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Synchronous and metachronous bilateral breast cancer: clinicopathologic characteristics and prognostic outcomes. Hum Pathol 2019; 92:1-9. [DOI: 10.1016/j.humpath.2019.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 11/18/2022]
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Sim Y, Tan VKM, Sidek NAB, Chia DKA, Tan BKT, Madhukumar P, Yong WS, Wong CY, Ong KW. Bilateral breast cancers in an Asian population, and a comparison between synchronous and metachronous tumours. ANZ J Surg 2018; 88:982-987. [PMID: 30141242 DOI: 10.1111/ans.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with unilateral breast cancer have an increased risk of developing bilateral breast cancer (BBC). Patients with metachronous BBC (mBBC) usually have an earlier age of onset, and their prognoses have been shown to be either similar or poorer than those with synchronous BBC (sBBC). Given the differing presentation and characteristics of breast cancers in the Asian population and the West, this study aims to characterize Asian patients with BBC. METHODS All patients who had oncological breast surgery between 2001 and 2010 at the Singapore General Hospital and National Cancer Centre Singapore were reviewed. Patients with BBC were identified and studied. RESULTS A total of 5520 Singaporean women had oncological breast surgery, 155 women (2.8%) had BBC. Of those with BBC, 47.1% (n = 73) were synchronous and 52.9% (n = 82) metachronous (mean interval of 39.4 months), and there was no difference in median age in both groups (54 years of age). Patients with sBBC were more likely to have a positive family history and had asymptomatic contralateral tumours. Although patients with sBBCs were more likely to have ER/PR positive and Her2 negative tumours, they had a lower 5-year overall survival than those with mBBC (P = 0.022). CONCLUSION Our study shows that Asian women with BBC have different characteristics to their Western counterparts. In particular, women with sBBC tended to have a lower 5-year overall survival compared to those with mBBC, despite having seemingly biologically favourable tumours, which suggest that there may be more underlying their tumour biology and genetics.
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Affiliation(s)
- Yirong Sim
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Veronique K M Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Nur A B Sidek
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Daryl K A Chia
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Benita K T Tan
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Preetha Madhukumar
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Wei Sean Yong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Chow Yin Wong
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
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de Mascarel I, Trojani M, Coindre JM, Faucher A. The Incidence of Cancer in Contralateral Reduction Mammaplasty after Mastectomy and Reconstruction of the Removed Breast. TUMORI JOURNAL 2018; 72:183-6. [PMID: 3705192 DOI: 10.1177/030089168607200211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fourty-one patients underwent breast reconstruction after mastectomy for cancer and reduction plasty of the second breast, over a 36-month period. These plasties were performed only for reasons of asymmetry, in the absence of any positive preoperative finding. Histologic examination using semiserial sectioning of the whole excised sample detected a high frequency of unsuspected cancer 14/41 (34%). There was a strong predominance of in situ carcinomas 11/41 (27%) over invasive carcinomas 3/41 (7%). These results were compared with those of other bilateral cancer series. When such cancers were detected by random biopsies or mastectomies, the rate of in situ carcinomas was much greater than in cancers detected only by physical and mammographic examination.
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Nelson DJ, Clark B, Munyard K, Williams V, Groth D, Gill J, Preston H, Chan A. A review of the importance of immune responses in luminal B breast cancer. Oncoimmunology 2017; 6:e1282590. [PMID: 28405507 DOI: 10.1080/2162402x.2017.1282590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/14/2022] Open
Abstract
Historically, the immune environment was not considered an important target for breast cancer treatment. However, the association of lymphocytic infiltrates in triple negative and HER-2 over-amplified breast cancer subtypes with better outcomes, has provoked interest in evaluating the role of the immune system in the luminal B subtype that accounts for 39% of breast cancers and has a poor patient prognosis. It is unknown which immunosuppressive cell types or molecules (e.g., checkpoint molecules) are relevant, or where measurement is most informative. We hypothesize that a profound immunosuppressive tumor and/or lymph node milieu is prognostic and impacts on responses to therapies.
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Affiliation(s)
- Delia J Nelson
- School of Biomedical Sciences, Curtin University, Bentley, Perth, WA, Australia; CHIRI Biosciences, Curtin University, Perth, WA, Australia
| | - Briony Clark
- School of Biomedical Sciences, Curtin University, Bentley, Perth, WA, Australia; CHIRI Biosciences, Curtin University, Perth, WA, Australia
| | - Kylie Munyard
- School of Biomedical Sciences, Curtin University, Bentley, Perth, WA, Australia; CHIRI Biosciences, Curtin University, Perth, WA, Australia
| | - Vincent Williams
- School of Biomedical Sciences, Curtin University , Bentley, Perth, WA, Australia
| | - David Groth
- School of Biomedical Sciences, Curtin University, Bentley, Perth, WA, Australia; CHIRI Biosciences, Curtin University, Perth, WA, Australia
| | - Jespal Gill
- Western Diagnostics Pathology , Myaree, Perth, WA, Australia
| | - Henry Preston
- Western Diagnostics Pathology , Myaree, Perth, WA, Australia
| | - Arlene Chan
- Breast Cancer Research Centre-WA, Hollywood Private Hospital, Nedlands, WA, Australia; Curtin Medical School, Curtin University, Perth, WA, Australia
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Cheung JY, Moon JH. Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients. Diagn Interv Radiol 2016; 21:16-21. [PMID: 25430525 DOI: 10.5152/dir.2014.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE We aimed to analyze the characteristics and long-term follow-up results of unexpected enhancing lesions on preoperative magnetic resonance imaging (MRI) of breast cancer patients. METHODS From August 2007 through February 2010, second-look ultrasound (SLUS) was recommended for 84 of 312 breast cancer patients having unexpected enhancing lesions on MRI. SLUS was performed for 85 unexpected enhancing lesions in 72 patients. We performed a retrospective review to determine the size, lesion type, enhancement kinetic curve, and location in relation to the index cancer. We obtained the pathologic outcome of the detected lesions and in case of a negative finding on SLUS, we performed follow-up examinations for at least two years. RESULTS Of 85 unexpected lesions, 72 (85%) were detected on SLUS. In total, 41 lesions (56.9%) were confirmed as malignant and 31 lesions (43.6%) as benign. Cancer rate was statistically higher in lesions having type III enhancement pattern, located at the same quadrant as the index cancer. However, no significant association was observed between the cancer rate and the lesion size and type. None of the 13 negative cases on SLUS developed cancer on follow-up. CONCLUSION In case of unexpected enhancing lesions on preoperative MRI of breast cancer patients, SLUS can be useful to find out the matched lesion. Lesions with type III enhancement pattern or those located at the same quadrant as the index cancer should be considered as a separate cancer. In the absence of any suspicious findings on SLUS, patient may be followed up with confidence.
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Affiliation(s)
- Joo Yeon Cheung
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Korea.
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Yıldız R, Urkan M, Hancerliogulları O, Kılbaş Z, Ozturk E, Mentes MO, Gorgulu S. Comparison of five different popular scoring systems to predict nonsentinel lymph node status in patients with metastatic sentinel lymph nodes: a tertiary care center experience. SPRINGERPLUS 2015; 4:651. [PMID: 26543785 PMCID: PMC4628030 DOI: 10.1186/s40064-015-1442-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 10/15/2015] [Indexed: 01/25/2023]
Abstract
Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clinically palpable axillary lymph nodes. Almost 50 % of sentinel lymph node positive patients have negative non-sentinel nodes and undergo non-therapeutic axillary dissection. Five different scoring systems, reported in the literature, were compared for their predictive ability of non-SLN involvement in patients with SLN positive breast cancer. 242 patients who underwent breast surgery and SLNB were included in the study. Of these, 70 who were confirmed to have SLN metastasis and received complementary ALND and constituted the final study population. The nomograms (MSKCC, M.D. Anderson Cancer Center, Tenon model, Stanford and Turkish) were statistically compared for their prediction of non-SLN metastasis (95 % confidence interval). We have determined only two clinicopathologic (multifocality and size of the primary tumor) situations which have a statistically significant association between SLN metastasis with using a multivariate logistic regression analysis. Multifocality (P = 0.001) and size of the primary tumor (P = 0.001) were associated with a higher probability of-SLN metastasis. No predictive model
was constructed that showed good area under the curve (AUC) discrimination in the validation series. Currently published predictive models lack accuracy when applied to a different population. Multi-institutional heterogenic population studies are important to determine the exact combination of scoring systems and/or nomograms.
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Affiliation(s)
- Ramazan Yıldız
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Murat Urkan
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Oğuz Hancerliogulları
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Zafer Kılbaş
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Erkan Ozturk
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Mustafa Oner Mentes
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
| | - Semih Gorgulu
- Department of Surgery, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey
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Tracy MS, Rosenberg SM, Dominici L, Partridge AH. Contralateral prophylactic mastectomy in women with breast cancer: trends, predictors, and areas for future research. Breast Cancer Res Treat 2013; 140:447-52. [PMID: 23893127 DOI: 10.1007/s10549-013-2643-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 01/02/2023]
Abstract
Recent studies have revealed increasing rates of contralateral prophylactic mastectomy (CPM) among women with unilateral early stage breast cancer. This trend has raised concerns, given the lack of evidence for a survival benefit from CPM and the relatively low risk of contralateral breast cancer for most women in this setting. In this article, we review available data regarding the value of CPM, predictors, and outcomes related to CPM, and areas for future research and potential intervention.
