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?
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.
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.