Survival of breast cancer based on stage

Statistics are given below for the overall survival rates for breast cancer based on certain stages of disease development. Breast cancer staging is largely determined by the presence and size of a tumor, whether the tumor is node negative or positive, and whether it has metastized beyond the breast. If breast cancer is diagnosed and it is determined that there is no metastasis to the lymph nodes (node negative, stage I or less) then the chances of survival are extremely possible. Once breast cancer has metastized to the lymph nodes the mode of treatment tends to shift to agressive chemotherapy, and the odds of survival are somewhat lower.

Breast Cancer survival statstics by stage

Stages   % survive 5 years % survive 10 years
0 ( in situ ) DCIS or <5mm 98 95
1 < 2 cm, node negative 85 75
2,3 node positive 55 40
4 metastasis 10 2

 

 

If the tumor can be detected and treated before it has reached a size of 2 cm and before it is seen to be affecting the the lymph nodes, then the overall survival rate is very good, at over 75% in 10 years. Once the cancer is node positive, the chance of survival beyond 10 years is less than 50%, and if the cancer has reached stage 4, prospects for survival are not very good at all.

 

 

Younger women tend to show a more favorable chance to survive advanced stage breast cancer than older women

 

If a women develops breast cancer while less than 40 years of age, her chances of surviving stage I and II cancers is slightly poorer than older women. But, for stage III breast cancers, younger women generally have a more favourable chance of survival than women over 70 years of age. It is true that older women generally tend to develop a milder form of breast cancer than younger women, but it still appears that the gap in survival rates between younger versus older women favors younger women when confronted with increasing stages of the disease. These differences, however, tend to be very small statistically, and overall a woman's chance of surviving breast cancer remains very high regardless of age.

Women between 50-70 have the highest survival rates for stage I breast cancers

The highest survival rates for stage I breast cancers tend to be for women aged 50-69. For stage II, III, and IV breast cancers, women between 40 and 49 years of age show the highest survival rates. Women younger than 39 tend to have the poorest survival rates for stages I and II breast cancers, while women over 70 tend to show the poorest survival rates for stage III and IV breast cancers.

Hormone receptor status can influence survival rates

When a breast cancer tumor is sent for histological analysis, one of the characteristics of the report will be the 'hormone receptor status' of the tumor. Estrogen receptor (ER) and progesterone receptor (PR) positive tumors tend to respond better to chemotherapy, which tends to be the treatment of choice for stage III and IV breast cancers. Breast cancers which are 'triple negative' (negative for ER, PR, and HER2 receptors) tend to have the least favourable survival rates, regardless of breast cancer stage. However, ER and PR status tends to have more of an influence on survival than HER2 status. Women with triple negative breast cancer tumors have an overall survival rate of about 55%, while women with the the ER+/PR+/HER2- subtype have an estimated 5-year survival rate of 84%.

Overall 'all stage' breast cancer survival rate is around 90%

The overall survival rate for women with breast cancer when all stages can be as high as 90%. In Situ breast cancers have a survival rate of close to 100%. For localized breast cancer (approximately stage I) the survival rate is thought to be around 98%. For breast cancer with regional spread ( approximately stage II:cancer spread into the chest wall,other breast, or regional lymph nodes) the survival rate has been estimated at around 83%. For breast cancers diagnosed with distant metastasis (stage III to IV: cancer spread to distant lymph nodes or distant body tissues) the survival rate is quite low, at around 23%.

 

Regional relapse following breast cancer treatment carries a poorer prognosis

Most localized breast cancers are treated by either breast conserving surgery with radiation therapy, or by mastectomy. It can be estimated that about 5% of women treated by breast conserving surgery and radiation therapy will experience a relapse or some sort. The prognosis following a breast cancer recurrence is influenced by a number of factors, including the time elapsed before the recurrence ( before or after five years), whether the cancer recurrs in the same breast (sometimes called a 'local recurrence), or if it recurrs in the contralateral breast, regional lymph nodes, or the chest wall (sometimes referred to as a 'regional' recurrence).

