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The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. [1][2] Its value is calculated using three pathological criteria: the size of the tumour; the number of involved lymph nodes; and the grade of the tumour. [1] It is calculated to select patients for adjuvant treatment.
In the USA the five-year survival rate for localized breast cancer was 96.8%, while in cases of metastases it was only 20.6%. Because the prognosis for breast cancer was at this stage relatively favorable, compared to the prognosis for other cancers, breast cancer as cause of death among women was 13.9% of all cancer deaths.
The American Cancer Society reports 5-year relative survival rates of over 70% for women with stage 0-III breast cancer with a 5-year relative survival rate close to 100% for women with stage 0 or stage I breast cancer. The 5-year relative survival rate drops to 22% for women with stage IV (metastatic) breast cancer. [3]
Dr. Elizabeth Comen, who treats breast cancer at Memorial Sloan Kettering Cancer Center in New York, said women should do the assessment with their doctors, not by themselves.
Staging breast cancer is the initial step to help physicians determine the most appropriate course of treatment. As of 2016, guidelines incorporated biologic factors, such as tumor grade, cellular proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression profiling into the staging system.
Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). Stages 1–3 are within the breast or regional lymph nodes. Stage 4 is a metastatic cancer. Metastatic breast cancer has a less favorable prognosis. Receptor status.
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