Breast cancer prognosis
By Dr Dewald Coolen
When faced with a diagnosis of breast cancer – or any other form of cancer – your first thought will be your survival. Our minds tend to gravitate toward the worst possibilities and although this is normal, it should be the exact opposite. People diagnosed with breast cancer today live longer than ever before.
WHAT DOES PROGNOSIS IN BREAST CANCER MEAN?
Prognosis simply means we assign a concrete number to indicate the probability of recovery from breast cancer for a specific patient. We use the following factors to help determine the prognosis:
- Size of the tumour
- Stage of the breast cancer
- Type of cancer
- Hormone receptor status with HER2 status
- Patient age
- Menopausal status for female patients
- General health
Survival rates are generally used to describe prognosis, but these are for big groups of people and each and every patient with breast cancer has a unique situation and therefore prognosis.
5-YEAR SURVIVAL RATES ACCORDING TO THE AMERICAN CANCER SOCIETY:
- Stage 0: 5-year survival for woman = 100%
- Stage I: 5-year survival for woman = 100%
- Stage II: 5-year survival for woman = 93%
- Stage III: 5-year survival for woman = 72%
- Stage IV: 5-year survival for woman = 22%
WHAT CAN WE DO TO IMPROVE PROGNOSIS?
- Neoadjuvant treatment: In advanced breast cancer, your doctor will advise treatment with chemotherapy or other types of medication for a substantial time period before surgery. This has shown to improve both disease-free survival and overall survival, especially in inflammatory breast cancer and HER2 positive breast cancer.
In a study* of 217 women, 39% had a complete pathological response at the time of surgery. The study showed all the cancer cells were killed by the treatment in 39% of the patients and no cancer cells could be found at surgery.
- Insulin resistance and prognosis of breast cancer: A recent study* showed insulin resistance was associated with a significantly worse prognosis. This suggests that metabolic status of the patient should be considered when deciding on adjuvant treatment.
The study looked at 116 women of which 40% were overweight and 16% obese. Treating insulin resistance as part of the management plan seems to be very important.
Insulin resistance is influenced by our genetics, but also by an unhealthy diet and lifestyle. Insulin levels can be kept lower with low sugar and simple carbohydrate diets. Regular exercise improves insulin levels and glucose control.
The following is advised:
• Do not smoke.
• Lower your alcohol intake.
• Maintain your ideal body weight.
• Exercise daily.
• Follow a low sugar diet and exclude processed foods.
DO PEOPLE WITH BREAST CANCER GAIN WEIGHT?
Losing weight becomes much harder as we grow older. Chemotherapy, steroids and hormonal blocking therapies like Tamoxifen might increase your body weight. The shock and associated stress with your diagnosis, surgery and treatment may also contribute to your weight gain. Being overweight can increase the risk of breast cancer recurrence significantly from 6% to 31% according to the reported literature*.