ABC of Breast Diseases: Prognostic Factors

Abstract

Prognostic factors are of value for three main reasons: FIG Freedom from recurrence of cancer in patients in relation to age when breast cancer first diagnosed. (Proportional hazards model showed age <35 to have relative risk of 1.6 for distant disease.) Prognostic factors can be broadly classified into two groups: chronological factors, which are indicators of how long the cancer has been present and relate to stage of disease at presentation, and biological factors, which relate to the intrinsic or potential behaviour of the tumour. However, recent evidence suggests that age at diagnosis may also be a risk factor: younger women (aged under 35) have a poorer prognosis than older patients with cancer of equivalent stage. ### Chronological factors FIG Survival in relation to size of breast cancer. ### Tumour size The pathological size of a tumour correlates directly with survival; patients with smaller tumours have a better survival rate than those with large tumours. Maximum pathological size should be assessed in fresh specimens, and the size should be subsequently confirmed or amended after histological examination. Status of axillary lymph nodes The single best prognostic factor is the presence or absence of axillary nodal metastases. There is a direct correlation between survival and the number of axillary lymph nodes involved. ### Metastases Patients in whom cancer has spread beyond the axillary or internal mammary nodes (M1 or stage IV disease) have a much worse survival rate than patients whose disease is apparently localised. There are differences in survival between patients depending on the site of the metastatic disease, with patients who have supraclavicular involvement as their only site …