Estimate breast cancer 5-year and 10-year recurrence risk from tumor size, grade, lymph nodes, ER/HER2/Ki-67 status. Includes molecular subtype classification and genomic assay guide.
Breast cancer recurrence risk estimation is central to treatment planning, particularly the decision about adjuvant chemotherapy. Modern oncology integrates clinical-pathological factors — tumor size, grade, lymph node status, ER/PR/HER2 status, and Ki-67 — with genomic assays to provide individualized risk profiles. This page summarizes those standard factors in one place so the estimate is easier to interpret alongside formal oncology follow-up.
This calculator provides an educational estimate of 5-year and 10-year recurrence risk based on standard prognostic factors. It classifies the tumor into molecular subtypes (Luminal A, Luminal B, HER2-enriched, Triple Negative), computes a Nottingham Prognostic Index-like score, and guides genomic assay selection. Validated tools like the 21-gene Oncotype DX Recurrence Score (TAILORx, RxPONDER trials) and 70-gene MammaPrint (MINDACT trial) have transformed the treatment paradigm for early-stage ER-positive breast cancer.
For clinical treatment decisions, this tool should be used alongside — not in place of — validated prognostic models (PREDICT, Adjuvant! Online) and genomic assay results interpreted by a medical oncologist. Check the example with realistic values before reporting.
This calculator provides an accessible educational estimate of breast cancer recurrence risk, molecular subtype classification, and genomic assay guidance — helping patients and healthcare providers understand individual prognoses and treatment options. It is useful as a discussion aid when reviewing pathology and assay options with a clinician, and it can help organize the standard factors before a formal oncology visit.
Simplified composite risk model incorporating: - Tumor size (T stage contribution) - Histologic grade (Nottingham combined grade) - Lymph node status (0, 1-3, 4-9, 10+) - ER and HER2 receptor status - Ki-67 proliferation index - Age at diagnosis NPI-like Score = (0.2 × tumor size in cm) + grade (1-3) + lymph node score (1-3) Molecular subtype from ER/PR/HER2/Ki-67 combination
Result: 5-year recurrence risk: ~26% — Moderate-high risk.
A 2.5 cm, grade 2, ER+/HER2- tumor with 1-3 positive nodes and intermediate Ki-67 falls in the Luminal B subtype. Oncotype DX is recommended (RxPONDER validated for 1-3 positive nodes). Recurrence score may identify patients who can safely omit chemotherapy.
Risk assessment has evolved from purely clinical-pathological models (NPI, Adjuvant! Online) to genomic tools that measure tumor biology directly. The TAILORx trial (2018) demonstrated that 70% of ER+/HER2- node-negative patients with intermediate Recurrence Scores could safely omit chemotherapy, sparing hundreds of thousands from unnecessary toxicity.
The PAM50 intrinsic subtype classification (Luminal A, Luminal B, HER2-enriched, Basal-like) reflects fundamental tumor biology that drives prognosis and treatment response. While immunohistochemistry (ER/PR/HER2/Ki-67) serves as a practical approximation, genomic testing provides more precise classification. The shift toward biology-driven treatment represents one of the greatest advances in personalized cancer medicine.
Emerging liquid biopsy technologies can detect minimal residual disease (MRD) after surgery through circulating tumor DNA (ctDNA). Studies show that ctDNA detection after curative treatment predicts recurrence months to years before clinical relapse. This may eventually replace static risk models with dynamic, real-time monitoring.
Oncotype DX is a 21-gene assay that provides a Recurrence Score (RS) from 0-100 for ER+/HER2- breast cancers. The TAILORx trial showed that patients with RS 0-25 and node-negative disease do not benefit from chemotherapy. RxPONDER showed that postmenopausal women with 1-3 nodes and RS ≤25 also do not benefit.
Luminal A (ER+, PR+, HER2-, Ki-67 low) has the best prognosis and often does not need chemotherapy. Luminal B (ER+, and either PR low, HER2+, or Ki-67 high) has higher recurrence risk and more often benefits from chemotherapy. The Ki-67 cutoff of ~14-20% is commonly used to distinguish them.
TNBC lacks ER, PR, and HER2 receptors, so it cannot be treated with endocrine therapy or anti-HER2 agents. It tends to be higher grade, more proliferative, and has higher early recurrence rates (years 1-5). However, it has a "plateau" effect — patients disease-free at 5 years have relatively low late recurrence risk.
Yes. Unlike TNBC, ER+ cancers have significant recurrence risk beyond 5 years — sometimes 10-20 years after diagnosis. This "late recurrence" risk drives decisions about extended endocrine therapy (10 years of tamoxifen or aromatase inhibitors). Genomic assays like Prosigna and Breast Cancer Index help estimate late recurrence risk.
The NPI combines tumor size, lymph node status, and histologic grade: NPI = (0.2 × size in cm) + grade (1-3) + lymph node score (1-3). Score interpretation: <3.4 = excellent prognosis, 3.4-5.4 = moderate, >5.4 = poor. It has been validated across populations since 1982.
Current guidelines recommend genomic testing primarily for ER+/HER2- cancers where the chemotherapy decision is uncertain. Node-negative and 1-3 node-positive patients benefit most. Oncotype DX and MammaPrint are the most commonly ordered. Testing is less informative for HER2+ or triple-negative cancers where chemotherapy is generally recommended regardless.