“So, what stage am I?”

This guest post is by Dr. Jaime Lewis

This question and the answer helps providers and patients in understanding the extent of disease and prognosis, guiding appropriate treatment, and clustering patients in studies and guidelines. It allows us to communicate regarding groups of patients believed to be similar.

The staging of breast cancer, and others, has been based on T (tumor size), N (regional lymph node status), and M (presence/absence of distant disease) categories – a system first developed in the 1940s. We have generally declared a clinical stage (based on history, physical exam, and imaging) and a pathological stage (including the results of surgery). The newest AJCC staging will also include prognostic staging determined T, N, M and relevant non-anatomic factors (grade, estrogen/progesterone/HER2 receptor status, 21 Gene Recurrence score, and potentially other genomic profiles when enough level I evidence becomes available).

We have seen staging for breast cancers change little by little over time. But the newest AJCC staging is something of a paradigm shift. Answering that question of stage will be a challenge requiring a computer program or a book – we will no longer be able to memorize the staging chart which has grown to cover 422 lines in the newest version. But, I am sure that it will allow us to more accurately categorize patients to determine prognosis and make treatment decisions.