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Staging, grading and prognosis of breast cancer

Staging breast cancer

The tests completed by your specialist show whether the breast cancer has spread to other parts of the body. This is called staging. It helps you and your health care team decide which treatment option is best for you.

The staging system most commonly used for breast cancer is the TNM system. In this system, letters and numbers are used to describe how big the tumour is (T), whether the cancer has spread to nearby lymph nodes (N), and whether the cancer has spread to the bones or other organs, i.e. whether it has metastasised (M).

In 2018, the staging system was updated to include details about the tumour such as oestrogen and progesterone receptor status, HER2 status and grade of the cancer. Oncotype Dx score may also be considered.

Early breast cancer is stage 1 or 2. The cancer is contained in the breast and may or may not have spread to lymph nodes in the armpit. Locally advanced breast cancer is stage 3. It means the cancer is larger than 5 cm, has spread to tissues around the breast such as the skin, muscle or ribs, or has spread to a large number of lymph nodes. The staging system for breast cancer is complex so ask your doctor to explain how it applies to you.

Grading breast cancer

The grade describes how active the cancer cells are and how fast the cancer is likely to be growing.

grade 1 (low grade)Cancer cells look a little different from normal cells. They are usually slow growing.
grade 2 (intermediate grade)Cancer cells do not look like normal cells. They are growing faster than grade 1 cancer cells.
grade 3 (high grade)Cancer cells look very different from normal cells. They are usually fast-growing.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. To work out your prognosis, your doctor will consider the stage and grade of the cancer, as well as features such as the cancer’s hormone receptor and HER2 status.

Survival rates for women with breast cancer have increased significantly over time due to better tests and scans, earlier detection and improved treatment methods. Doctors commonly use five-year survival rates as a way to discuss prognosis. This is because research studies often follow people for five years – it does not mean you will survive for only five years. Compared with other cancers, breast cancer has one of the highest five-year survival rates if diagnosed early.

This information is reviewed by

This information was last reviewed July 2020 by the following expert content reviewers: Prof Bruce Mann, Professor of Surgery, The University of Melbourne, and Director, Breast Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Dr Marie Burke, Radiation Oncologist, and Medical Director GenesisCare Oncology, QLD; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Ruth Groom, Consumer; Julie McGirr, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Catriona McNeil, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Dr Roya Merie, Staff Specialist, Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, NSW; Dr Eva Nagy, Oncoplastic Breast Surgeon, Sydney Oncoplastic Surgery, NSW; Gay Refeld, Clinical Nurse Consultant – Breast Care, St John of God Subiaco Hospital, WA; Genny Springham, Consumer.