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Affiliation(s)
- Michaela S Tracy
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, 450 Brookline Ave Boston, Boston, MA 02215, USA
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Beesley H, Holcombe C, Brown S, Salmon P. Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: Analysis of 60 consecutive cases in a specialist breast unit. Breast 2013; 22:179-184. [DOI: 10.1016/j.breast.2012.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022] Open
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Adams AL, Dabbs DJ. Commonly encountered dilemmas in breast cancer reporting and staging. Semin Diagn Pathol 2012; 29:109-15. [PMID: 23062418 DOI: 10.1053/j.semdp.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment modalities for common malignancies such as breast carcinoma have become increasingly complex, necessitating more rigorous documentation by pathologists of the histopathologic features required for staging and therapy. In 2009 the American Joint Committee on Cancer published the most recent update to its Cancer Staging Manual, the most salient points of which are readily available on the College of American Pathologists' Web site. Based on these guidelines, herein we summarize some of the more commonly encountered dilemmas in breast cancer reporting, with emphasis on tumor size, lymph node status, determination of mitotic count for tumor grade, and skin/chest wall involvement (pathologic stage T4).
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Affiliation(s)
- Amy L Adams
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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Vichapat V, Garmo H, Holmberg L, Fentiman IS, Tutt A, Gillett C, Lüchtenborg M. Prognosis of metachronous contralateral breast cancer: importance of stage, age and interval time between the two diagnoses. Breast Cancer Res Treat 2011; 130:609-18. [PMID: 21671018 DOI: 10.1007/s10549-011-1618-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/28/2011] [Indexed: 01/05/2023]
Abstract
Studies comparing the prognosis after contralateral breast cancer (CBC) with that after unilateral breast cancer (UBC) shows conflicting results. We assessed the risk of breast cancer-specific death for women with metachronous CBC compared to those with a UBC in 8,478 women with invasive primary breast cancer registered in the Guy's and St. Thomas' Breast Cancer Tissue and Data Bank. Risk factors associated with breast cancer-specific death for women with CBC were estimated using Cox proportional hazards modelling. Prognoses after UBC and CBC were compared, with survival time for women with CBC calculated: (i) from CBC, (ii) from the initial cancer with CBC as a time-dependent covariate. Women diagnosed with CBC within 5 years after the initial primary breast cancer had a worse prognosis than those with CBC after 5 years and those with UBC. Women with CBC who had positive lymph nodes at the initial breast cancer diagnosis were at an increased risk of dying from breast cancer compared to those without [HR 2.5 (95% CI 1.5-4.0)]. For all stages of the initial breast cancer, a worse prognosis was observed after CBC. CBC increased the hazard originating from the initial cancer at any follow-up time, but the highest hazards were associated with a short interval to CBC. Metachronous CBC adds to the risk of dying from breast cancer. The risk increases substantially when it occurs shortly after the initial cancer, indicating a CBC in some instances may be an indicator of active distant disease. The occurrence of CBC implies a new surveillance and therapeutic situation.
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Affiliation(s)
- Voralak Vichapat
- Cancer Epidemiology Group, Division of Cancer Studies, School of Medicine, King's College London, London, UK.
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Gujral DM, Sumo G, Owen JR, Ashton A, Bliss JM, Haviland J, Yarnold JR. Ipsilateral breast tumor relapse: local recurrence versus new primary tumor and the effect of whole-breast radiotherapy on the rate of new primaries. Int J Radiat Oncol Biol Phys 2010; 79:19-25. [PMID: 20471183 DOI: 10.1016/j.ijrobp.2009.10.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/16/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The justification for partial breast radiotherapy after breast conservation surgery assumes that ipsilateral breast tumor relapses (IBTR) outside the index quadrant are mostly new primary (NP) tumors that develop despite radiotherapy. We tested the hypothesis that whole-breast radiotherapy (WBRT) is ineffective in preventing NP by comparing development rates in irradiated and contralateral breasts after tumor excision and WBRT. METHODS AND MATERIALS We retrospectively reviewed 1,410 women with breast cancer who were entered into a prospective randomized trial of radiotherapy fractionation and monitored annually for ipsilateral breast tumor relapses (IBTR) and contralateral breast cancer (CLBC). Cases of IBTR were classified into local recurrence (LR) or NP tumors based on location and histology and were subdivided as definite or likely depending on clinical data. Rates of ipsilateral NP and CLBC were compared over a 15-year period of follow-up. RESULTS At a median follow-up of 10.1 years, there were 150 documented cases of IBTR: 118 (79%) cases were definite or likely LR; 27 (18%) cases were definite or likely NP; and 5 (3%) cases could not be classified. There were 71 cases of CLBC. The crude proportion of definite-plus-likely NP was 1.9% (27/1,410) patients compared with 5% (71/1,410) CLBC patients. Cumulative incidence rates at 5, 10, and 15 years were 0.8%, 2.0%, and 3.5%, respectively, for definite-plus-likely NP and 2.4%, 5.8%, and 7.9%, respectively for CLBC, suggesting a difference in the rates of NP and CLBC. CONCLUSIONS This analysis suggests that WBRT reduces the rate of ipsilateral NP tumors. The late presentation of NP has implications for the reporting of trials that are testing partial breast radiotherapy.
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Affiliation(s)
- Dorothy M Gujral
- Section of Academic Radiotherapy, Royal Marsden Hospital, Sutton, United Kingdom
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Green M, Aspinall S, Kollias J. Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer. Breast 2009; 18:276-8. [PMID: 19850479 DOI: 10.1016/j.breast.2009.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 07/18/2009] [Accepted: 09/13/2009] [Indexed: 11/25/2022] Open
Abstract
Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle reduction with free nipple graft. The duration of surgery ranged from 75 to 146 (median 110) minutes. Between 475 and 2350 (median 1090) grams of breast tissue was excised from the contra-lateral breast. No immediate or delayed complications were observed and there were no delays in commencing adjuvant therapy. Immediate contra-lateral breast reduction in women with mammary hypertrophy undergoing mastectomy for breast cancer is safe and effective means of reducing the physical, psychological and cosmetic problems associated with unilateral mammary hypertrophy following mastectomy.
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Affiliation(s)
- Michael Green
- Breast, Endocrine and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, Australia
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Tebé C, Márquez-Calderón S, Ramón Benítez J, Sánchez-Lanuza M, Fernandez R, Aguado MJ, Pons JMV, Pla R. [Current state of breast cancer surgery in Andalusia and Catalonia]. Cir Esp 2009; 86:369-77. [PMID: 19800055 DOI: 10.1016/j.ciresp.2008.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 09/15/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgery is an essential element of breast cancer treatment. The aim of this study was to describe the progress and current practice in oncological breast surgery in Catalonia and Andalusia. MATERIAL AND METHOD An observational study was conducted, collecting data from the Minimum Basic Data Set at Hospital Discharge. RESULTS A total of 37,537 women from Catalonia and 24,186 from Andalusia were studied. The rate of admission due to breast cancer in women increased substantially during the study period, as well as the percentage of women who underwent breast-conserving surgery. However, the increase in breast-conserving surgery has not been consistent among age groups and hospital levels. CONCLUSIONS As a whole, the increase in breast-conserving surgery has shown the need for interventions to promote the use of procedures of proven effectiveness.
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Affiliation(s)
- Cristian Tebé
- Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Barcelona, España.
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Cumulative survival in early-onset unilateral and bilateral breast cancer: an analysis of 1907 Taiwanese women. Br J Cancer 2009; 100:563-70. [PMID: 19190627 PMCID: PMC2653740 DOI: 10.1038/sj.bjc.6604898] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
As the epidemiological pattern of breast cancer in modernising Asian countries differs greatly from that in Western countries, it is worthwhile to investigate the long-term prognoses of unilateral and bilateral breast cancer in these nations. A retrospective cohort study composed of 1907 Taiwanese women was conducted to follow 1863 unilateral and 44 bilateral cases of breast cancer. Time-dependent Cox regression was used to assess the risk of breast cancer death by considering the time course of unilateral and bilateral tumour development. The 15-year survival rates were 68.37, 62.63, and 26.42% for unilateral, synchronous bilateral, and metachronous bilateral breast cancer, respectively. Differences among types were most apparent after 5 years of follow-up. After adjusting for significant prognostic factors, the risk of death for overall bilateral breast cancer was 2.50-fold greater (95% CI, 1.43-4.37) compared to unilateral breast cancer. The corresponding figures were 1.12-fold (95% CI, 0.42-3.02) and 6.11-fold (95% CI, 3.14-11.89) for synchronous and metachronous bilateral breast cancer, respectively. Taiwanese women, who are frequently diagnosed with breast cancer before 50 years of age, showed poorer survival for metachronous bilateral than for synchronous bilateral or unilateral breast cancer. Survival was markedly poorer compared to recent data from Sweden.
