Prognosis

Prognosis predicts the likely course and outcome of a disease, such as the likelihood of it returning and life expectancy. Find out about prognosis and breast cancer below.

1. What is prognosis (outlook)?

Prognosis, also called outlook, is an estimate of the likely course and outcome of a disease, such as the likelihood of it coming back (recurrence) and the person’s life expectancy. 

After a diagnosis of breast cancer, people often worry about their prognosis but vary in the amount of information they want to know. Some prefer not to ask about their prognosis while others want as much information as possible. It's up to each person to decide how much information they want. Talking to your family, friends and treatment team may help you decide what information is most helpful for you.

2. How is prognosis estimated?

Prognosis is estimated by looking at what has happened over many years to large groups of people diagnosed with a similar cancer. However, everyone’s situation is different so no one can say for certain what will happen to you. Also, treatments and survival rates are constantly improving, which affects the accuracy of estimates for people being treated today.

Prognosis is described in different ways. It may be put into words (such as excellent, good, poor) or numbers. It’s often expressed as a 5- or 10-year survival rate. This is an estimate of how many people are likely to be alive 5 or 10 years following their diagnosis. 

A 90% 5-year survival rate means that 90 out of 100 people diagnosed with breast cancer are likely to be alive 5 years after their diagnosis. It doesn’t mean these people will only live for 5 years; it just states how many people are likely to be alive at that point.

Cancer Research UK has general statistics on 5- and 10-year breast cancer survival rates on their website. Remember, these statistics are based on large groups of patients and cannot predict what will happen in your individual case.

3. What affects prognosis?

There are a number of factors that affect breast cancer prognosis. These include:

For more information see our booklet Understanding your pathology results or visit our pathology report page.

Other factors that may affect your prognosis include your age, menopausal status (whether you’ve been through the menopause or not), lifestyle factors and your general health.

All of these factors will be considered when estimating your prognosis and deciding what treatment you’re offered.

4. Ways to estimate prognosis

Computer programs

Doctors sometimes use online programs to estimate prognosis.

The programs use information about the person and their breast cancer alongside data from large research studies. The results are often presented, in the form of graphs, as a percentage survival rate at 5 and/or 10 years after diagnosis.

Some programs also estimate the survival benefit from treatments such as or hormone therapy. Your doctor may show you a graph of this information to help you with decisions about whether to have these treatments. The programmes are designed to be used with a member of your treatment team.

Predict

Predict is an online decision-making tool. It uses information about you and your breast cancer and estimates how different treatments after surgery for early invasive breast cancer might improve survival.

Nottingham Prognostic Index (NPI)

This is a scoring system which looks at the grade and size of the breast cancer and whether there are any breast cancer cells in the lymph nodes. It gives a score which estimates your prognosis as good, moderate or poor. For each category there are estimates of the number of people alive five years after diagnosis.

Genomic assays (also called gene expression profiling or gene assays)

Some tests analyse groups of genes found in breast cancer to provide information about the risk of recurrence. They’re not suitable for everyone and will usually only be considered if you have invasive breast cancer, the cancer is oestrogen receptor positive (ER+) and HER2 negative with no more than three positive lymph nodes.

Oncotype DX

This test predicts how likely a cancer is to recur after surgery and the expected benefit of having chemotherapy.

The test gives a recurrence score, reported as a number between 0 and 100. The higher the score the greater the risk of recurrence of an invasive breast cancer and the more likely it is chemotherapy will be recommended.

Find out more about Oncotype DX.

Endopredict

This test predicts how likely a cancer is to spread to somewhere in the body within 10 years in people who will be taking hormone therapy for at least five years.

The result, called the EPclin score, is reported as high or low risk. A low risk score means it’s unlikely the breast cancer will spread in the next 10 years. Most people with a low risk score won’t benefit from chemotherapy. A high risk score means it’s more likely the breast cancer will spread in the next 10 years. Chemotherapy is recommended for most people with a high risk score.

Find out more about EndoPredict.

Prosigna

This test predicts how likely a cancer is to spread to somewhere in the body within 10 years in people who will be taking hormone therapy for at least five years.

The test gives a score between 0 and 100. Based on this score and whether any lymph nodes under the arm are affected, the results are reported as ‘low’, ‘intermediate’ or ‘high’ risk. 

Your specialist will use the score, along with other information about your breast cancer, to help decide what treatment to recommend.

5. Cancer ‘cure’ and ‘all clear’

Many people who have cancer want to know if they’re cured. You may hear words like ‘cure’ and ‘all clear’ in the media.

‘Cured’ means there’s no chance of the breast cancer coming back. However, it’s not possible to be sure that breast cancer will never come back. Treatment for breast cancer will be successful for most people, and the risk of recurrence gets less as time goes on. Recurrence, unfortunately, can happen even many years after treatment, so no one can say with certainty that you’re definitely cured.

‘All clear’, or ‘in remission’ which is another term you may have heard used, means there’s no obvious sign of cancer at the moment. 

If your breast cancer has spread to other parts of your body (known as secondary breast cancer) this will affect your prognosis. Secondary breast cancer can be treated, sometimes for many years, but not cured. Find out more about secondary breast cancer.

In order to be as clear as possible, your treatment team is more likely to talk about your chances of survival over a period of time or the possibility of remaining free of breast cancer in the future.

6. How your prognosis might affect you

It can be difficult to take in and make sense of information about your prognosis. Having a good prognosis may reassure you, although you may still worry. If your prognosis is less good, you may feel anxious about the future. However you feel, there’s no evidence that people’s attitude to having cancer alters their prognosis.

No tests can tell you with complete certainty what will happen to you. Sometimes people with a poor prognosis live for a long time. Equally, breast cancer can come back in people with a seemingly excellent prognosis.

It’s normal to want to make plans for the future and the uncertainty about a diagnosis of breast cancer can be hard to live with. Most people find that it gets easier over time but sometimes you may need more support. This can come in all sorts of ways: from your friends or family, your breast care nurse, specialist or GP. You can also be referred to a counsellor who is trained to help people explore their feelings following a diagnosis of, and treatment for, breast cancer.

Whatever challenges or concerns you’re facing, we're here to support you. Whether you want to speak to our nurses, join our online forum or connect with volunteers who have faced what you’re facing now, we can help you feel more in control. See below for more information on our helpline and support services. 

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Last reviewed in June 2019. The next planned review begins in February 2023.

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