Patients with breast cancer relapses are typically generally treated with either a 'salvage mastectomy', or radiation to the chest wall, regional lymph nodes, or both. Systemic therapy (chemotherapy) may be implemented at that point, but that will be determined on an individual basis based on the liklihood of distant metastasis, characteristics of the tumor, and other factors.

 

Regional recurrence with five years carries a less favourable prognosis, but overall survival statistics are still good.

Generally speaking, if the breast cancer returns 'regionally' (either to the chest wall, contralateral breast, or nearby (regional) lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer. Women with an early, regional breast cancer recurrence have an approximately 50% chance of distant metastasis within five years of the relapse. The ten year survival rate for all women with breast cancer recurrence following either mastectomy or breast conserving surgery with radition therapy is about 61%, with a 10 year distant metastasis-free rate of about 59%. But, for women in which the breast cancer recurrence is local only, and occurs after five years of treament, the prognosis is very favorable.

Most relapses occur in the same breast, within five years

Within the small proportion (about 5%) of breast cancers which do return following treatment, the position and elapsed time of recurrence can be observed statistically. The majority (about 1.7%) of recurrences occur in the same breast (ipsilateral breast) within 5 years of the original diagnosis. About 1.2% of recurrences appear in the same breast more than five years afters the original diagnosis. And, generally speaking, the longer the interval before the recurrence of breast cancer, the better the prognosis.

For breast cancer recurrence within the chest wall, approximately 0.8% occur within the first five years following diagnosis, and about 0.4% after five years. About 1% of women will experience regional lymph node metastasis within 10 years following diagnosis.

Percentage of women who experience local or regional breast cancer recurrence

Recurrence place and time interval Percentage of all cases following BCS with radiation, or mastectomy. 5 year 'distant metastasis-free' rate. 10 year 'distant metastasis-free' rate 10 year survival rate
Local recurrence, within five years 1.7% 61    
Local recurrence, after five years 1.2% 80    
Chest wall recurrence, within five years 0.8% 42 52 50
Chest wall recurrence, after five years. 0.4% 65 56 62
Regional lymph node recurrence (within 10 years) 1%   33 30

 

The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occured locally and after five years. Patients with a greater than five years interval before a local/same breast recurrence have a distant metastasis-free rate of about 80% within five years. Women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds. For women in which the recurrence of breast cancer happens within the chest wall within five years, the 5-year distant recurrence-free rate is about 42%. By comparison, women with a chest wall recurrence after five years following treatment have a slightly better 5-year postrelapse distant metastasis rate of about 65%.

10 year breast cancer survival rates are better for later, rather than earlier development

The ten year surival rates for women with breast cancer recurrence are about 62% for a late chest wall relapse (after five years), and about 52% for an early chest wall relapse (within five years). Similarly, the rates of being 'distant metastasis-free' are about 56% with a later chest wall recurrence and about 52% for an earlier chest wall recurrence. However, if the breast cancer recurs within the regional lymph nodes following the original treatment by either mastectomy or conserving surgery with radiation therapy, the 10 year distant metastasis-free rate is only about 30%, with an estimated 10 year survival rate of about 33%.

 

Reference

  1. American College of Radiology, Resident Education: A Module for Mammography, 1997
  2. Parise, C., Bauer, K., Caggiano, V., Breast cancer survival: The association of age within stage of disease.Sutter Institute for Medical Research, Sacramento, CA; California Cancer Registry, Sacramento, CA J Clin Oncol 29: ( 2011)
  3. Ugnat, AM., Xie, L., Morriss, J., Semenciw, R., Mao, Y. Survival of women with breast cancer in Ottawa, Canada: variation with age, stage, histology, grade and treatment. British Journal of Cancer (2004) 90, 1138–1143
  4. Re, JP., Blanco Villalba, M., Streich, G., Breast cancer overall survival: Local statistics versus international statistics.J Clin Oncol 28, (2010)
  5. Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure.Breast J. (Mar 2002);8(2):81-7.

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Copyright Steven B. Halls, MD Last edited 08-July-2011

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