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Majdak-Paredes E, Fatah F. Hereditary breast cancer syndromes and clinical implications. J Plast Reconstr Aesthet Surg 2009; 62:181-9. [DOI: 10.1016/j.bjps.2008.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 06/09/2008] [Accepted: 07/01/2008] [Indexed: 11/30/2022]
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Diagnostic and prognostic utility of molecular markers in synchronous bilateral breast carcinoma. Mod Pathol 2008; 21:1200-7. [PMID: 18469799 DOI: 10.1038/modpathol.2008.35] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histologic criteria have a limited role in determining whether the synchronous bilateral breast carcinomas represent two primaries or a metastasis to the contralateral breast. We studied the molecular analysis of synchronous bilateral breast carcinoma and whether they are originating from a single or different clone. We examined 17 patients with breast carcinoma, including 12 patients with synchronous bilateral carcinomas and control group of 5 infiltrating ductal carcinomas with regional lymph node metastases. Mutations were quantitatively determined to detect loss of heterozygosity (LOH) and microsatellite size alterations for a broad panel of 15 markers, involving 10 chromosomes using polymerase chain reaction. The carcinomas were classified as de novo or metastasis based on three levels of concordance: (1) marker-affected tumors were considered concordant if 50% or more of the same markers were mutated, (2) same gene copy affected, and (3) temporal sequence of mutation acquisition. In synchronous bilateral breast carcinoma patients, molecular analysis showed discordant mutations in all cases, supporting the diagnosis of de novo bilateral primary breast carcinomas. In patients with lymph node metastases, the primary breast carcinoma and metastases shared the same mutations, revealing a metastatic lesion. In conclusion, the application of molecular technology may play an important role for the differential diagnosis of dual primary carcinomas vs a metastatic breast cancer to contralateral breast. In this study, synchronous bilateral breast cancers represent two independent primaries rather than metastatic events.
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Herbert GS, Sohn VY, Brown TA. The impact of nodal isolated tumor cells on survival of breast cancer patients. Am J Surg 2007; 193:571-3; discussion 573-4. [PMID: 17434357 DOI: 10.1016/j.amjsurg.2007.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Isolated tumor cells (ITCs), often detectable only with immunohistochemical techniques, have an unknown significance in the prognosis of breast cancer. The American Joint Committee on Cancer guidelines classify such patients as N0 (immunohistochemistry +), staging them with node-negative patients. We sought to further elucidate the impact of ITCs on survival. METHODS We conducted a retrospective review of all women at our institution with breast cancer from 1996 to 2005. Of 514 patients, 16 had isolated tumor cells detected only with immunohistochemical staining. Survival then was compared with historical survival rates for women with node-free disease. RESULTS The 16 women with N0 (i+) disease had stage I or II disease. There was no documented recurrence among these women, with an average follow-up period of 2.5 years. CONCLUSIONS Our data suggest that ITCs detected in lymph nodes do not adversely impact survival or disease-free survival compared with women with node-negative disease. Larger studies will be required to confirm these findings.
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Affiliation(s)
- Garth S Herbert
- Department of Surgery, Madigan Army Medical Center, 9040A Reid St., Tacoma, WA 98431, USA.
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Chang DT, Feigenberg SJ, Indelicato DJ, Morris CG, Lightsey J, Grobmyer SR, Copeland EM, Mendenhall NP. Long-term outcomes in breast cancer patients with ten or more positive axillary nodes treated with combined-modality therapy: the importance of radiation field selection. Int J Radiat Oncol Biol Phys 2007; 67:1043-51. [PMID: 17336214 DOI: 10.1016/j.ijrobp.2006.10.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 10/10/2006] [Accepted: 10/20/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the long-term outcome of a consistent treatment approach with electron beam postmastectomy radiation therapy (PMRT) in breast cancer patients with > or =10 positive nodes treated with combined-modality therapy. METHODS AND MATERIALS TSixty-three breast cancer patients with > or =10 positive lymph nodes were treated with combined-modality therapy using an electron beam en face technique for PMRT at the University of Florida. Patterns of recurrence were studied for correlation with radiation fields. Potential clinical and treatment variables were tested for possible association with local-regional control (LRC), disease-free survival (DFS), and overall survival (OS). RESULTS TAt 5, 10, and 15 years, OS rates were 57%, 36%, and 27%, respectively; DFS rates were 46%, 37%, and 34%; and LRC rates were 87%, 87%, and 87%. No clinical or treatment variables were associated with OS or DFS. The use of supplemental axillary radiation (SART) (p = 0.012) and pathologic N stage (p = 0.053) were associated with improved LRC. Patients who received SART had a higher rate of LRC than those who did not. Moderate to severe arm edema developed in 17% of patients receiving SART compared with 7% in patients not treated with SART (p = 0.28). CONCLUSIONS TA substantial percentage of patients with > or =10 positive lymph nodes survive breast cancer. The 10-year overall survival in these patients was 36%. The addition of SART was associated with better LRC.
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Affiliation(s)
- Daniel T Chang
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA
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Abstract
With availability of genetic testing and development of statistical models for risk stratification, more women are being identified as having increased risk for breast cancer. A number of risk-reducing treatment options with varying efficacy exist for them, including frequent surveillance, chemoprevention, prophylactic salpingo-oophorectomy (PSO), and prophylactic mastectomy (PM). Those most likely to benefit from PM are BRCA gene carriers and those who have a strong family history of breast cancer. Prevetive PM remains controversial, however. There are no randomized controlled trials to substantiate the potential benefit or harms of PM. This article describes the high-risk women in whom PM may be considered, and summarizes data on the efficacy of PM as a treatment for the prevention of breast cancer.
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Affiliation(s)
- Shaheen Zakaria
- Department of Surgery, Mayo Clinic and Mayo Foundation, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Ricci MD, Munhoz AM, Pinotti M, Geribela AH, Teixeira LC, Aldrighi C, Ferreira MC, Filassi JR, Pinotti JA. The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention. Ann Plast Surg 2007; 57:125-32; discussion 133. [PMID: 16861988 DOI: 10.1097/01.sap.0000216245.16475.b9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival METHODS Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected RESULTS Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. CONCLUSION CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.
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Affiliation(s)
- Marcos Desidério Ricci
- Department of Gynecology and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
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Graves KD, Peshkin BN, Halbert CH, DeMarco TA, Isaacs C, Schwartz MD. Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors. Breast Cancer Res Treat 2006; 104:321-9. [PMID: 17066320 PMCID: PMC3060055 DOI: 10.1007/s10549-006-9423-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 09/30/2006] [Indexed: 01/08/2023]
Abstract
BACKGROUND Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1/2) mutation are at risk of developing contralateral breast cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast (contralateral prophylactic mastectomy, CPM) in addition to mastectomy of the affected breast. METHODS We conducted the present study to determine the predictors and outcomes of CPM in the year following BRCA1/2 genetic counseling and testing. Four hundred and thirty-five women affected with unilateral breast cancer who received positive or uninformative BRCA1/2 genetic test results completed assessments prior to genetic counseling and testing and 1, 6, and 12 months after receipt of results. RESULTS Prior to testing, 16% had undergone CPM (in conjunction with mastectomy of the affected breast). In the year following testing, 18% with positive test results and 3% with uninformative test results opted for CPM. CPM following testing was associated with a positive genetic test result, younger age at cancer diagnosis [odds ratio (OR) = 0.94], and higher cancer-specific distress at baseline (OR = 3.28). CPM was not associated with distress outcomes at 12 months. CONCLUSIONS Following a positive test result, 18% of women previously affected with unilateral breast cancer had a CPM. Women affected with breast cancer at a younger age, particularly those with positive genetic test results and higher cancer-specific distress, are more likely to choose CPM than women who receive uninformative test results and who are less distressed and older at diagnosis. CPM does not appear to impact distress outcomes.
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Affiliation(s)
- Kristi D Graves
- Cancer Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA.
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Shahedi K, Emanuelsson M, Wiklund F, Gronberg H. High risk of contralateral breast carcinoma in women with hereditary/familial non-BRCA1/BRCA2 breast carcinoma. Cancer 2006; 106:1237-42. [PMID: 16475207 DOI: 10.1002/cncr.21753] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The objectives of the current study were to estimate the risk of developing contralateral breast carcinoma (CBC) among women with hereditary/familial non-BRCA1/BRCA2 breast carcinoma and to determine the factors that may predict their risk of CBC. METHODS The study sample consisted of all families (n = 217 families) that were referred between 1994-2001 to the Clinic of Cancer Genetics at the University Hospital of Umeå for suspected hereditary breast carcinoma. The study included all women in the 217 families who had carcinoma of the breast as their first primary invasive malignancy diagnosed between 1970-2001 in northern Sweden. Exclusion criteria were an estimated lifetime risk < 20%, BRCA1/BRCA2 mutation, noninvasive carcinoma (ductal or lobular carcinoma in situ), and bilateral breast carcinoma. In the final analysis, 204 women were included from 120 families. RESULTS The cumulative probability of developing CBC among women who had hereditary/familial non-BRCA1/BRCA2 breast carcinoma after 20 years was 27.3% (95% confidence interval, 15.0-37.8) compared with the expected risk (4.9%) among women in northern Sweden who had primary breast carcinoma. A significantly increased risk of CBC was associated with age younger than 50 years at the time of diagnosis of the first primary breast carcinoma (P = 0.006). Adjuvant hormone therapy reduced the risk of CBC (P = 0.036). CONCLUSIONS Women with hereditary/familial non-BRCA1/BRCA2 breast carcinoma had a high risk of developing CBC. This risk was attenuated further among women who were younger at the time of onset, who had a cumulative probability of developing CBC of nearly 40% after 15 years, which is similar to the estimated risk among BRCA1/BRCA2 mutation carriers. The results of this study emphasized the importance of genetic counseling for these women.
