1. What is prognosis?
Prognosis describes the likely course and outcome of a disease, such as the likelihood of it coming back after treatment and a person’s life expectancy.
Prognosis is described in different ways. It may be expressed as:
- Words such as excellent, good or poor
- Numbers such as a percentage chance of survival
2. Should I know my prognosis?
It’s up to you to decide how much information you want to know about your own prognosis.
People vary in the amount of information they want to know and everyone’s different.
Some people prefer not to ask about prognosis. Others want as much information as possible.
Sometimes people are not sure whether they want to know this information. Or they may regret discussing it with their treatment team if they found it upsetting.
It’s worth thinking about the type of information you may be given and how that might affect you if it’s not what you expected or hoped for.
Talking to your family, friends and treatment team may help you decide what information is most helpful for you.
Sometimes doctors are reluctant to discuss prognosis. But if you decide you want to know your prognosis, your treatment team can estimate this and explain it to you.
3. Breast cancer survival rates
Prognosis is often expressed as a 5- or 10-year survival rate.
This number represents how many people in a similar situation to you are likely to be alive 5 or 10 years after their diagnosis and treatment.
It does not mean these people will only live for 5 or 10 years. It just states how many people are likely to be alive at that point.
For example, a 5-year survival rate of 90% means 90 out of 100 people diagnosed with breast cancer are likely to be alive 5 years after their diagnosis.
The figure is usually an estimate using information from many thousands of people with breast cancer.
Cancer Research UK has general statistics on 5- and 10-year breast cancer survival rates on its website. Remember, these numbers are based on large groups of patients and cannot predict what will happen to you.
4. Estimating your prognosis
Prognosis is estimated by looking at what has happened over many years to large groups of people diagnosed with a similar cancer.
However, everyone’s situation is different so no one can say for certain what will happen to you.
Treatments and survival rates are constantly improving, which also affects the accuracy of estimates for people being treated now.
What affects prognosis?
Things that affect breast cancer prognosis include:
- The type of breast cancer
- The grade of the breast cancer
- The size of the breast cancer
- Whether the cancer has spread to the lymph nodes
- Whether the cancer has spread to other parts of the body
- Whether the cancer is hormone receptor positive
- Whether the cancer is HER2 positive
This information is usually found in your pathology results.
Other things that may affect your prognosis include your age, whether you have been through the menopause, lifestyle factors and your general health.
All these things will be considered when estimating your prognosis and deciding what treatment you’re offered.
Ways to estimate prognosis
Computer programs
Doctors sometimes use online programs to estimate prognosis.
The programs use information about you and your breast cancer alongside data from large research studies.
The results are often presented, in the form of graphs, as a percentage survival rate at 5 or 10 years after diagnosis.
Some programs estimate how much treatments like chemotherapy or hormone therapy might improve your chances of survival.
Your doctor may show you a graph of this information to help you with decisions about whether to have these treatments.
The programs are designed to be used with a member of your treatment team.
Predict
Predict is an online decision-making tool.
It uses information about you and your breast cancer and estimates how different treatments after surgery might improve survival.
Nottingham Prognostic Index (NPI)
This scoring system can be used by your treatment team. It looks at the grade and size of the breast cancer and whether there are any breast cancer cells in the lymph nodes.
It gives a score which estimates your prognosis as good, moderate or poor and helps your treatment team plan your treatment.
For each category there are estimates of the number of people alive 5 years after diagnosis.
Genomic assays (also called gene expression profiling or gene assays)
Some tests analyse groups of genes found in breast cancer to give information about the risk of recurrence.
They’re not suitable for everyone and will usually only be considered if your cancer has certain features.
The three tests that may be used are:
5. Can breast cancer be cured?
Many people who have cancer want to know if they can be cured.
Cured means there’s no chance of the cancer coming back.
If you have been diagnosed with early breast cancer, your treatment is given with the intention of curing you. You may also hear this referred to as ‘curative intent’.
However, it’s not possible to be sure that breast cancer will never come back.
Treatment for breast cancer will be successful for most people, and the risk of recurrence reduces as time goes on, but it does not go away altogether. Recurrence can happen even many years after treatment.
‘All clear’ or ‘in remission’ are other terms you may have heard used. These mean there’s no obvious sign of cancer at the moment.
Your treatment team is likely to talk about your chances of survival over a period of time or the possibility of staying free of breast cancer in the future.
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. Treatment for secondary breast cancer is given to control and slow down the spread of the cancer.
6. Coping with fear and worry
It can be difficult to take in and make sense of information about your prognosis.
Whatever you’re told about your prognosis, you may worry or feel anxious about the future.
There’s no evidence that feeling worried or stressed alters your 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 after a diagnosis of breast cancer can be hard to live with.
Most people find it gets easier over time but sometimes you may need more support. This could come from your friends or family, your breast care nurse, specialist or GP.
You can also be referred to a counsellor who is trained to help you explore your feelings after your diagnosis or treatment.
Breast Cancer Now is also here to support you. Whether you want to speak to our nurses, join our online forum or connect with someone who has faced what you’re facing now, we can help you feel more in control.
