Breast Cancer prognosis and survival is determined by so many factors that it is difficult to make generalizations. It must be stressed that every single breast cancer patient will have a unique scenerio. The most consistent predictor of breast cancer survival remains the cancer 'stage' at the time of diagnosis. If the breast cancer can be treated before metastasis has occurred, the outlook will almost always be highly positive.
Breast cancer 'stage' of course refers to the spread or extent of the cancer. Stage zero means the breast cancer is still 'in situ', while stage IV means that the cancer has metastasized to other body regions.
In terms of 'age', it is a curious fact that the survival rates are actually lower for women younger than 40 than for women older than 40. Breast cancers in younger women tend to grow quite aggressively, and the survival rate for younger women is actually about 7% less than for older women overall.
Breast cancer 'grade' refers to the size and shape of the malignant breast cancer cells. If the breast cancer cells look very different than normal breast tissue cells, and somewhat random in appearance, they are called 'poorly differentiated' and described as 'high grade'. Higher grade breast cancer cells tend to have a poorer prognosis.
The hormone receptor status of a breast tumour is not usually included in formal discussions of prognosis. Every breast tumour may potentially have a different hormone receptor status. When a breast cancer tumour is 'positive' for the hormones estrogen and progesterone, it implies two things: First, that the cancer has the potential to grow very quickly, but, secondly that the tumor will very likely be highly responsive to chemotherapy/hormonal therapy treatments. Therefore, overall survival will be higher for hormone receptor 'positive' breast tumours.
A relatively new addition to the discussion of breast cancer survival statistics and prognosis is oncogene expression. An oncogene is a tiny fragment of genetic material which is carried in a chromosome, and which can 'cause' normal cells to become malignant. The oncogene HER-2 in particular has be linked to more aggressive breast cancers. About 1/3 of all breast tumours produce the HER-2 oncogene, and these patients tend to have higher rates of recurrence and lower overall survival rates. The overall survival for women with HER-2 expression is estimated at below 40%. On average, women with HER-2 amplification have a much greater risk of dying from breast cancer within two years, when compared to women without HER-2 amplification.
Breast cancers or 'carcinomas' are mostly of epithelial cell origin. These are the kinds of cells that for 'linings' (walls) of most of our organs and vessels. There are quite a few very rare types of breast cancers which are comprised of non-epithelial cells (for example, muscle cells), and a great many breast cancers are actually not 'pure', but are a mixture of different kinds of cells. However, there are basically six types of 'standard' breast carcinomas, and statistically, some of these tend to show a better prognosis than others. The six most common types of breast cancer are 'general' infiltrating ductal carcinoma (NOS or not otherwise specified), infiltrating 'lobular' carcinoma, (forming in the lobules and not the ducts), mucinous or colloid breast carcinoma, medullary breast carcinoma, tubular breast carcinoma, and inflammatory breast carcinoma.
Generally speaking, tubular, mucinous, and medullary breast carcinomas have a better prognosis than the other sub-types. The table below give a very general approximation of the survival rates that may be associated with the different breast cancer sub-types. But please bear in mind that this is a rough generalization only, and survival will always be determined by the individual characteristics of each breast cancer and each patient. Nonethelss, the 'relative' aggressiveness of the different breast cancer sub-types can be interpreted from the table. (Note: DCIS is not really a sub-type; it just indicates that breast cancer has be detected at the earliest possible stage (stage 0) and is almost always near 100% curable.)
|breast cancer sub-type||Estimated Overall Survival|
|DCIS-ductal carcinoma in situ)||98% to 100%|
|Tubular breast carcinoma||95%|
|Infiltrating lobular carcinoma||86%|
|Infiltrating ductal carcinoma||84%|
|Medullary breast carcinoma||78%|
|Mucinous breast carcinoma||75%|
|Inflammatory breast carcinoma||32% to 42%|
Tubular breast carcinoma cells have a unique distinctive tubular formation when viewed microscopically, and it tends to affect women older than 50. Survival rates for tubular breast cancer are around 95% over 10 years, and the 5 year 'disease-free' survival rate has been shown to be about 88%.
Infiltrating lobular carcinoma usually appears as a subtle thickening in the upper-outer breast quadrant. As the name suggests, these tumours originate mostly in the breast lobules ( where the milk is produced) rather than the lining of the breast ducts. It is a less common type of breast cancer, accounting for about 5% of all cases. Prognosis for infiltrating and invasive lobular breast carcinomas will naturally be influenced by tumor size and grade and stage. But, lobular breast cancers, when positive for estrogen and progesterone receptors, tend to respond very well to hormone therapy. The overall survival for infiltrating lobular carcinoma is a little bit higher than for ductal carcinoma. Survival rates range from about 77% to 93%, but on average the survival rate can be estimated at about 86%.
Infiltrating ductal breast carcinoma of the generic type (NOS) is by far the most common breast cancer type, and represents about 78% of all cases. The term 'infiltrating' vs. 'invasive' is somewhat related to the cancer stage; if the ductal carcinoma is infiltrating the duct wall, then it will usually be termed 'infiltrating', but if the cancer cells ard found beyond the duct wall and are starting to 'invade' the surrounding tissue, then it will be termed 'invasive' ductal carcinoma. Obviously, and 'invasive' ductal carcinoma suggests a more serious situation and the surival rates will most likely be slightly lower. Tumor size also plays a big role in survival with these breast tumours. On mammogram, infiltrating ductal breast carcinomas often can appear star-shaped, or 'stellate'.
The overall survival rate for invasive ductal carcinoma can be estimated at around 84%. Some studies have the figure closer to 58- 63%, but tumor size can really make a difference. Breast tumors less than 1 cm have an overall survival rate of around 95%.
Medullary carcinoma of the breast usually occurs in women in their later 40s to 50s, and it is so-named because the malignant cells resemble those of the 'medulla' in the brain. (gray matter). The five year survival rate for medullary breast carcinoma is on average about 78%. Most cases (almost 75%) of women with operable medullary breast tumors are alive after 20 years. It should be noted that for stage I medullary breast cancers, and even in general when the axillary lymph nodes are disease free, the survival rate can be as high as 95%.
Mucinous breast carcinoma is mostly characterized by poorly defined cells and quite a lot of mucos production. The prognosis is highly favorable in most cases, with overall survival rates estimated at around 75%.
Inflammatory breast cancer is among the least common sub-types, but it also tends to be the most aggressive. Unlike the other kinds of breast cancer, inflammatory breast cancer is usually treated first with chemotherapy, and then with surgery. Survival rates are improving for inflammatory breast cancer, but unfortunately only about 32% to 42% of patients survive beyond 3 years.
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