Expert: Claes-Gustaf Nordquist, M.D. - 5/14/2008

Question
i am 2 42 year old black women with triple negative breast cancer i did chemo (dose dens ac ) a mastectomy and 25 doses of radiation here is my pathology report what is my survival rate with this report, i am african american 42 with triple negative infiltrating and intraepithelial  ductal carcinoma. for the infiltrating, grade is moderately differentiated total score 7 nuc 3 tub 3 m.f.=1. size 1.1 (i had chemo first before surgery it was 5.5) necrosis present lymphovasular invasion present microcalcifications (in tumor) present .in the intraepithelial ductal carcinoma in situ grade 3. ductal intraepithelial grade3 type cribriform size/extent: 2 foci approximately 6 cm and 1.3 cm in extent necrosis: present nuclear grade 3 microcalcifications present one lymp node positive for metastatic carcinoma 1/1 micrometasis (>0.2 to 2 mm) what is my survival rate and  how probale is it that my cancer will come back

Answer
Well, I'll try to explain my position on this. Statistics and probabilities are all very well when you are dealing with large numbers of cases. Then you can tell with a high degree of accuracy how many that will survive for a specific time based on past experience. Here we are only dealing with one single case, YOU! Then it becomes much more uncertain. So much so that it becomes somewhat meaningless. Pathology (grade) is also only one variable of several that have to be taken into account. Another is your stage. Yet another is the size of your primary tumor. Yet another is the therapy you have received. Since therapy is developing all the time that brings in extra uncertainties. A grade 3 tumor is as grades go not a very nice one. If I have read your report correctly (most of it was about the microscopy, I would have liked to get more information with regards to the macroscopic picture too = number of tumors, tumor size, location etc. that information is also important) your tumor was rather big. You also had one (but only one) lymph node metastasis. And it was small. Based on this I can only offer you some kind of educated guess since there are quite a few uncertainties. That evaluation would be around a 50% chance of success, but as I told you there are many uncertainties involved here. To try to predict survival time if your therapy is not successful would be pure guesswork - as would be the case too if indeed it is successful!