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Affiliation(s)
- Katarina Shahedi
- Department of Radiation Sciences/Oncology, University of Umeå, Umeå, Sweden
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Affiliation(s)
- Gary J Whitman
- Breast Imaging Section, Division of Diagnostic Imaging, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas 77230-1439, USA
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Kuo WH, Yen AMF, Lee PH, Hou MF, Chen SC, Chen KM, Chen THH, Chang KJ. Incidence and risk factors associated with bilateral breast cancer in area with early age diagnosis but low incidence of primary breast cancer: analysis of 10-year longitudinal cohort in Taiwan. Breast Cancer Res Treat 2006; 99:221-8. [PMID: 16544057 DOI: 10.1007/s10549-006-9194-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 02/07/2006] [Indexed: 11/27/2022]
Abstract
This study aims to examine the incidence and risk factors of bilateral breast cancer in area with low incidence rate. A total of 120 and 1902 women with bilateral and unilateral breast cancers were enrolled; various factors, including those concerning their medical history and life style, were extracted. Using Kaplan-Meier method, we calculate the cumulative incidence of contralateral breast cancer. The results show as follows. The cumulative incidences of contralateral breast cancer at 1, 3, 5 years after diagnosis of first breast cancer were 1.15, 1.94, and 2.97%, respectively. The statistically significant risk factors included menopause (Hazard Ratio (HR) =1.56, (1.00-2.42)), invasive lobular carcinoma (HR=2.98, (1.35-6.56)), receiving chemotherapy (HR=2.21, (1.43-3.42)) and/or radiotherapy (HR=3.32, (2.19-5.05) and a protective factor was tamoxifen therapy (HR=0.5 (0.34-0.74). Size of the second occurred tumour (2.97 cm) tended to be smaller than the first one (3.58 cm) with borderline statistical significance (p=0.0731). Comparing to the existing data on Western countries, we find a higher risk for developing contralateral breast cancer in Taiwan where a low incidence of first breast cancer rate with early age diagnosis is noted. It suggests that first primary breast tumour with early age of onset and lobular carcinoma are found more likely to develop bilateral breast cancers.
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MESH Headings
- Adult
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/therapy
- Cohort Studies
- Female
- Humans
- Incidence
- Longitudinal Studies
- Lymphatic Metastasis/pathology
- Menopause
- Middle Aged
- Risk Factors
- Taiwan/epidemiology
- Time Factors
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Affiliation(s)
- Wen-Hung Kuo
- Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Umetani N, Mori T, Koyanagi K, Shinozaki M, Kim J, Giuliano AE, Hoon DSB. Aberrant hypermethylation of ID4 gene promoter region increases risk of lymph node metastasis in T1 breast cancer. Oncogene 2005; 24:4721-7. [PMID: 15897910 DOI: 10.1038/sj.onc.1208538] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ID4 gene is a member of the inhibitor of DNA-binding (ID) family, which inhibits DNA binding of basic helix-loop-helix transcription factors. Certain human primary breast cancers reportedly have low or no expression of ID4 protein, but its role in carcinogenesis and cancer progression is unknown. To determine its possible role, we examined epigenetic inactivation of ID4 gene by promoter hypermethylation in human breast cell lines and T1 breast cancer tissues. Methylation status of ID4 promoter CpG island was assessed by methylation-specific PCR (MSP); ID4 mRNA level was assessed by quantitative real-time RT-PCR. Of eight cell lines, two were fully methylated, four were partially methylated, and two were not methylated. ID4 mRNA level was suppressed in fully methylated cell lines. ID4 hypermethylation was observed in 16 of 24 (67%) node-positive and seven of 36 (19%) node-negative T1 primary breast cancers matched by patient age and tumor diameter. It was a significant risk factor for nodal metastasis (OR 13.1, P=0.0004). ID4 mRNA level was suppressed in hypermethylated cancer specimens (P=0.014). ID4 may play an important suppressive role in tumor progression, and its silencing by hypermethylation may increase the risk of regional lymph node metastasis.
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Affiliation(s)
- Naoyuki Umetani
- Department of Molecular Oncology, John Wayne Cancer Institute, Santa Monica, CA 90404, USA
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Takahashi H, Watanabe K, Takahashi M, Taguchi K, Sasaki F, Todo S. The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer. Breast Cancer 2005; 12:196-202. [PMID: 16110289 DOI: 10.2325/jbcs.12.196] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.
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Affiliation(s)
- Hiromasa Takahashi
- Department of Pediatric Surgery, Hokkaido University Postgraduate School of Medicine, Kita-15 Nishi-7 Kita-ku 060-8638 Sapporo, Japan.
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Hartman M, Czene K, Reilly M, Bergh J, Lagiou P, Trichopoulos D, Adami HO, Hall P. Genetic implications of bilateral breast cancer: a population based cohort study. Lancet Oncol 2005; 6:377-82. [PMID: 15925815 DOI: 10.1016/s1470-2045(05)70174-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women with breast cancer are at high risk of bilateral breast cancer. We aimed to assess the incidence of bilateral breast cancer in relation to age and time since diagnosis of first cancer. METHODS We analysed a population-based cohort of 123757 women with a first primary breast cancer diagnosed in Sweden from 1970 to 2000 for frequency of bilateral breast cancers and deaths by means of record linkage. Second primary breast cancers were categorised as synchronous bilateral breast cancers if diagnosed within 3 months of the first primary cancer or as metachronous if diagnosed more than 3 months after diagnosis of first primary cancer. FINDINGS We identified 6550 women who had developed bilateral breast cancer. Age-incidence patterns of synchronous and unilateral breast cancer were similar, although the absolute rates of synchronous bilateral cancer were 50-100 times lower than those of unilateral cancer. A woman aged 80 years or older is at least twice as likely to be diagnosed with synchronous bilateral breast cancer than is a woman younger than 40 years. In the first 20 years after diagnosis of primary breast cancer, incidence of metachronous bilateral cancer decreased from about 800 per 10(5) person-years to 400 per 10(5) person-years in patients diagnosed with primary breast cancer before the age of 45 years, whereas incidence remained at 500-600 per 10(5) person-years in those age 45 years or older at diagnosis. After 30 years' follow-up, cumulative risk of metachronous bilateral breast cancer was about 15% irrespective of age at first primary breast cancer. INTERPRETATION The higher than expected risk of synchronous bilateral breast cancer could be explained by non-genetic factors. By contrast, incidence of metachronous bilateral cancer fits neither a model of highly penetrant genes nor aggregation of environmental risk factors.
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Affiliation(s)
- Mikael Hartman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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Gilroy JS, Morris CG, Mendenhall NP. Breast-conserving therapy in patients with bilateral breast cancer: do today's treatment choices burn bridges for tomorrow? Int J Radiat Oncol Biol Phys 2005; 62:379-85. [PMID: 15890578 DOI: 10.1016/j.ijrobp.2004.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 09/23/2004] [Accepted: 09/24/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine how often initial treatment choices limit treatment options for subsequent breast cancer management in patients undergoing breast-conserving therapy (BCT), in particular with treatment of internal mammary nodes. METHODS AND MATERIALS Between January 1985 and June 2001, 464 women with pathologic Stage 0, I, and II (T0-2, N0-1) breast cancer underwent BCT at our institution. All 464 patients had computed tomography-based treatment planning. In patients with bilateral breast cancer, the planning computed tomography scans were used to determine the impact initial radiation therapy fields had on treatment options for subsequent contralateral breast cancer. RESULTS There were 500 breast cancers diagnosed in 464 patients. Thirty-six patients (8%) had bilateral breast cancer with 9 (2%) synchronous and 27 (6%) metachronous primaries. In 80 patients, the ipsilateral internal mammary nodes were explicitly treated. Initial breast cancer treatment choices impacted subsequent treatment decisions for the contralateral breast in only 2 of 464 patients (0.4%) in the study: 2 of 80 patients (2.5%) whose internal mammary nodes were treated, and 2 of 27 patients (7.4%) who developed metachronous bilateral breast cancer. CONCLUSIONS Initial BCT, including internal mammary node irradiation, rarely compromised future contralateral breast-conserving therapy.
