Receiving a diagnosis of breast cancer can leave you with a flood of questions. For many people, one of the first might be “What does this mean for my future?” Doctors call this your prognosis — the outlook of the disease — which includes how well breast cancer like yours generally responds to treatment and how it may affect your life expectancy.

A prognosis can’t predict the future. However, by understanding the factors that influence prognosis, you can better prepare for decisions and follow-up care with your healthcare team. In this article, we’ll share the latest information on breast cancer prognosis, as well as some other facts about breast cancer that you might not know.

Factors That Influence Breast Cancer Prognosis

The stage of breast cancer is an important predictor of prognosis. The stages of breast cancer range from 0 to 4. Sometimes, these are written in Roman numerals, such as stage II instead of stage 2. Stages can also have substages, using a letter (e.g., stage 2A). These are based on factors such as tumor size, axillary lymph node involvement, and how far the cancer cells have spread throughout the body.

Breast cancer stages are determined by tumor size, whether the cancer has reached the lymph nodes, and how far it has spread in the body.

For early-stage and locally advanced breast cancer (stages 0 through 3), multiple factors influence a person’s prognosis:

• Tumor size
• Tumor grade (how abnormal the cancer cells look under a microscope)
• Lymph node involvement (whether cells have spread to lymph nodes)

Details about the axillary lymph nodes — those located in the underarm area — also have what’s known as prognostic significance, or influence on your prognosis. When no cancer cells are found in these nodes, it’s called node-negative, and survival rates are generally higher. When cancer is found, it’s called node-positive. Outcomes tend to worsen as the number of affected nodes increases.

Breast cancer cells may have certain genetic features that can influence treatment options and prognosis:

• HER2 status — Whether cancer cells have high levels of a protein called human epidermal growth factor receptor 2 (HER2)
• Hormone receptor status — Whether the cancer cells contain estrogen receptors (ERs) or progesterone receptors (PRs)
• The genetic profile of the tumor, determined by specific diagnostic tests

Early detection via mammography (breast X-ray) and biopsy (tissue sample) leads to a better prognosis. If the breast cancer has spread to other parts of the body, it’s called metastatic breast cancer or stage 4 breast cancer. The presence of metastases has a negative impact on breast cancer survival.

How Are Survival Rates Determined?

“Survival rate” is a term often used to describe prognosis in cancer research. Researchers determine survival rates by following large groups of people after a breast cancer diagnosis and tracking their outcomes. One of the most common measurements is the five-year relative survival rate. This is the likelihood that someone with breast cancer will still be alive five years after the diagnosis compared to someone without the disease.

The U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program tracks outcomes of people living with breast cancer to determine survival rates. Survival rates are measured separately for different kinds of breast cancer.

However, instead of using the clinical stage (0 through 4), SEER classifies breast cancer into one of the following groups:

• Local — Cancers that haven’t spread beyond the breast
• Regional — Cancers that have begun to reach nearby lymph nodes
• Distant — Cancers that have metastasized (spread) to other parts of the body

In contrast, doctors typically classify breast cancer by the clinical stage (0 through 4) as defined by the American Joint Committee on Cancer (AJCC). When talking about survival, doctors consider the stage of breast cancer along with other key factors.

Prognosis for Stage 0 Breast Cancer

Stage 0 breast cancer is the earliest form of breast cancer and is noninvasive. This means that cancer cells are only in the milk ducts. It’s also usually called ductal carcinoma in situ (DCIS).

Once a person with DCIS undergoes surgery to remove the affected breast tissue, they have a very good prognosis, with a five-year survival rate greater than 99 percent. Although a person may experience a recurrence (when the cancer comes back), most cases of DCIS are cured after the first round of treatment.

Prognosis for Stage 1 Breast Cancer

Stage 1 breast cancer is the earliest form of invasive breast cancer. Cancer cells have begun to move from the milk ducts into the surrounding breast tissue. The standard treatment approach is surgery, with or without radiation or systemic therapy (chemotherapy, hormone therapy, or immunotherapy).

