From A-list celebrities to the people in our own lives, breast cancer remains a universal health challenge. The statistics are sobering: according to the World Health Organisation (WHO), breast cancer caused an estimated 670,000 deaths globally in 2022. Also read | Oncologist warns women not to ignore this first sign of breast cancer
Remarkably, roughly half of all cases occur in women with no specific risk factors other than sex and age, per WHO. As the most common cancer for women in 157 out of 185 countries, understanding the nuances of a diagnosis is more critical than ever.
When a breast cancer diagnosis is made, patients are often inundated with medical terminology. While many are familiar with the ‘stage’ of cancer (how far it has spread), the ‘grade’ is an equally vital piece of the puzzle.
Understanding the grades: slow-growing to aggressive
In an interview with HT Lifestyle, Dr Bhavisha Ghugare, senior consultant, surgical breast oncology, HCG Cancer Centre, Borivali, clarifies the distinction: “The grade describes how the cancer cells look under the microscope compared to healthy cells.”
Pathologists determine the grade by assessing how closely the tumour cells resemble normal breast tissue, Dr Ghugare explains. This is often calculated using the Nottingham grading system, which scores tubule formation, nuclear pleomorphism (cell size and shape), and mitotic count (rate of cell division).
Grade 1: Low-grade and less aggressive
According to Dr Ghugare, Grade 1 is the least aggressive type. “Grade 1 breast cancer is almost identical in appearance to normal breast cells. It is slow-growing,” she explains. Because these cells behave more like healthy tissue, early diagnosis of Grade 1 cancer typically offers a very high chance of successful, less intensive treatment.
Grade 2: Moderately differentiated
This is the ‘middle ground’ of diagnoses. “Grade 2 cancer appears as cancer cells that are somewhat different in appearance from normal breast cells and grow at a moderately fast rate,” says Dr Ghugare. Because it sits between low- and high-grade, doctors often look more closely at other biological markers to determine the best treatment path.
Grade 3: high-grade and fast-growing
Grade 3 is characterised by rapid growth and a starkly different appearance from normal cells. “The fast growth may mean treatment has to be more aggressive,” Dr Ghugare notes. Treatment plans for grade 3 are often comprehensive, potentially involving a combination of surgery, chemotherapy, radiation, and newer targeted therapies.
Why is grade only one piece of the story
It is a common misconception that a higher grade automatically dictates a poor outcome. Dr Ghugare is quick to dispel this: “It is crucial to note that cancer grade does not determine the survival of the patient alone.”
To build a full picture, according to Dr Ghugare, doctors evaluate a ‘multidisciplinary’ set of factors:
⦿ Stage: The physical size and spread of the tumour.
⦿ Lymph node involvement: Whether the cancer has reached the immune system’s drainage points.
⦿ Hormone receptors & HER2 status: These dictate if the cancer ‘feeds’ on hormones like estrogen.
⦿ Genetic markers: Personalised DNA signals of the tumour.
⦿ General health: The patient’s ability to tolerate specific treatments.
Precision and early detection
The landscape of breast cancer management is shifting toward ‘precision medicine’. “Better diagnosis and newer treatment modalities have improved management across all grades,” says Dr Ghugare. Innovations in immunotherapy and targeted therapy mean that even aggressive, high-grade cancers are being managed more effectively than ever before.
However, the ‘gold standard’ remains early detection. Tools like mammograms, clinical exams, and consistent self-examinations are the most vital factors in changing the trajectory of the disease.
“Knowing these grades can enable patients to make better health-related decisions and have informed discussions with their doctors. With timely diagnosis and expert care, breast cancer — even at higher grades — can be effectively managed,” Dr Ghugare concludes.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