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Affiliation(s)
- Jeffrey S Gilroy
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Man YG, Magrane GG, Lininger RA, Shen T, Kuhls E, Bratthauer GL. Morphologically similar epithelial and stromal cells in primary bilateral breast tumors display different genetic profiles: implications for treatment. Appl Immunohistochem Mol Morphol 2005; 12:305-14. [PMID: 15536329 DOI: 10.1097/00129039-200412000-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The morphologic features of primary bilateral breast carcinoma have been well elucidated, but it is not known whether tumors at two sides share a common genetic profile and undergo the same clinical course. To address this issue, morphologically comparable epithelial and stromal cells in 18 paired primary bilateral breast tumors were microdissected and subjected to comparisons for the frequency and pattern of loss of heterozygosity (LOH) and microsatellite instability (MI), as well as the profiles of comparative genomic hybridization. Of 18 paired bilateral epithelial samples assessed with 10 DNA markers at five chromosomes, 78 altered loci were found; of these, 23 (29.5%) displayed concurrent and 55 (70.5%) showed independent LOH, MI, or both. Of 18 paired bilateral stromal samples assessed with the same markers, 70 altered loci were seen; of these, 9 (12.9%) displayed concurrent and 61 (87.1%) showed independent LOH, MI, or both. Collectively, all the markers and 30 (83.3%) of 36 paired bilateral epithelial and stromal cells displayed significantly more (P < 0.01) independent than concurrent LOH, MI, or both. In contrast, the epithelial cells of a pulmonary small cell carcinoma metastasized to both breasts displayed concurrent LOH at each of the four altered loci. Of seven selected cases for comparative genomic hybridization, six (86%) displayed chromosomal changes, but none showed an identical pattern and frequency of changes in both breasts. The significantly higher rate of independent genetic alterations in morphologically comparable cells of paired bilateral primary breast tumors supports the notion that the development and clinical course of tumors in two sides differ substantially; consequently, different interventions might be needed for the optimal management of bilateral breast tumors.
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Affiliation(s)
- Yan-Gao Man
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology and American Registry of Pathology, Washington, DC 20306-6000, USA.
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Standards, Options et Recommandations 2004 pour une bonne pratique de la consultation personnelle et de la relecture en anatomie et cytologie pathologiques en cancérologie (rapport intégral). Ann Pathol 2005; 25:149-71. [PMID: 16142171 DOI: 10.1016/s0242-6498(05)86183-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE To develop good practice guidelines for second opinion in anatomic and surgical pathology in oncology, in collaboration with the French Society for Anatomic and Surgical Pathology. METHOD The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs using the definitions of the Standards, Options and Recommendations project. Once the guideline has been defined, the document is submitted to independent reviewers for review. RESULTS The working group defined four types of second opinions in anatomic and surgical pathology: personal consultation, inter-institutional consultation, peer review consultation for a scientific survey, intra-departmental consultation in the context of quality control. The main recommendation is that second opinion should respect the patients' rights and the medical ethics code. For each of the four situations defined recommendations have been developed, taking this principle into consideration.
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Retsky M, Demicheli R, Hrushesky W, Speer J, Swartzendruber D, Wardwell R. Recent translational research: computational studies of breast cancer. Breast Cancer Res 2004; 7:37-40. [PMID: 15642181 PMCID: PMC1064118 DOI: 10.1186/bcr981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The combination of mathematics – queen of sciences – and the general utility of computers has been used to make important inroads into insight-providing breast cancer research and clinical aids. These developments are in two broad areas. First, they provide useful prognostic guidelines for individual patients based on historic evidence. Second, by suggesting numeric tumor growth laws that are correlated to clinical parameters, they permit development of biologically relevant theories and comparison with patient data to help us understand complex biologic processes. These latter studies have produced many new ideas that are testable in clinical trials. In this review we discuss these developments from a clinical perspective, and ask whether and how they translate into useful tools for patient treatment.
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Affiliation(s)
- Michael Retsky
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
| | - Romano Demicheli
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
| | - William Hrushesky
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
| | - John Speer
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
| | - Douglas Swartzendruber
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
| | - Robert Wardwell
- Children's Hospital and Harvard Medical School, Milan National Cancer Institute, Dorn VA Medical Center, Pepperdine University, Boston, Massachusetts, USA
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Krauss DJ, Kestin LL, Mitchell C, Martinez AA, Vicini FA. Changes in temporal patterns of local failure after breast-conserving therapy and their prognostic implications. Int J Radiat Oncol Biol Phys 2004; 60:731-40. [PMID: 15465189 DOI: 10.1016/j.ijrobp.2004.04.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 03/30/2004] [Accepted: 04/02/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this analysis was to evaluate patterns and rates of ipsilateral breast tumor recurrence (IBTR) over time based on the type of failure (true recurrence/marginal miss [TR/MM] vs. elsewhere [E]) and to compare these to rates of contralateral failure in women with Stages I/II breast cancer treated with conservative surgery (CS) and radiation therapy (RT). METHODS AND MATERIALS Between 1980 and 1997, 1448 patients with Stages I/II invasive breast carcinoma were treated with CS and RT to a median total dose of >60 Gy. IBTRs were analyzed in terms of their location as follows: TR/MM, referring to those occurring in the same quadrant, and E, referring to the development of a malignancy remote from the index lesion. Outcomes were characterized in terms of their temporal recurrence patterns and correlated with rates of contralateral breast failure (CL). The median follow-up was 8.5 years. RESULTS A total of 79 ipsilateral and 98 contralateral failures were observed during the follow-up period corresponding to 5-, 10-, and 15-year actuarial rates of 2%, 7%, and 10% and 4%, 9%, and 12% respectively. Fifty-nine ipsilateral failures (74.7%) were designated as TR/MM and 20 (25.3%) as E. The corresponding 5-, 10-, and 15-year actuarial rates of TR/MM and E failures were 2%, 5%, and 8% and 0.1%, 2%, and 3%, respectively. The median times to total ipsilateral, TR/MM, E, and contralateral failure were 6.5, 5.7, 7.4, and 5.2 years, respectively. Between 0 and 5 years of follow-up, E failures represented 7% of the total ipsilateral failures observed. From 5-10 and 10-15 years, E failures represented 39% and 27% of the total, respectively (p = 0.01). Contralateral failure was significantly more likely to occur in the first 5 years of follow-up than IBTR, accounting for 50 (63.3%) of the 79 failures in that interval (p = 0.02). No significant differences in survival rates were detected between any of the various failure types. On multivariate analysis, only reduced time to tumor recurrence was found to be adversely associated with overall survival. CONCLUSIONS The rates and patterns of IBTR vary with time and, after 5 years, approach the rates of development of a contralateral breast cancer. E failures are, overall, less frequent than TR/MM but contribute increasingly to the IBTR rate after 5 years. Time to tumor recurrence is the most reliable predictor of prognosis after IBTR.
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Affiliation(s)
- Daniel J Krauss
- Department of Radiation Oncology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48072, USA
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Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004; 233:830-49. [PMID: 15486214 DOI: 10.1148/radiol.2333031484] [Citation(s) in RCA: 950] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer. Results were correlated with histopathologic findings. RESULTS Analysis included 177 malignant foci in 121 cancerous breasts, of which 89 (50%) foci were palpable. Median size of 139 invasive foci was 18 mm (range, 2-107 mm). Mammographic sensitivity decreased from 100% in fatty breasts to 45% in extremely dense breasts. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of ductal carcinoma in situ (DCIS) (P < .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P < .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P < .001). MR showed higher sensitivity than did mammography for all tumor types (P < .01) and higher sensitivity than did US for DCIS (P < .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. CONCLUSION In nonfatty breasts, US and MR imaging were more sensitive than mammography for invasive cancer, but both MR imaging and US involved risk of overestimation of tumor extent. Combined mammography, clinical examination, and MR imaging were more sensitive than any other individual test or combination of tests.
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Affiliation(s)
- Wendie A Berg
- American College of Radiology Imaging Network, 301 Merrie Hunt Drive, Lutherville, MD 21093, USA.
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Molland JG, Donnellan M, Janu NC, Carmalt HL, Kennedy CW, Gillett DJ. Infiltrating lobular carcinoma—a comparison of diagnosis, management and outcome with infiltrating duct carcinoma. Breast 2004; 13:389-96. [PMID: 15454194 DOI: 10.1016/j.breast.2004.03.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Revised: 03/10/2004] [Accepted: 03/24/2004] [Indexed: 10/26/2022] Open
Abstract
The treatment and outcomes for 182 patients with lobular carcinoma were compared with 1612 patients with infiltrating ductal carcinoma managed concurrently at The Strathfield Breast Centre. The lobular carcinomas were larger (P < 0.0001) but of lower grade (P < 0.0001). Diagnosis with mammography and FNA was less sensitive in ILC (mammography P = 0.0002, FNA P < 0.0001). Although similar numbers of patients underwent initial attempted conservation, patients with ILC were more likely to have positive margins at attempted breast conservation surgery and the final mastectomy rate was higher (58.2% ILC versus 47% IDC, P = 0.0041). Of the patients who had successful conservation, the local recurrence rates for ILC (3.9%) were equivalent to the patients with IDC (5.3%). There was no significant difference in overall survival (90% ILC, 87% IDC, median follow-up 3.6 years ILC, 4.3 years IDC) or disease free survival (87.9% ILC, 81.6% IDC). Although mastectomy is more likely to be necessary to obtain clear margins, breast conservation therapy is reasonable in patients with infiltrating lobular carcinoma where clear margins can be obtained.
