What's my Prognosis, Doc?

I think it’s fair to say that the first thought of many, if not most of my patients, when they first receive a breast cancer diagnosis is: How am I going to survive this?

Am I going to survive this?

The questions on my mind at that initial consultation are a little different.

I work under the presumption that whilst a cancer diagnosis is scary and can be devastating to hear, actually, with good treatment, most breast cancer patients do very well.

Five year survival after a breast cancer diagnosis is 90%.

Ten year survival drops a little but is still close to 85%.

If we look at the roughly two thirds of women who have no sign of disease beyond the breast at diagnosis, five year survival is almost 100%.

For women with advanced breast cancer at diagnosis - that is cancer which has spread beyond the breast and armpit - the numbers don’t look as good. Five year survival rates drop to 27%. Fortunately, this is not a large group, making up about 5% of women with newly diagnosed breast cancer.

Ultimately though, these are just numbers. Whilst they can be a source of comfort or fear, it’s important to realise statistics don’t tell us what will happen to a particular woman. It’s great if she has a 99% chance of doing well - but what if she’s the 1% who does badly? Similarly, in more concerning disease, if there’s a 95% chance of disease relapse, but a particular patient never does, the 95% number creates a lot of fear and anxiety which is (fortunately) never realised.

So, what does this all mean? Is prognosis and/or statistics irrelevant to you? Not quite.

If the question on your mind when you’ve been told the dreaded “C” word is: “Am I going to survive this?”, what are the questions on my mind? Well I’m evaluating the above and more complex statistical breakdowns. Sure, I want to understand your prognosis. But not because I want to know if ultimately you'll be cured or will relapse. That information is simply unavailable. I want to understand your risk of relapse to use it in planning treatment to reduce that risk.

Fighting breast cancer: Planning treatment to reduce risk of relapse

It’s important to understand the risk of cancer recurring after it has been surgically removed. If the risk is higher, clearly this indicates a high chance there are still surviving breast cancer cells somewhere in the body. In turn, we will want to add in further treatment/s to combat this risk; treatment to try and mop up any stray cancer cells before they cause a relapse.

Low risk = Low risk of cancer coming back = Less chance of additional treatment helping.

High risk = High risk of cancer coming back = More chance of additional treatment helping.

Do you want to know about risk? Who is at higher risk and who is at lower risk? I think I’ve said enough for one day and will leave this for my next blog post.