Breast Cancer Recurrence Risk Calculator
Estimate 5-year local breast cancer recurrence risk after mastectomy using the O'Rourke prognostic index with tumor grade, lymph node status, and lymphovascular invasion.
About This Calculator
The Breast Cancer Recurrence Risk Calculator estimates the likelihood of local breast cancer recurrence within 5 years of mastectomy using the O'Rourke prognostic index. This clinical tool was developed by O'Rourke, Galea, Morgan, and colleagues (1994) based on a retrospective study of 966 patients with primary operable breast cancer treated by simple mastectomy and node biopsy without postoperative irradiation or systemic adjuvant therapy.
The O'Rourke index combines three pathological factors: tumor grade (how abnormal the cancer cells appear under a microscope, graded 1-3), lymph node status (whether cancer has spread to axillary lymph nodes), and lymphovascular invasion (whether cancer cells have invaded blood or lymphatic vessels). Each factor is assigned a weighted score and the total predicts the 5-year local recurrence risk. The index has been validated in multiple subsequent studies and remains a useful clinical tool for identifying patients who may benefit from adjuvant radiation therapy to the chest wall.
The study found that 23% of patients developed local recurrence over a median follow-up of 7 years. Patients with high scores had a 39% chance of local recurrence at 5 years, compared to just 3-5% for patients with low scores. Different types of local recurrence carry different prognoses — single small lesions respond well to local therapy while diffuse dermal infiltration is more resistant.
Regional Notes
India: Breast cancer is the most common cancer among women in India, with increasing incidence in urban areas. Indian studies report 5-year local recurrence rates after mastectomy ranging from 5-15% depending on stage, with higher rates in locally advanced disease common at presentation.
United States: The NCI estimates 316,950 new breast cancer cases in 2025. With modern multimodal therapy including radiation, chemotherapy, and hormonal therapy, 5-year local recurrence rates after mastectomy have declined to 5-10% for early-stage disease.
United Kingdom: NHS data shows 5-year local recurrence rates of 3-8% for early-stage breast cancer treated with modern protocols. The PREDICT tool (NHS) is commonly used in UK practice for estimating overall survival and recurrence risk.
Frequently Asked Questions
What is the breast cancer recurrence risk calculator?
This calculator estimates the 5-year local recurrence risk of breast cancer after mastectomy using the O'Rourke prognostic index. It considers three key factors: tumor grade (1-3), lymph node status (positive or negative), and lymphovascular invasion (present or absent). The tool is based on the 1994 study by O'Rourke et al. published in the British Journal of Surgery.
What does local recurrence of breast cancer mean?
Local breast cancer recurrence refers to cancer returning in the same area as the original tumor, specifically in or deep to the mastectomy skin flaps or in the conserved breast tissue. It differs from regional recurrence (nearby lymph nodes) and distant recurrence (metastasis to other organs). The O'Rourke index specifically predicts local recurrence after simple mastectomy.
How is the O'Rourke score calculated?
The O'Rourke score is calculated by adding points for tumor grade (Grade 1 = 1, Grade 2 = 2, Grade 3 = 3), lymph node status (negative = 0, positive = 3), and lymphovascular invasion (absent = 0, present = 2). The total score ranges from 1 to 8, with higher scores indicating greater risk of local recurrence. A score of 1-2 is very low risk (3-5%), 3-4 moderate (7-10%), 5-6 high (15-22%), and 7-8 very high (33-39%).
What factors increase the risk of breast cancer recurrence?
Key factors include higher tumor grade, positive lymph node status, presence of lymphovascular invasion, larger tumor size, young age at diagnosis (under 35), estrogen receptor-negative status, HER2-positive status, obesity, high blood sugar, and heavy alcohol consumption. Smoking is also associated with a 41% higher probability of breast cancer recurrence.
How can I reduce my risk of breast cancer recurrence?
Maintain a healthy weight, eat a high-quality diet rich in vegetables and low in saturated fat, exercise regularly to boost immune function, limit alcohol to fewer than 3 drinks per week, avoid smoking, and follow your oncologist's recommendations for adjuvant therapies such as tamoxifen, aromatase inhibitors, chemotherapy, or radiation therapy.
Is this calculator a substitute for medical advice?
No, this calculator is an educational tool based on published research and should not replace professional medical advice. The O'Rourke index was developed from a 1994 study of 966 patients treated without modern adjuvant therapies. Always consult your oncologist for a personalized assessment of your recurrence risk and treatment plan.
What is the difference between local, regional, and distant recurrence?
Local recurrence means cancer returns in the same breast or chest wall area. Regional recurrence means cancer returns in nearby lymph nodes (axillary, supraclavicular, or internal mammary nodes). Distant recurrence (metastasis) means cancer spreads to distant organs such as bones, liver, lungs, or brain. The O'Rourke index specifically predicts local recurrence after mastectomy.
Are breast cancer recurrence rates different between countries?
Recurrence rates are broadly similar across developed countries with access to modern treatment. In India, 5-year local recurrence rates after mastectomy range from 5-15% depending on stage and treatment received. In the US, rates are 5-10% with modern approaches. In the UK, NHS data shows 5-year local recurrence rates of 3-8% for early-stage breast cancer. The O'Rourke index provides risk estimates from an era without systemic adjuvant therapy.