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FA C T S F O R L I F E Breast Cancer Prognosis • Tumor size, What is prognosis? Prognosis is the expected or probable outcome of a disease. It is a best guess of a person’s chances of survival (recovery). Your breast cancer prognosis is based on how well other people with a similar type and stage of breast cancer have done when getting the same treatment. Each person is different. Your doctor cannot say for certain what will happen to you. What does my pathology report show? Breast tissue that is removed during a biopsy or surgery is sent to a pathologist. A pathologist is a doctor who looks at the tissue under a microscope. They determine if the tissue contains cancer. If you have cancer, your pathology report describes your diagnosis. This report will also describe many features of the tumor. Try not to focus on any one item in the report. It is the sum of all the information that is most important to your prognosis and treatment. Your doctor (either your surgeon or your oncologist) will go over the main findings of the report with you. They can answer any questions you may have. Make sure you ask your doctor for copies of your reports and keep them for your records. Some of the most important items you may find on your pathology report(s) that help determine your prognosis are: • Whether or not the cancer has spread beyond the breast to the lymph nodes, • Tumor grade (how closely the cancer cells look like normal cells), and • Characteristics of the tumor (such as hormone receptor status and HER2/neu status). Breast cancer stage Breast cancer stage is used to help plan your treatment. It is the most important factor for prognosis. Stage is not always listed in pathology reports. It comes from the results of the biopsy of the tumor tissue, any biopsies of the lymph nodes and other tests. These biopsies and some tests may not be done at the same time. You may have more than one pathology report. Your medical team combines all the information and determines the breast cancer stage. There are a few ways to classify stage. The most widely used is the TNM system (which stands for tumor, nodes and metastases). TNM takes into account: • The size of the tumor (T), • The number and location of lymph nodes (N) with cancer, and • Whether or not there is metastasis (M). Doctors use a scale to describe breast cancer stages: 0, I, II, III and IV. In general, the earlier the stage, the better the prognosis. So, stage 0, I and II breast cancers have a better prognosis than stage III and IV breast cancers. For more information, visit www.komen.org or call Susan G. Komen’s breast care helpline at 1-877 GO KOMEN (1-877-465-6636) Monday through Friday, 9 AM to 10 PM ET. Non-invasive and invasive breast cancers Non-invasive cancer Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer. It is also called stage 0. In situ [in SY-too] means “in place.” With DCIS, the abnormal cells are still within the milk ducts (the canals that carry breast milk to the nipple during breastfeeding). They have not invaded the surrounding breast tissue. Although DCIS is non-invasive, without treatment, the abnormal cells could turn into invasive breast cancer. With treatment, prognosis for DCIS is excellent. Invasive cancer Invasive breast cancer has spread from the milk ducts or lobules (the round sacs in the breast that produce milk) into the surrounding breast tissue. It is possible that they could have spread to the lymph nodes or other parts of the body. Prognosis of invasive breast cancer depends on the stage and other factors. Tumor grade Tumor grade is a measure of how similar tumor cells are to normal cells under a microscope. The more abnormal the cells appear, the higher the tumor grade. In general, the lower the tumor grade, the better the prognosis. Grade 1 has the best prognosis. Proliferation rate (cell division) The proliferation rate describes how quickly the tumor cells are growing. This helps show how aggressive a tumor is. Also, how likely it is to spread to other parts of the body. When this rate is low, the cancer is growing more slowly and the prognosis is better. The Ki-67 test is a common way to measure this rate. These tests are not done at all hospitals. Your pathology report may include other information not described on this fact sheet. Make sure you ask your doctor to discuss your report with you. Type of invasive breast cancer Most invasive breast cancers begin in the milk ducts (invasive ductal carcinomas). The next most common type of breast cancer occurs in the lobules (invasive lobular carcinomas). Other factors related to prognosis Hormone receptor status Some breast cancers need estrogen and/or progesterone (female hormones that are produced in the body) to grow. These breast cancers are “hormone receptorpositive.” They can be treated with hormone therapy. Hormone therapy improves survival for these breast cancers. HER2/neu status Some breast cancers have a lot of HER2/neu protein on the surface of their cells. These “HER2/neu-positive” tumors tend to be aggressive. They also have been related to a poorer prognosis in the past. But, there are now effective targeted therapy drugs such as trastuzumab (Herceptin®). These targeted therapies have greatly improved survival for those with these cancers. Resources Susan G. Komen® 1-877 GO KOMEN (1-877-465-6636) www.komen.org Susan G. Komen®’s pathology report information — www.komen.org/diagnosis National Comprehensive Network (NCCN) — 1-888-909-6226, www.nccn.org Related fact sheets in this series: • Biopsy • Coping With a Cancer Diagnosis • Inflammatory Breast Cancer • Metastatic Breast Cancer • Types of Breast Cancer Tumors • What is Breast Cancer? The above list of resources is only a suggested resource and is not a complete listing of breast cancer materials or information. The information contained herein is not meant to be used for self-diagnosis or to replace the services of a medical professional. Komen does not endorse, recommend or make any warranties or representations regarding the accuracy, completeness, timeliness, quality or non-infringement of any of the materials, products or information provided by the organizations referenced herein. The Running Ribbon is a registered trademark of Susan G. Komen®. ©2014 Susan G. Komen® Item No. KOMEED009900 11/14