breast cancer recurrence and survival.

Larger tumors usually 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.

Tumor grade

How similar the cancer cells are to normal cells.

The more abnormal the cells, the higher the grade.

High-grade tumors are more likely to spread to lymph nodes and other parts of the body than low-grade tumors.

Higher grade tumors usually have a poorer prognosis than lower grade tumors.

Pathologist’s exam of tissue or cells under a microscope.

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 and aromatase inhibitors).

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).

HER2 status

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).

Tumor profiling tests (gene expression profiling), such as Oncotype DX®, MammaPrint® and PAM50 (Prosigna®)

The activity level of many genes in a cancer cell at any one time.

The activity level of genes within tumor cells help show the risk of metastases for some breast cancers.

A test result showing a low risk of metastases helps some people avoid chemotherapy.

Ribonucleic Acid (RNA).

Tumor type

Certain 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.

Ki-67

Number 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 Moffat, 2014 [13].

Which factors best determine prognosis and predict response to treatment is under study. 

A factor only becomes a part of standard practice after a great deal of research has shown it’s accurate and reliable.

Learn about factors that affect treatment for metastatic breast cancer.

Breast cancer staging

Breast cancer stage is the most important factor for prognosis (chance for survival).

Ductal carcinoma in situ (DCIS) is considered stage 0 (or non-invasive) breast cancer and has the best prognosis.

There are 4 main stages of invasive breast cancer (stages I-IV). The lower the breast cancer stage, the better the prognosis tends to be.

Breast cancer stage is determined by:

Oncotype DX® score is 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.

Updated 12/31/20