Life expectancy in breast cancer
The survival rate is the number that has the most important meaning for many patients with a cancer diagnosis.
In medicine, however, it cannot usually be given in years; instead, information is given about the percentage of patients still alive after 5 years. These statistics must be used with great care, as they are often generalized and the survival rate, especially with breast cancer, depends on a variety of factors. Only the attending physician can make an individual, cautious estimate.
What is the overall breast cancer survival rate?
In medicine, especially with cancer, the probability of survival is given as a 5-year survival.
These statistics do not look at how long the individual patients survive, but rather how many patients are still alive after 5 years. For breast cancer, the 5-year survival rate is 88% for women and 73% for men with breast cancer. The 10-year survival rate is 82% for women and 69% for men. So you can say that breast cancer is comparatively with one good survival rate is socialized.
However, these two statistics are very generalized survival rates. The individual rate depends on many factors, such as tumor size, degree of degeneration or lymph node involvement. In addition, the survival rate changes if, after primary therapy, recurrences of the tumor or metastases occur over time. Furthermore, statistical information on the survival rate or the prognosis must always be handled carefully, since the individual course of the disease can also be presented completely differently. Due to the many factors that influence the survival rate, only the attending physician can make an estimate of the individual survival rate by looking at all the findings.
Also read our topic: Chances of recovery from breast cancer
What is the life expectancy with breast cancer?
Life expectancy is the length of time between a specific point in time when cancer is diagnosed and the person dies.
In the case of cancer, the exact determination of life expectancy is hardly possible because too many factors can have an influence and the individual course of the disease can hardly be foreseen. Previously, the average life expectancy for metastatic breast cancer was around 2 years from the onset of the first metastasis. This information on life expectancy is considered out of date, as modern treatment options also offer good treatment options for advanced breast cancer. Instead of life expectancy, studies are more often used to measure 5-year survival. If the disease can be brought to a complete standstill over a long period of time, normal life expectancy can be assumed in the absence of other diseases.
Also read: Prognosis in breast cancer
Which factors influence the survival rate and life expectancy positively?
The positive factors include small tumors less than 2 cm, which show only a slight degree of degeneration (G1) in the grading.
A low degree of degeneration means that the tumor cells are still very similar to normal mammary gland tissue. From this it can be deduced that early detection of breast cancer can also have a positive effect on the survival rate, also because there are usually no lymph nodes involved. This means that the tumor has not yet invaded the lymph vessels in the breast and is therefore still locally limited. In this context, it continues to have a positive effect on the survival rate if the tumor has not yet broken through any vessels.
The receptor status is referred to as a positive constellation if the tumor is hormone receptor positive and HER2 receptor is negative. Hormone receptor positive tumors can be treated well with hormone therapy in addition to chemotherapy. The age of the patient also matters. An age of over 35 years at the onset of the disease is to be rated positively.
More information on this topic: Breast cancer stages
Which factors influence the survival rate and life expectancy negatively?
The most important prognostic factor, also in relation to the survival rate, is the lymph node status in the armpit.
If tumor cells are found in these lymph nodes, this is seen as a negative factor. A large tumor at the time of diagnosis is also to be rated as a negative factor, as is a G3 grade. In this context, G3 means that the differentiation of the tumor cells already differs greatly from the original tissue and that they tend to be more malignant. In addition, various receptors on the tumor play an important role. It is negative when the tumor does not have any hormone receptors but has HER2 receptors. So far, the presence of HER2 receptors has been considered a negative factor, even if specific antibodies (trastuzumab) against this receptor can be given with this type, which show a very good effect.
The occurrence of local recurrences, i.e. tumor foci, for example on the chest wall or in the armpit, has a negative effect on the survival rate. For relapses after breast removal in the armpit, the 5-year survival rate drops to 50-55%. If recurrences occur in different places at the same time, the 5-year survival rate is around 21%. It is also crucial whether the relapse occurs in less than two years or more than two years after the first therapy. So-called early relapses (after less than two years) are often more difficult to treat and have a higher risk of further relapses and metastases. This of course has an impact on the survival rate.
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What is the survival rate for triple negative breast cancer?
The triple negative breast cancer has the worst survival rate compared to the other breast cancer types.
The reason for this is that at the time of the initial diagnosis, the tumor size is often larger, as it describes a relatively aggressive growth. Therefore, when the diagnosis is made, the lymph nodes in the armpit are often affected by tumor cells. Since the lymph node status is an essential factor for the prognosis and the survival rate, a worsened survival rate must be expected.
