Breast cancer chances of cure and prognosis

As increased age is a risk factor for the disease, rising life expectancy in Germany is considered to be one reason for the increase in new cases. The good news is that although more and more women in Germany are developing breast cancer, the mortality rate is falling.

Early detection programs such as mammography screening from the age of 50. The fact that more and more breast cancers are being detected at an early stage after reaching the age of 50 is a contributing factor. In addition, medical advances in therapy, as well as increasingly specialized treatment teams, make it possible to treat breast cancer much better today than in the past.

How long can sufferers of breast cancer live?

The survival rate for breast cancer depends mainly on the stage at which the cancer is detected and how aggressive the cancer cells are. If the tumor is localized, about 90 percent of women with the disease can be cured.

The following table shows how many breast cancer patients have five or. still alive ten years after diagnosis of the disease [1]:

Age groupsInterval length: 5 yearsInterval length: 10 years
15-44 90 percent 85 percent
45-54 92 percent 87 percent
55-64 91 percent 86 percent
65-74 88 percent 83 percent
75 and older 76 percent 68 percent

Note: The table shows survival as a relative rate. Relative survival rate explains how many people with a certain disease are still alive after a defined period of time after diagnosis compared to the general population.

How often breast cancer is fatal?

Once breast cancer has spread to distant organs, i.e Metastases has formed (UICC stage IV), long-term cure is considered unlikely. Life expectancy depends on which organs have distant metastases: With bone metastases, one can still live for many years; with brain metastases, life expectancy is shorter.

The diagram shows the distribution of UICC stages at initial breast cancer diagnosis (ICD-10 C50) in 2015/2016 in Germany [2].

In the very fewest cases, metastases are found in the body when the cancer is first diagnosed (stage IV).

In some cases, a second tumor after already survived breast cancer. This tumor can occur in the same breast, in the lymph nodes of the axilla, in the opposite breast or in the chest wall. These recurrences are known as Recurrences and can be treated well. It is important that a complete staging with CT, MRI and bone scintigram is performed and distant metastases are excluded.

Field report

Kathrin Heinrich beats breast cancer twice

If the new breast cancer develops in the same breast where the first tumor was located or on the chest wall of the operated side, doctors speak of a local recurrence. Since these tumors are localized, they have a long-term chance of being cured. Local recurrences form in about five to ten percent of all breast cancer patients within the first ten years after initial diagnosis. Frequently detected during palpation examinations or during follow-up by mammography, ultrasonography, or MRI.

Even for recurrences with metastases, we now have highly effective and relatively well-tolerated therapies that prolong survival.

Prof. Dr. Michael Untch, Chief Physician of the Women’s Clinic and Head of the Interdisciplinary Breast Center at Helios Klinikum Berlin-Buch

Prognosis and progression of breast cancer

According to the interdisciplinary S3 guideline for early detection, diagnosis, therapy and follow-up of breast carcinoma, the following factors should be collected as standard in order to assess the course of the disease and determine the therapy [3]:

  • TNM classification (tumor size, lymph node involvement, presence of distant metastases)
  • Resection margin status (R classification)
  • Fine-tissue tumor type (histological type)
  • the receptors ER, PR, HER 2
  • Degree of malignancy (histological grading)
  • Level of Ki-67, a marker that measures the frequency of cell division
  • Invasion of the tumor into vessels (lymphatic vessel invasion)
  • the age of onset

In addition, the following factors are considered relevant for the prognosis of a breast carcinoma and the planning of the individual therapy regimen:

  • molecular characteristics of the tumor and receptor status
  • Menopausal status
  • secondary diseases ("comorbities")

TNM classification for breast cancer

With the TNM status, statements can be made about the prognosis of a breast cancer disease. The positive correlation between tumor size and survival or the risk of disease recurrence has been known for many years. Specifically, the larger the tumor, the greater the risk of recurrence.

If the lymph nodes (nodi) are affected by tumor cells, the prognostic value of lymph node involvement is higher than the prognostic value of tumor size. The more lymph nodes affected, the higher the risk of recurrence.

Supporting recovery

Which sports are suitable during breast cancer therapy?

growth rate of a mammary carcinoma

Histological grading

The growth rate of a breast carcinoma is reflected, among other things, in the histological grade of the cancer cells. The higher this value, the faster the cancer cells divide and the more aggressively the tumor grows .

The interdisciplinary S3 guideline recommends the grading according to Elston and Ellis. Accordingly, cancer cells are divided into three different histological grades:

  • G1: well differentiated
  • G2: moderately differentiated
  • G3: poorly differentiated

Well-differentiated cells (G1) most closely resemble healthy cells, and their growth is less aggressive. Moderately differentiated cells (G2) are referred to as intermediate malignancy. These cells divide more rapidly than in G1 but less rapidly than in G3. Poorly differentiated cells (G3) show the greatest differences from healthy cells, they divide rapidly, and the cancer grows aggressively.

Proliferation index Ki-67

The tumor marker Ki-67, which is found in the cancer cells, also plays a role in the growth rate of breast carcinomas. If the protein Ki-67 is present in large amounts in the cancer cells (more than 20 percent), they grow rapidly. If the Ki-67 value is low (maximum 13 percent), the cancer cells grow more slowly.

New markers

In recent years, new markers have been discovered that can be determined: Mutations in the BRCA genes for therapy with PARP inhibitors, PD-L1 for therapy with immune antibodies (so-called T-cell checkpoint inhibitors), PIK3 mutations for treatment with corresponding inhibitors, the so-called PIK3 inhibitors.

All of these markers are measured in patients who have distant metastases. The corresponding substances are approved for the specific markers. For the treatment of patients without metastases, these substances are being tested in international studies in which our hospitals and centers are participating.

The resection margin status (R classification)

Resection margin status indicates whether the tumor could be completely removed or whether cancer cells remain at the cut edge of the tissue.

The term R-classification goes back to the English "residual tumor", which can be translated as "remaining tumor". Thus, the R classification indicates the absence or presence of residual tumor . A distinction is made in:

  • RX – whether a residual tumor is present cannot be assessed
  • R0 – no residual tumor: the edge of the incision is free of cancer cells
  • R1 – microscopic residual tumor: cancer cells remain in the cut margin and are visible under the microscope
  • R2 – macroscopic residual tumor: tumor remains in the incision margin that is visible to the naked eye or can be palpated

Molecular properties of the tumor and receptor status

Based on their molecular characteristics, breast cancer cells can be divided very roughly into three molecular classes:

  • Luminal carcinomas (A and B)
  • HER-type
  • Basal-like carcinomas (about 80 percent of them are triple negative tumors)

On the one hand, the different classes provide information about how the tumor will respond to a particular treatment. On the other hand, they also have prognostic relevance: recurrences and distant metastases are less frequent in luminal tumors, but the risk remains the same over many years. Triple-negative tumors are at higher risk for recurrence and metastasis in the first three years after initial diagnosis, but they rarely occur thereafter [4].

Breast cancer cure rates

The chances of curing breast cancer are better the earlier the tumor is detected and treated.

The following table from the report "Cancer in Germany" shows how many breast cancer patients are still alive five and ten years after their initial diagnosis, respectively ("five-year survival rate" and "ten-year survival rate"). The report is published biennially and is jointly published by the Center for Cancer Registry Data at the Robert Koch Institute and the Society of Epidemiological Cancer Registries e. V. (GEKID) published [2 ].

*Note: The relative survival rate explains what percentage of people with a particular disease are still alive after a defined period of time following diagnosis compared to the general population.

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