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Affiliation(s)
- J G Molland
- Breast Endocrine Unit, Department of Surgery, Ground Floor West, Repatriation General Hospital Concord, Hosipital Road, Concord NSW 2139, Australia.
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Dowdy SC, Stefanek M, Hartmann LC. Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy. Am J Obstet Gynecol 2004; 191:1113-23. [PMID: 15507929 DOI: 10.1016/j.ajog.2004.04.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Investigators have used retrospective and prospective study designs to provide much needed data on the extent of risk reduction after prophylactic oophorectomy and mastectomy in women at increased risk for breast and ovarian cancer. In this publication we identify those women who may wish to consider prophylactic surgery, review data demonstrating the efficacy of prophylactic surgery, and discuss potential surgical complications. We also present data about the frequency of use and psychosocial impact of prophylactic surgery in this typically young group of women. Finally, we provide general treatment guidelines for the practicing clinician.
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Affiliation(s)
- Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Kollias J, Pinder SE, Denley HE, Ellis IO, Wencyk P, Bell JA, Elston CW, Blamey RW. Phenotypic similarities in bilateral breast cancer. Breast Cancer Res Treat 2004; 85:255-61. [PMID: 15111764 DOI: 10.1023/b:brea.0000025421.00599.b7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bilateral breast cancers that develop at similar times in an individual are likely to have been subjected to similar hormonal, environmental and genetic influences during tumourogenesis compared with metachronous tumours. As such, it is possible that tumour phenotype in synchronous bilateral breast cancer may display similar biological characteristics. The aim of this study was to identify phenotypic similarities between synchronous and metachronous bilateral breast cancers which may suggest a common origin. Thirty-three cases of synchronous and 46 cases of metachronous bilateral breast cancer that displayed similar tumour type were analysed for concordance in relation to various histological and immunohistochemical parameters. A higher level of concordance was demonstrated for synchronous cases with the highest level seen for oestrogen receptor. It is likely that this is related to similar tumourogenic pathways occurring at equivalent exposure times to various environmental and hormonal influences, although, in a proportion of cases, inherited genetic factors may play a role.
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Affiliation(s)
- J Kollias
- Nottingham City Hospital, Nottingham, UK.
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Mertens WC, Hilbert V, Makari-Judson G. Contralateral Breast Cancer: Factors Associated with Stage and Size at Presentation. Breast J 2004; 10:304-12. [PMID: 15239788 DOI: 10.1111/j.1075-122x.2004.21333.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Few reports have evaluated factors associated with the stage at presentation of contralateral breast cancer and whether contralateral cancer presentation has changed in recent years, during which increased screening and enhanced adjuvant therapy of the initial tumor has been introduced. Patients with initial cancers staged 0-IIIB diagnosed between 1980 and 1999 who subsequently developed contralateral breast cancer were evaluated for stage, primary tumor size and histologic features, patient age and year of diagnosis, synchronous or metachronous presentation, and time from initial tumor to diagnosis of contralateral breast cancer. Tumor presentation was compared with contemporaneously diagnosed unilateral breast cancer patients. A total of 171 patients were diagnosed with contralateral breast cancer; 161 cases if lobular carcinoma in situ for either the initial or the contralateral tumor were excluded. Contralateral tumors were of significantly smaller size and of earlier stage than initial tumors. Contralateral cancers demonstrated earlier stage distributions with more recent year of diagnosis; initial tumors in contralateral patients did not. Earlier stage at presentation of contralateral tumors was associated in a multivariate model with more recent year of contralateral tumor diagnosis and earlier stage at presentation of the initial tumor; contralateral tumor size was associated with the size of the initial tumor. More recently diagnosed contralateral breast cancers are presenting with earlier stages of disease. The stages of initial tumors in these patients have not undergone such an improvement. Initial tumor size and stage is strongly associated with contralateral breast cancer size and stage; this association is independent of the year of diagnosis. Increased compliance with screening might be expected to improve both initial tumor stage and tumor size presentations in contralateral tumor patients, as well as the presentation of contralateral cancers.
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Affiliation(s)
- Wilson C Mertens
- Baystate Regional Cancer Program, Springfield, Massachusetts 01107, USA.
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Swain SM, Wilson JW, Mamounas EP, Bryant J, Wickerham DL, Fisher B, Paik S, Wolmark N. Estrogen receptor status of primary breast cancer is predictive of estrogen receptor status of contralateral breast cancer. J Natl Cancer Inst 2004; 96:516-23. [PMID: 15069113 DOI: 10.1093/jnci/djh097] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tamoxifen reduces the risk for contralateral breast cancer by approximately 30%-50%, with benefits probably limited to women with estrogen receptor (ER)-positive primary disease. In a retrospective analysis of data from National Surgical and Adjuvant Breast and Bowel Project trials B-18, B-22, and B-25, we determined whether the ER status of primary breast cancer predicts the ER status of a subsequent contralateral breast cancer and whether tamoxifen treatment affects this relationship. In these trials, tamoxifen at 20 mg/day had been administered only to women aged 50 years or older, rather than to those determined by the ER status of their primary tumor, allowing an assessment of the treatment's effects in ER-negative disease. METHODS Among the 5513 eligible patients, 176 patients developed a contralateral breast cancer. The ER status of the primary and contralateral tumor was determined and cross-classified for women who did not receive tamoxifen (i.e., those aged 49 years or younger) and for women who did (i.e., those aged 50 years or older). ER data were available for 110 evaluable invasive contralateral breast cancers. RESULTS Among patients who did not receive tamoxifen (n = 62), 89% with an ER-positive primary cancer had an ER-positive contralateral breast cancer and 70% with an ER-negative primary breast cancer had an ER-negative contralateral breast cancer (odds ratio for the association between primary and contralateral ER status = 14.8, 95% confidence interval = 3.8 to 74.3; P<.001). Among patients who received tamoxifen (n = 48), 56% with an ER-positive primary cancer had an ER-positive contralateral breast cancer and 78% with an ER-negative primary cancer had an ER-negative contralateral breast cancer (odds ratio = 3.4, 95% confidence interval = 0.53 to 39.2; P =.25). CONCLUSION The ER status of the primary breast cancer was associated with that of the contralateral breast for patients not receiving tamoxifen. Patients with an ER-positive primary cancer who received tamoxifen had a lower concordance rate with fewer ER-positive contralateral breast cancers, which may be a result of tamoxifen treatment.
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MESH Headings
- Age Factors
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor/analysis
- Breast Neoplasms/chemistry
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Estrogen Receptor Modulators/therapeutic use
- Female
- Humans
- Incidence
- Medical Records
- Middle Aged
- Neoplasms, Hormone-Dependent/chemistry
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/pathology
- Neoplasms, Hormone-Dependent/surgery
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/prevention & control
- Neoplasms, Second Primary/chemistry
- Neoplasms, Second Primary/prevention & control
- Odds Ratio
- Predictive Value of Tests
- Randomized Controlled Trials as Topic
- Receptors, Estrogen/analysis
- Retrospective Studies
- Risk Assessment
- Survival Analysis
- Tamoxifen/therapeutic use
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El Hanchi Z, Berrada R, Fadli A, Ferhati D, Brahmi R, Baydada A, Kharbach A, Chaoui A. Cancer du sein bilatéral. Incidence et facteurs de risque. ACTA ACUST UNITED AC 2004; 32:128-34. [PMID: 15123135 DOI: 10.1016/j.gyobfe.2003.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2001] [Accepted: 01/30/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To clarify, thanks to a retrospective study of 24 bilateral breast cancer cases, the frequency, the risk factors and the prognosis of bilateral breast cancers. PATIENTS AND METHOD Between 1984 and 1999, out of 506 patients treated for unilateral non-metastatic breast cancer at Gynecologic and Obstetric ward, at Maternity Souissi of Rabat, 24 cases of bilateral breast cancers were diagnosed. Our results were compared to those of the literature. RESULTS The frequency of bilateral breast cancers was 4.7% (24/506). In 87.5% of cases, these were metachronous cancers with a mean interval of 45 months (12-144 months). Patients under 40 at first cancer ran a fivefold superior risk than women more than 40 (P < 0.05). In cases of T3 or T4 tumors, the risk was 10-fold superior to that in smaller ones (P < 0.05). DISCUSSION AND CONCLUSION Significantly more first metachronous tumors were invasive adenocarcinoma cancers. Histologic type of first and second tumor was the same in all cases. The prognosis depends at once on the first and second cancer staging and the treatment must be done according to the same rules as in the first cancer.
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Affiliation(s)
- Z El Hanchi
- Service de gynécologie-obstétrique, maternité universitaire Souissi M 1, CHU Ibn-Sina de Rabat, Tunisia.
