Education And Debate

ABC of Breast Diseases: Prognostic Factors

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6968.1573 (Published 10 December 1994) Cite this as: BMJ 1994;309:1573
  1. W R Miller,
  2. I O Ellis,
  3. J R C Sainsbury,
  4. J M Dixon

    Prognostic factors are of value for three main reasons:

    • To help select the appropriate treatment for individual patients

    • To allow comparisons of treatments between groups of patients at similar risks of recurrence or death

    • To improve our understanding of breast cancer, which may permit the development of new strategies or treatments

    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 …

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