However, the survival rate is largely modulated by the individual response to chemotherapy. Patients who respond well to chemotherapy have a similar survival rate as patients with prognostically more favorable breast cancer types.
For more information, see: What is triple negative breast cancer?
What are the chances of recovery if the lymph nodes are affected?
Lymph node involvement plays an important prognostic role in breast cancer. It depends on whether the lymph nodes are affected and how many. The more lymph nodes already contain nests of tumor cells, the statistical lower the chances of recovery. A lymph node involvement suggests that the cancer has already spread beyond its local borders. If 1-3 lymph nodes are affected and the tumor is hormone receptor negative or HER2 positive at the same time, it is called a high risk tumor. If more than 4 lymph nodes are involved, it is a high risk tumor regardless of the receptor status. This also has a major impact on therapy. If the lymph nodes in the armpit are affected, they are completely removed during the surgical treatment and each is examined individually. In the subsequent chemotherapy, hormone or antibody therapy, if the lymph nodes were positive, a more aggressive therapeutic approach would also be chosen in order to give the patient the best chance of healing. There are no specific figures on the chances of recovery from lymph node involvement, as there are too many other factors involved to dare to generalize. The individual risk can only be assessed by the attending physician, who can also only refer to statistics and experience.
Also read: Lymph node involvement in breast cancer
What are the chances of recovery if there are metastases?
In breast cancer, one has to distinguish lymph node metastases from metastases in other organs. If one speaks colloquially of lymph node involvement, one automatically means metastases in the lymph nodes. Lymph node involvement is associated with a higher chance of recovery than metastases in other organs. Breast cancer tends to metastasize to the lungs, liver, skeleton or brain, for example. As soon as metastases are present in these organs, the primary therapeutic goal is usually no longer curing the disease.The metastases are a sign that the breast cancer has spread throughout the body through the bloodstream and that it is hardly possible to bring the disease to a standstill again. Therapy at this stage focuses more on maintaining body functions and the patient's quality of life. Even with metastases, years of survival can be possible, which is why it is difficult to make statements about the survival rate. Furthermore, one must differentiate according to the location of the metastasis. Bone metastases, for example, can be treated well with modern therapy and the burden on the patient can be comparable to that of a non-malignant chronic disease.
For more information, see: Metastasis in breast cancer
How does the size of the tumor affect the survival rate?
The size of the primary tumor is one of the relevant factors that can also influence the survival rate.
A tumor that is as small as possible is prognostically more favorable for the survival rate than a large tumor finding. Tumors that are less than or equal to 2 cm are classified as low risk tumors. It is assumed that small tumors are still local. With large tumors, there is a higher risk that they have already penetrated the lymphatic system and that tumor cells are already present in the lymph nodes.
Also read our topic: Surgery for breast cancer
How does stage affect survival?
Breast cancer is divided into different stages according to the TNM classification. Each letter of TNM stands for a different characteristic of the tumor.
T classifies the size and extent of the tumor itself. A local focus that is less than or equal to 2cm has a positive effect on the survival rate. In the case of small findings, there are often no lymph nodes involved, which have a significant impact on prognosis and survival rate. In the case of larger tumors, either a very aggressive growth or a long growth time must be assumed, which lowers the chances of local cancer.
N (English nodes = lymph nodes) provides information about the lymph node status. The TNM classification also differentiates between the various locations of the lymph nodes. For the survival rate, however, it is more important how many lymph nodes are affected.
The M in the classification stands for metastases. This does not mean lymph node metastases, but metastases in other organs, such as the lungs or liver.
If you would like more information about the TNM classification, we recommend our website: TNM system
How does grading affect the survival rate?
When grading, you look at the tumor cells under the microscope.
The pathologist assesses how far the tumor cells have differentiated from the original tissue. Classically, the tumor tissue is divided into three grades. For breast cancer, grading is carried out according to the Elston and Ellis system.
G1 is the closest to the original tissue, but is nevertheless to be rated as malignant, while G3 speaks for a poorly differentiated tissue which no longer bears much resemblance to the origin. A G2 tumor still shows moderately differentiated malignant tissue. The grade G1 has the best prognosis, also with regard to the survival rate, since these tumors show a more favorable course. G3 tumors more frequently show aggressive and rapid growth and are therefore associated with a poorer survival rate.
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