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[Sentinel lymph node biopsy in breast cancer: technical aspects and results]. ANNALES DE CHIRURGIE 2003; 128:144-9. [PMID: 12821079 DOI: 10.1016/s0003-3944(03)00039-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy for breast cancer has been introduced in the mid-1990s and it has now been performed on thousands of patients. Although this procedure has not been validated by randomised clinical trials, it has been rapidly adopted around the world by surgical specialists in clinical practice as a diagnostic procedure instead of the axillary lymph node dissection. The critical issue in sentinel lymph node biopsy is the false negative results which could expose the patients to axillary recurrence and lead to understaging and incorrect adjuvant therapy decisions. The current problem is to perfect the procedure for an optimal use in routine reducing this risk of false negative results. This false negative rate declines sharply when the technique is performed in selected patients by experienced surgeons using a combined detection. In this article, we review the technical aspects and results of the sentinel lymph node biopsy in breast cancer and discuss the recommendations for the optimal clinical practice.
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Lee SG, Orel SG, Woo IJ, Cruz-Jove E, Putt ME, Solin LJ, Czerniecki BJ, Schnall MD. MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology 2003; 226:773-8. [PMID: 12601182 DOI: 10.1148/radiol.2263020041] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the role of screening magnetic resonance (MR) imaging in the detection of synchronous contralateral breast cancer in patients with newly diagnosed breast cancer. MATERIALS AND METHODS Between January 1999 and July 2001, 182 patients with newly diagnosed breast cancer (after either core or excisional biopsy with positive or close margins of resection) underwent bilateral contrast material-enhanced MR imaging at 1.5 T with a dedicated bilateral breast multicoil array. The contralateral breast was imaged for cancer screening. Family history of breast cancer, index cancer histology, breast density, and age at diagnosis of first breast cancer were assessed as potential risk factors for synchronous contralateral breast cancer. RESULTS Fifteen patients (8.2%) had a suspicious enhancing lesion depicted in the contralateral breast. Seven patients (3.8%) had malignant results: ductal carcinoma in situ (DCIS) in four, invasive ductal carcinoma with DCIS in two, and invasive ductal carcinoma in one. Eight patients (4.4%) had benign results: fibrocystic changes in four, atypical ductal hyperplasia in two, atypical lobular hyperplasia and focal lobular carcinoma in situ in one, and ductal hyperplasia in one. Six patients with negative MR findings underwent prophylactic mastectomy; no malignancy was found. No significant differences were noted among patients with true-positive (n = 7), false-positive (n = 8), or negative (n = 167) MR findings with regard to family history of breast cancer (P <.27), index cancer histology (P <.19), breast density (P <.34), or age at diagnosis of first breast cancer (P <.10). CONCLUSION The preliminary results demonstrate the feasibility of using MR imaging of the breast in a screening role, specifically to evaluate the contralateral breast in patients with newly diagnosed breast cancer to detect mammographically and clinically occult synchronous breast cancer.
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Affiliation(s)
- Steven G Lee
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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Vlastos G, Mirza NQ, Meric F, Hunt KK, Mirza AN, Newman LA, Ames FC, Kuerer HM, Ross MI, Feig B, Babiera G, Buchholz TA, Hortobagyi GN, Singletary SE. Breast-conservation therapy in early-stage breast cancer patients with a positive family history. Ann Surg Oncol 2002; 9:912-9. [PMID: 12417515 DOI: 10.1007/bf02557530] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Our goal was to evaluate the role of breast-conservation therapy in early-stage breast cancer patients with a family history (FH) of breast cancer. METHODS Between 1970 and 1994, 1324 female patients with breast cancer were treated with breast-conservation therapy at our institution. From these, we identified 985 patients with stage 0-II breast cancer and who had available information on FH status. FH was considered positive in any patient who had a relative who had been previously diagnosed with breast cancer. Disease-specific survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. RESULTS The stage distribution for the 985 patients was as follows: 0 in 65 (7%), I in 500 (51%), and II in 420 (43%). The median age was 50 years (range, 21-88), with a median follow-up time of 8.8 years (range,.25-29). The median tumor size was 1.5 cm. FH was positive in 31%. There were no significant differences in locoregional recurrence, distant recurrence, disease-specific survival, or incidence of contralateral breast cancer in patients with a positive FH versus patients with a negative FH. CONCLUSIONS Breast-conservation therapy is not contraindicated in early-stage breast cancer patients with a positive FH.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Contraindications
- Female
- Germ-Line Mutation
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local
- Radiotherapy, Adjuvant
- Treatment Outcome
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Affiliation(s)
- Georges Vlastos
- Department of Obstetrics and Gynecology, Senology Geneva University, Geneva, Switzerland
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Carmichael AR, Bendall S, Lockerbie L, Prescott R, Bates T. The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:388-91. [PMID: 12099647 DOI: 10.1053/ejso.2002.1266] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM There is uncertainty in the literature as to whether bilateral breast cancer carries a worse prognosis than unilateral disease because some studies suggest that the development of a second primary does not influence survival, while others report a decreased survival in patients suffering from bilateral disease. METHODS A prospectively accrued and regularly validated database of 1945 patients with breast cancer treated in a district general hospital between 1963 and 1999 was analysed for clinical and pathological tumour characteristics including family history, grade, type of tumour, treatment and outcome. RESULTS Five per cent of patients (92) suffered from metachronous and 43 (2%) from synchronous bilateral breast cancer. A family history of breast cancer was more common in patients with metachronous bilateral breast cancer (38%), compared with the unilateral group (15%) and the synchronous bilateral breast cancer group (17%) (chi(2)=22.9, P<0.001). Patients with synchronous bilateral breast cancer had a significantly worse overall survival when compared with those with metachronous bilateral or unilateral breast cancer (log-rank test chi(2)=6.1, P=0.047). CONCLUSION Women with metachronous breast cancer were more likely to have positive family history, while those with synchronous bilateral breast cancer tend to have shorter survival when compared with those with unilateral breast cancer. Synchronous bilaterality is not, however, an independent risk factor on multivariate analysis.
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Affiliation(s)
- A R Carmichael
- The Breast Unit, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK.
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Safal M, Lower EE, Hasselgren PO, Hungness ES, Gazder P, Aron B, Shaughnessy EA, Yassin R. Bilateral synchronous breast cancer and HER-2/neu overexpression. Breast Cancer Res Treat 2002; 72:195-201. [PMID: 12058961 DOI: 10.1023/a:1014958514851] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bilateral synchronous breast cancer appears to have a worse prognosis than comparable unilateral breast cancer. HER-2/neu expression in bilateral breast cancer has not been reported. The purpose of this study was to review the characteristics of patients with bilateral synchronous breast cancer and to report the incidence of HER-2/neu overexpression. Between 1984 and 1998, 58 patients were diagnosed with bilateral synchronous breast cancer (defined as both cancers diagnosed within 3 months). The paraffin blocks from both breast specimens were available and immunostained in 21 patients. Of 42 breast specimens, there were 31 invasive carcinomas and 11 noninvasive carcinomas. Of the 21 paired specimens immunostained for HER-2/neu, 11 were invasive cancers in both breasts, nine were invasive cancers in one breast and noninvasive cancers in the other breast, and one was noninvasive cancers in both breasts. Of the 31 invasive carcinomas, HER-2/neu was overexpressed (2-3+) in 22 (71%) and negative (0-1+) in nine (29%). In contrast, 35 of 101 (34.7%) consecutive unilateral invasive breast cancer specimens from our institution overexpressed HER-2/neu. The difference in HER-2/neu overexpression between patients with bilateral synchronous breast cancer and unilateral breast cancer (22/31 v.s. 35/101) was statistically significant (chi square = 11.3, p < 0.001). In cases where both breasts had invasive carcinoma, HER-2/neu overexpression could be either in one (six patients) or both breasts (four patients). The increased mortality of patients with bilateral synchronous breast cancer may be due to the higher incidence of HER-21neu overexpression.
