When you hear the words “You have cancer,” your first thought is, “Will I live or die?” Here’s an overview of the information a patient needs to determine the severity of their diagnosis and a general prognosis; and a reminder that there’s always hope, no matter how dire the data.
Start with your specific diagnosis.
Yes, you have breast cancer. But that’s just a tiny part of the story. There are various kinds of breast cancer. Some are super-aggressive (inflammatory breast cancer); others aren’t even considered truly cancer, but pre-cancer (DCIS). And within these types, yours might be early-stage, or advanced.
Get a copy of your pathology report; then read our post, Reading The Pathology Report - A Layperson’s Guide To Understanding Your Breast Cancer Diagnosis. Next, write down any questions you may have, and bring them with you to your next appointment with the oncologist. Be persistent in getting your questions answered; cancer is a serious diagnosis, and you need to be an “empowered patient” when it comes to treatment.
Find out your cancer’s grade.
Pathologists grade cancer according to how aggressive it is. This grade, which should be found in your pathology report, is based on an assessment of the cancer cells themselves: how irregular the cells look; how many are actively dividing, and how far removed they are from acting like normal breast tissue cells.
Depending on the scoring system used, your cancer will be graded 1, 2, or 3 (with 3 being the most aggressive/serious); low, medium, or high; or somewhere on a scale from 1 to 9, with 9 the most serious. The more serious your cancer, the more of a challenge it will be to successfully treat.
Determine your lymph node status.
One of the major indicators of whether or not you’ll die from breast cancer is whether it has spread beyond the breast – and if so, how far.
The surgeon will take samples from several of the lymph nodes in your armpit, which is the first place cancer is likely to go when it leaves the breast. Generally speaking, the risk of dying from breast cancer is greater if there’s cancer in your lymph nodes (“lymph node involvement”), than if there isn’t.
But don’t fear – millions of women with lymph node involvement survive. It’s just one factor in your prognosis.
Find out your cancer’s stage.
After looking at the information in the pathology report, your oncologist will “stage” your cancer. S/he’ll identify it as stage 0, I, II, III, or IV – with 0 a pre-cancer, and IV cancer that’s metastasized to another part of the body beyond the breast and underarm lymph nodes. Some oncologists will add an “a” or “b” to the stage – e.g., stage IIb. The higher the stage, the more serious your cancer.
Ask your oncologist for 5-year survival statistics.
Once you understand all the information in your pathology report, along with knowing your stage, you can get a pretty good idea about whether you’ll survive breast cancer. If you’re a numbers person, though, you may find comfort in statistics: what percentage of women, with a diagnosis close to yours, survive for 5 years? (Why 5 years? Because that’s the most common way cancer survival is measured.)
Understand that survival statistics are heavily affected by treatment; if you choose the most aggressive treatment, your survival statistics will look rosier. In addition, there are lifestyle changes you can make to increase your survival chances (exercising, cutting back on alcohol). In short: With so many variables, (some controllable, some not), even the most specific statistic is a shot in the dark.
That said, take comfort in the fact that nearly 75 percent of women whose breast cancer hasn’t metastasized (spread beyond the lymph nodes) survive. So unless you’ve received a stage IV diagnosis, you have an excellent chance of being alive 5 years from now – and hopefully way beyond.
In closing, here’s a great way to think about your chance for surviving breast cancer, from a post on statistics by my friend and colleague Phyllis Johnson, a long-time survivor:
“Understand that statistics don't predict what will happen to you. They’re a snapshot of a group of people in the past. You are unique. There is no study with people exactly like you. Use statistics to give you some information about ways you can reduce your risk for breast cancer, such as exercising and avoiding alcohol. Use them to help you make treatment decisions. But don't let statistics scare you.”
Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.