Breast cancer spread to lymph nodes life expectancy

Breast cancer is the most common cancer in the UK. Survival for breast cancer is generally good, particularly if you are diagnosed early. This is probably because of screening, early diagnosis and improved treatment.

Survival depends on many different factors. So no one can tell you exactly how long you will live. It depends on your:

• type and stage of cancer
• level of fitness
• previous treatment

Your doctor can give you more information about your own outlook (prognosis). You can also talk about this with the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.

Survival by stage

No UK-wide statistics are available for different stages of breast cancer or individual treatments. These figures are for survival by stage for women in England, five years after diagnosis. These are from women diagnosed between 2013 and 2017 and followed up to 2018.

Stage 1

Most women (around 98%) will survive their cancer for 5 years or more after diagnosis.

Stage 2

Around 90 out of 100 women (around 90%) will survive their cancer for 5 years or more after diagnosis. 

Stage 3

More than 70 out of 100 women (more than 70%) will survive their cancer for 5 years or more after diagnosis. 

Stage 4

Around 25 out of 100 women (around 25%) will survive their cancer for 5 years or more after they are diagnosed. The cancer is not curable at this point, but may be controlled with treatment for some years.

Where this information comes from

Cancer survival by stage at diagnosis for England, 2019
Office for National Statistics

These figures are for people diagnosed in England between 2013 and 2017. 

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.

Survival for all stages of breast cancer

Generally for women with breast cancer in England:

• Around 95 out of every 100 women (around 95%) survive their cancer for 1 year or more after diagnosis
• Around 85 out of every 100 women (around 85%) will survive their cancer for 5 years or more after diagnosis
• Around 75 out of every 100 women (around 75%) will survive their cancer for 10 years or more after diagnosis

Where this information comes from

Cancer survival by stage at diagnosis for England, 2019
Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.

What affects survival

Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.

The type of cancer and grade of the cancer cells can also affect your survival. Grade means how abnormal the cells look under the microscope.

Your general health and fitness also affect survival, the fitter you are, the better you may be able to cope with your cancer and treatment.

Another factor that can affect survival is whether the cancer cells have receptors for particular cancer drugs.

About these statistics

The terms 1 year survival and 5 year survival don't mean that you will only live for 1 or 5 years.

The Office for National Statistics (ONS) and researchers collect information. They watch what happens to people with cancer in the years after their diagnosis. 5 years is a common time point to measure survival. But some people live much longer than this.

5 year survival is the number of people who have not died from their cancer within 5 years after diagnosis.

Statistics are averages based on large numbers of patients. They can’t predict exactly what will happen to you. No two patients are exactly alike and response to treatment also varies from one person to another.

JOHN W. FINN, M.D., Chief Medical Director, Hospice of Michigan's Maggie Allesee Center for Quality of Life, Detroit, Michigan

Am Fam Physician. 2006;73(11):2062-2067

Case Scenario

A 65-year-old woman is receiving chemotherapy for recurrent breast cancer, which has metastasized to the bone, pleura, and liver. Her physician has delayed several treatment courses and modified the chemotherapy dosage because, despite supportive treatment, she has developed persistent anemia. Bone marrow biopsy and aspiration revealed hypercellularity with excess blast cells (20 percent). The patient has developed “preleukemia” (i.e., refractory anemia with excess blast cells), and her physician has told her that she has six months or less to live.

How did her physician come up with this six-month time frame? I have been told that a patient's first question after receiving a terminal illness diagnosis is commonly, “How much time do I have left?” How accurate can a physician be when predicting death? What factors should be considered when determining a prognosis?

Commentary

Physicians often overestimate a terminal patient's life expectancy. One study1 showed that physicians overestimated survival by a factor of 5.3. A few clinical guideposts and a basic understanding of disease progression can improve a physician's ability to offer patients and their families more accurate time frames in which to organize their priorities.

Although medical decisions often are based on a patient's prognosis, an accurate diagnosis and definitive treatment have become more important in the modern medical setting. Patients usually receive little prognostic information, and advocacy groups traditionally focus only on survival. This is changing, however, as medicine becomes increasingly evidence-based. Researchers are evaluating treatment outcomes based on factors beyond simple survival (e.g., cost of treatment, quality of life, severity of symptoms, caregiver and societal burdens).2

Specific to the case scenario, the most important prognostic factors to consider when treating a woman with recurrent breast cancer (e.g., locally recurrent in the chest wall, regional lymph nodes or, most commonly, distant metastasis to the bone) are the disease-free interval (i.e., the time between completion of primary treatment and disease recurrence) and the extent and locations of metastases. These factors can help predict the clinical behavior and progression of the disease.

A patient with a long disease-free interval (i.e., one year or more) and limited metastasis will have a better prognosis than a patient who has been disease free for less than one year and has more widespread metastasis. Metastasis to the bone or pleura is not imminently life threatening; however, metastasis to the liver, lung, or brain considerably reduces the patient's life expectancy. A patient with metastasis to the liver and lung has a median life expectancy of less than six months. A patient with widespread metastasis or with metastasis to the lymph nodes has a life expectancy of less than six weeks. A patient with metastasis to the brain has a more variable life expectancy (one to 16 months) depending on the number and location of lesions and the specifics of treatment. Certain cancer complications (e.g., recurrent hypercalcemia and septicemia, malignant pericardial effusion, and abdominal carcinomatosis with ascites and partial bowel obstruction) are associated with less favorable prognoses. Many patients with comparable diseases will respond similarly; however, some will either do much worse or much better than expected. A patient's prognosis also is based on his or her response to treatment.

Other than cancer histopathology, metastasis, and tumor complications, the two most important factors to look at when determining a prognosis are: (1) how well the patient is able to perform activities of daily living (e.g., bathing, dressing, toileting), and (2) how burdensome the symptoms are to the patient.3 Physicians can use the Karnofsky performance scale (KPS)3 to help determine a patient's ability to perform activities of daily living. If a patient is sedentary for 50 percent or more of his or her waking hours and is becoming increasingly dependent on caregivers, or if he or she has a KPS score of less than 50 percent, the life expectancy is two to three months.3 Symptoms such as difficulty swallowing, dry mouth, shortness of breath, lack of appetite, and weight loss may portend a poorer prognosis4 and may accompany anorexia-cachexia syndrome (wasting). Increasing symptoms and diminished functionality cause progressive debilitation. Progressive debilitation (and its subsequent complications) is the underlying mechanism that causes death in patients who are terminal.

Other important prognostic considerations include comorbidity, age, and nutritional status. Psychosocial and spiritual factors also should be considered. Recent evidence5 has called into question the notion that patients with a strong “will to live” often live longer than those who have accepted that they are going to die; however, patients with inadequate social support, and patients who are impoverished or poorly adherent to prescribed regimens, may have shorter life expectancies. Unresolved relationship issues or existential distress may prolong the dying process.

In the final stages of cancer, patients typically deteriorate rapidly.6 Patients can live several months with little food intake, but they cannot live without adequate fluid intake. Therefore, a decrease in fluid intake and urinary output can help determine when a patient should receive palliative care.

Ultimately, the family physician's role in determining a prognosis depends on his or her communication with the patient's oncologist and how involved he or she is in the patient's care. A future Curbside Consultation piece will address issues related to delivering a poor prognosis to a patient.

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