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Affiliation(s)
- Malek Safal
- Department of Internal Medicine/Hematology-Oncology, The Barrett Cancer Center, University of Cincinnati, OH, USA
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Lee MM, Heimann R, Powers C, Weichselbaum RR, Chen LM. Efficacy of Breast Conservation Therapy in Early Stage Bilateral Breast Cancer. Breast J 2002; 5:36-41. [PMID: 11348254 DOI: 10.1046/j.1524-4741.1999.005001036.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the outcome of patients with bilateral breast cancer as compared to unilateral breast cancer treated with breast conservation therapy. Sixty patients with bilateral breast cancer (BBC) and 1,080 unilateral breast cancer (UBC) patients treated with breast conservation therapy from 1977 to 1994 were analyzed for outcome. Of the 60 bilateral patients, 44 were metachronous bilateral breast cancer patients (MBBC) and 16 were synchronous bilateral breast cancer patients (SBBC). The majority of patients received lumpectomy, axillary node dissection, and localized radiation therapy. Median tumor size was 1.4 cm for BBC and 1.5 cm for UBC patients. Median total dose to the tumor bed was 60 Gy for both unilateral and bilateral patients. Of the 44 MBBC patients, 14 received breast conservation for both the first and second lesions, while 30 received breast conservation for only the second metachronous lesion. Thus 58 lesions in 44 patients were treated with breast conservation therapy. Of the SBBC patients, 13 of 16 patients received breast-conserving therapy for both breasts, while 3 received a mastectomy for the second synchronous primary. Median follow-up was 50 months for SBBC patients, 45 months for MBBC patients, and 52 months for UBC patients. Local control and survival were analyzed in patients with SBBC, MBBC, and UBC. The interval to development of local recurrence and survival were calculated from the time of development of the second breast lesion in patients with MBBC. No differences were found for survival and failure-free survival in patients with SBBC, MBBC, or UBC. Five-year overall survival by lifetable analysis was 76% for SBBC, 78% for MBBC, and 87% for UBC patients (p = 0.32 by log-rank analysis). The 5-year failure-free survival was 79% for SBBC, 73% for MBBC, and 85% for UBC patients (p = 0.28 by log-rank analysis). No significant differences were seen for median age, tumor size, pathologic node status, tamoxifen use, chemotherapy use, or median total radiation dose for SBBC, MBBC, or UBC patients. A significant difference was found in the incidence of family history of breast cancer in patients with unilateral versus bilateral breast cancer (p = 0.028 by chi-square analysis). However, there was no difference in outcome of patients by family history of breast cancer. The local control was identical in both BBC and UBC patients, with a local failure rate of 3%. Therefore, breast conservation therapy in local-regional, early stage breast cancer is a rational and efficacious treatment modality for patients with SBBC, MBBC, and UBC.
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Affiliation(s)
- Misa M. Lee
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
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Fowble B, Hanlon A, Freedman G, Nicolaou N, Anderson P. Second cancers after conservative surgery and radiation for stages I-II breast cancer: identifying a subset of women at increased risk. Int J Radiat Oncol Biol Phys 2001; 51:679-90. [PMID: 11597809 DOI: 10.1016/s0360-3016(01)01665-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess the risk and patterns of second malignancy in a group of women treated with conservative surgery and radiation in a relatively contemporary manner for early-stage invasive breast cancer, and to identify a subgroup of these women at increased risk for a second cancer. METHODS AND MATERIALS From 1978 to 1994, 1,253 women with unilateral Stage I-II breast cancer underwent wide excision, axillary dissection, and radiation. The median follow-up was 8.9 years, with 446 patients followed for >or= 10 years. The median age was 55 years. Sixty-eight percent had T1 tumors and 74% were axillary-node negative. Radiation was directed to the breast only in 78%. Adjuvant therapy consisted of chemotherapy in 19%, tamoxifen in 19%, and both in 8%. Factors analyzed for their association with the cumulative incidence of all second malignancies, contralateral breast cancer, and non-breast cancer malignancy were: age, menopausal status, race, family history, obesity, smoking, tumor size, location, histology, pathologic nodal status, region(s) treated with radiation, and the use and type of adjuvant therapy. RESULTS One hundred seventy-six women developed a second malignancy (87 contralateral breast cancers at a median interval of 5.8 years, and 98 non-breast cancer malignancies at a median interval of 7.2 years). Nine women had both a contralateral breast cancer and non-breast cancer second malignancy. The 5- and 10-year cumulative incidences of a second malignancy were 5% and 16% for all cancers, 3% and 7% for contralateral breast cancer, 3% and 8%, for all second non-breast cancer malignancies, and 1% and 5%, respectively, for second non-breast cancer malignancies, excluding skin cancers. Patient age was a significant factor for contralateral breast cancer and non-breast cancer second malignancy. Young age was associated with an increased risk of contralateral breast cancer, while older age was associated with an increased the risk of a second non-breast cancer second malignancy. A positive family history increased the risk of contralateral breast cancer, but not non-breast cancer malignancies. The risk of a contralateral breast cancer increased as the number of affected relatives increased. Tamoxifen resulted in a nonsignificant decrease in contralateral breast cancer and an increase in non-breast cancer second malignancies. The 5-and 10-year cumulative incidences for leukemia and lung cancer were 0.08% and 0.2%, and 0.8% and 1%, respectively. There was no significant effect of chemotherapy or the regions treated with radiation on contralateral breast cancer or non-breast cancer second malignancy. The most common types of second non-breast cancer malignancies were skin cancers, followed by gynecologic malignancies (endometrial), and gastrointestinal malignancies (colorectal and pancreas). CONCLUSION The 10-years cumulative incidence of a second cancer in this study was 16%. Young age and family history predicted for an increased risk of contralateral breast cancer, and older age predicted for an increased risk of non-breast cancer malignancy. The majority of patients treated with conservative surgery and radiation with or without adjuvant systemic therapy will not develop a second cancer. Long-term follow-up is important to document the risk and patterns of second cancer, and knowledge of this risk and the patterns will influence surveillance and prevention strategies.
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MESH Headings
- Adult
- Age Factors
- Aged
- Axilla
- Breast Neoplasms/epidemiology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymphatic Irradiation
- Mastectomy, Segmental
- Middle Aged
- Neoplasms, Second Primary/epidemiology
- Risk
- Risk Factors
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Affiliation(s)
- B Fowble
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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McDonnell SK, Schaid DJ, Myers JL, Grant CS, Donohue JH, Woods JE, Frost MH, Johnson JL, Sitta DL, Slezak JM, Crotty TB, Jenkins RB, Sellers TA, Hartmann LC. Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol 2001; 19:3938-43. [PMID: 11579114 DOI: 10.1200/jco.2001.19.19.3938] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. RESULTS Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.
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Affiliation(s)
- S K McDonnell
- Division of Medical Oncology, Mayo Clinic Cancer Center, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Kollias J, Ellis IO, Elston CW, Blamey RW. Prognostic significance of synchronous and metachronous bilateral breast cancer. World J Surg 2001; 25:1117-24. [PMID: 11571945 DOI: 10.1007/bf03215857] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Women previously treated for primary operable breast cancer are at increased risk of developing cancer in the contralateral breast, but the clinical significance of this development is unclear. The purpose of this study was to assess the impact of synchronous bilateral breast cancer or the development of a metachronous contralateral breast primary on the prognosis. In a series of 3210 women age < or = 70 years treated between 1975 and 1995 for primary operable breast cancer, 106 were identified to have bilateral breast cancer. Of these women, 26 were noted to have synchronous bilateral breast primaries (0.8%), and 80 developed a contralateral breast cancer after treatment for an initial primary breast cancer. Using life-tables analysis, there was a significant difference in survival between women with unilateral breast cancer, those with synchronous bilateral breast cancers, and those with metachronous contralateral breast with survivals at 16 years of 53.8%, 42.4%, and 60.1%, respectively (p < 0.0001), from the date of the diagnosis of the first primary tumor. There was no difference in survival seen between the three groups when survival was calculated from the date of diagnosis of the second primary in cases of metachronous contralateral breast cancer (p = 0.31). When contralateral breast cancer was incorporated as a time-dependent covariate in a Cox multivariate model together with the three factors used to determine the Nottingham Prognostic Index (invasive tumor size, grade, and lymph node stage), contralateral breast cancer continued to be a significant prognostic determinant (p = 0.02). The survival of women with synchronous bilateral breast cancer or metachronous breast cancers diagnosed within 2 years of the original primary was worse than those with unilateral disease. However, the time duration to metachronous contralateral breast cancer did not have prognostic significance in a multivariate model compared with the prognostic features of the original primary.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Neoplasms, Multiple Primary/mortality
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Prognosis
- Risk
- Survival Analysis
- Survival Rate
- Time Factors
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Affiliation(s)
- J Kollias
- Professorial Unit of Surgery, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Chen Y, Semenciw R, Kliewer E, Shi Y, Mao Y. Incidence of second primary breast cancer among women with a first primary in Manitoba, Canada. Breast Cancer Res Treat 2001; 67:35-40. [PMID: 11518464 DOI: 10.1023/a:1010665603732] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Second primary breast cancer is of importance because of the increasing incidence of first primary breast cancer and improved survival. There is lack of information on the disease in Canada. We studied 14,220 women with a first primary breast cancer (invasive only) diagnosed during the period from 1970 to 1997, in Manitoba, Canada. A breast cancer was considered to be a second primary if it was an invasive lesion diagnosed at least six months after the diagnosis of an initial primary breast cancer. The incidence rate of second primary breast cancer was approximately six per 1,000 person-years, and the cumulative incidence during the 28-year study period was 14.3%. Average age at diagnosis of first primary breast cancer had increased significantly since 1970. The incidence was higher in 1975-1979, and there was no significant difference among other study periods after adjustment for the age at diagnosis of first primary breast cancer. Standardized incidence ratios showed no significant difference among six age groups after adjusting for calendar year. However, women with a first primary breast cancer had an increased risk of developing a second primary breast cancer compared with the risk of developing a first primary breast cancer among the general female population. The SIR was markedly greater among women who had a first primary breast cancer before the age of 40 years, and decreased significantly with increasing age at diagnosis of first primary breast cancer. The data provide epidemiological information on second primary breast cancer risk for the general female population in Manitoba, Canada.
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Affiliation(s)
- Y Chen
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.
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