Stage 1 breast cancer has a five-year survival rate of nearly 100 percent and is often curable.

Prognosis for Stage 2 Breast Cancer

In stage 2 breast cancer, cancer cells have continued to multiply in the breast tissue and possibly nearby lymph nodes. The standard treatment is still surgery. However, additional treatments may be included depending on the cancer’s characteristics. These might include:

• Hormone therapy
• Chemotherapy
• Targeted therapy
• Radiotherapy

Side effects may vary depending on the type of treatment you have. For example, some treatment types can cause nail and skin changes. After surgery for breast cancer, itching is common during recovery.

Stage 2 breast cancer is divided into stages 2A and 2B. In stage 2A, the cancer may still be confined to the breast and considered localized. The five-year survival rate for localized breast cancer is about 99 percent. In some stage 2A and all stage 2B cancers, there is lymph node involvement. This is regional breast cancer, and the five-year survival rate is about 87 percent, according to the National Breast Cancer Foundation Inc.

Prognosis for Stage 3 Breast Cancer

The earliest form of advanced-stage breast cancer is stage 3 breast cancer. The cancer has spread to more lymph nodes under the arm and may also affect the muscle behind the breast. Because the disease is further along at the time of diagnosis, the prognosis is less favorable than that of early-stage breast cancer.

Information from the Susan G. Komen organization notes that survival rates range from 66 percent to as high as 98 percent. This wider range of outcomes is due to additional substages included in stage 3 cancer. It’s also caused by molecular features that can affect treatment options (e.g., breast cancer cells with hormone receptors and HER2 have better survival rates than those triple negative).

Prognosis for Stage 4 Breast Cancer

Stage 4 breast cancer is the most advanced stage breast cancer. It’s recognized when cancer has spread to other parts of the body. It’s treatable with chemotherapy and drug therapy, but it’s not curable.

Since it’s more advanced, stage 4 breast cancer has a poorer prognosis. According to the American Cancer Society, the five-year survival rate is around 32 percent for women and 20 percent for men.

Prognosis for Triple-Negative Breast Cancer

Some breast cancers contain high levels of the HER2 protein or hormone receptors — namely, ER or PR. These cancers can often be successfully treated with drugs that target those specific proteins. However, some cases are negative for ER, PR, and HER2. This is known as triple-negative breast cancer (TNBC), which is more difficult to treat.

Some types of breast cancer, such as triple-negative and inflammatory, tend to have worse prognoses because they're more aggressive and difficult to treat.

Although TNBC can be found at any stage of invasive breast cancer, it’s more aggressive, and there are fewer treatment options. Therefore, it has a worse prognosis compared with other invasive breast cancers.

According to the American Cancer Society, the five-year survival rates for women with TNBC, based on different SEER stages, are as follows:

• Local — 92 percent
• Regional — 67 percent
• Distant — 15 percent

Prognosis for Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare form of invasive breast cancer. It causes inflamed skin and distinct changes to the breast, including discoloration, heat, and typically peau d’orange (skin thickened, dimpled, and textured like an orange peel). IBC is associated with a worse prognosis relative to other forms of advanced breast cancer.

The five-year survival rates for women with IBC, by SEER stage, are:

• Regional — 53 percent
• Distant — percent
• All SEER stages combined — 40 percent

Improving Survival Rates for Breast Cancer

Finding breast cancer early usually leads to better outcomes, but research also aims to improve survival for people with advanced or aggressive forms, including metastatic disease. In recent years, new types of breast cancer treatment, such as immunotherapy, have shown promise, especially for TNBC, which is often harder to treat. Also, there have been advances in a more precise type of radiotherapy, called stereotactic radiotherapy, which can be used to treat metastases with more efficacy.

Even with this progress, more work is needed. Taking part in oncology clinical trials gives researchers a chance to test new treatments and may help improve care for others in the future.

In addition to medical care, healthy lifestyle choices can make a difference. Staying at a healthy weight, eating well, and getting regular exercise may help support overall survival in the long term.

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