Factors that Affect Prognosis and Treatment

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 provider 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 (chances for survival) and guide treatment for early and locally advanced breast cancer. They include:

Lymph node status
Tumor size
Tumor grade
Type of tumor (how the cancers cells look under a microscope)
Hormone receptor status (estrogen and progesterone receptor status)
HER2 status
Proliferation rate
Tumor profiling score:
- Oncotype DX^®
- MammaPrint^®

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 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 node(s) (removed during surgery) under a microscope. This is the most accurate method.
Tumor size	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.
Tumor grade	How similar the cancer cells are to normal cells. The more abnormal the cells, the higher the grade.	Higher grade tumors are more likely to spread to lymph nodes and other parts of the body than lower 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, 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).
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^® and MammaPrint^®	The activity level of many genes in a cancer cell at any one time.	The activity level of genes within tumor cells helps 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	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	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 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 affect treatment for metastatic breast cancer.

Breast cancer staging

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

Ductal carcinoma in situ (DCIS) is stage 0 (or 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:

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 04/11/24

TOOLS & RESOURCES

Fact Sheet

Breast Cancer Prognosis

Fact Sheet

Triple Negative Breast Cancer