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Gonçalves E, Fontes F, Rodrigues JR, Calisto R, Bento MJ, Lunet N, Morais S. The contribution of second primary cancers to the mortality of patients with a first primary breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07361-3. [PMID: 38869665 DOI: 10.1007/s10549-024-07361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Second primary cancers (SPCs) are estimated to affect nearly 5% of patients with breast cancer within 10 years of their diagnosis. This study aimed to estimate the contribution of SPCs to the mortality of patients with a breast first primary cancer (FPC). METHODS A population-based cohort of 17,210 patients with a breast FPC diagnosed between 2000 and 2010 was followed for SPCs (31/12/2015) and vital status (30/06/2021). Patients diagnosed with an SPC (265 synchronous and 897 metachronous, ≤ 1 and > 1 year after the FPC, respectively) were matched (1:3, by five-year age group and year of breast FPC diagnosis) to those without an SPC and alive when the corresponding SPC was diagnosed. RESULTS Significantly higher hazards of death were found among patients with an SPC [hazard ratio of 1.56, 95% confidence interval (CI) 1.29-1.89 for synchronous SPCs; and 2.85, 95%CI 2.56-3.17 for metachronous SPCs] compared to patients with a breast FPC only. Estimates were higher for synchronous lung, stomach, non-Hodgkin lymphoma and breast SPCs, and metachronous liver, stomach, ovary, lung, rectum, corpus uteri, colon, breast, and non-Hodgkin lymphoma SPCs. The 15-year cumulative mortality was 59.5% for synchronous SPCs and 68.7% for metachronous SPCs, which was higher than in patients with a breast FPC only (43.6% and 44.8%, respectively). CONCLUSIONS In Northern Portugal, patients with an SPC following a breast FPC have a higher mortality compared with patients with a breast FPC only.
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Affiliation(s)
- Elisabete Gonçalves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Filipa Fontes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
- Unidade de Investigação em Enfermagem Oncológica - Centro de Investigação (CI-IPOP) & Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Rede de Investigação em Saúde), Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - Jéssica Rocha Rodrigues
- Grupo de Investigação em Epidemiologia, Resultados, Economia e Gestão em Oncologia - Centro de Investigação (CI-IPOP) & Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Rede de Investigação em Saúde), Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
- Serviço de Epidemiologia, Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
| | - Rita Calisto
- Grupo de Investigação em Epidemiologia, Resultados, Economia e Gestão em Oncologia - Centro de Investigação (CI-IPOP) & Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Rede de Investigação em Saúde), Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
- Serviço de Epidemiologia, Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
| | - Maria José Bento
- Grupo de Investigação em Epidemiologia, Resultados, Economia e Gestão em Oncologia - Centro de Investigação (CI-IPOP) & Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Rede de Investigação em Saúde), Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
- Serviço de Epidemiologia, Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto), Porto, Portugal
- Departamento de Estudos de Populações, ICBAS - Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal.
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
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Kim H, Yoon TI, Kim S, Lee SB, Kim J, Chung IY, Ko BS, Lee JW, Son BH, Lee YJ, Gwark S, Kim HJ. Age-Related Incidence and Peak Occurrence of Contralateral Breast Cancer. JAMA Netw Open 2023; 6:e2347511. [PMID: 38100108 PMCID: PMC10724757 DOI: 10.1001/jamanetworkopen.2023.47511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Young patients with breast cancer have higher risk for developing contralateral breast cancer (CBC) and have epidemiologic characteristics different from those of older patients. Objective To examine the incidence and peak occurrence of CBC according to age at primary breast cancer (PBC) surgery. Design, Setting, and Participants This cohort study included patients who were diagnosed with and underwent surgery for unilateral nonmetastatic breast cancer at Asan Medical Center, Korea, between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2018. Data were analyzed from December 1, 2021, through April 30, 2023. Patients were divided into 2 groups according to their age at surgery for PBC: younger (≤35 years) vs older (>35 years). Main Outcomes and Measures The main outcomes were cumulative incidence and hazard rate of CBC in the entire study population and in subgroups divided by cancer subtype, categorized according to hormone receptor (HR) and ERBB2 status. Results A total of 16 251 female patients with stage 0 to III breast cancer were analyzed; all patients were Korean. The mean (SD) age was 48.61 (10.06) years; 1318 patients (8.11%) were in the younger group, and 14 933 (91.89%) were in the older group. Median follow-up was 107 months (IQR, 79-145 months). Compared with the older group, the younger group had significantly higher incidence of CBC (10-year cumulative incidence, 7.1% vs 2.9%; P < .001) and higher risk (hazard ratio, 2.10; 95% CI, 1.62-2.74) of developing CBC. The hazard rate, which indicates risk for developing CBC at a certain time frame, differed according to the subtype of primary cancer. In patients with the HR+/ERBB2- subtype, the risk increased continuously in both age groups. In patients with the triple negative subtype, the risk increased until approximately 10 years and then decreased in both age groups. Meanwhile, in the HR-/ERBB2+ subtype, risk peaked earlier, especially in the younger group (1.7 years since first surgery in the younger group and 4.8 years in the older group). Conclusions and Relevance In this cohort study, patients aged 35 years or younger with breast cancer had a higher risk of developing CBC than older patients. Moreover, young patients with the HR-/ERBB2+ subtype tended to have a shorter interval for developing CBC. These findings might be useful in guiding treatment decisions, such as contralateral prophylactic mastectomy.
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Affiliation(s)
- Hakyoung Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Tae In Yoon
- Division of Breast Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jin Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sungchan Gwark
- Department of Surgery, Ewha Woman’s University College of Medicine, Ewha Woman’s University Mokdong Hospital, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Deng Z, Jones MR, Wolff AC, Visvanathan K. Evaluation of Predict, a prognostic risk tool, after diagnosis of a second breast cancer. JNCI Cancer Spectr 2023; 7:pkad081. [PMID: 37773987 PMCID: PMC10660126 DOI: 10.1093/jncics/pkad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The UK National Health Service's Predict is a clinical tool widely used to estimate the prognosis of early-stage breast cancer. The performance of Predict for a second primary breast cancer is unknown. METHODS Women 18 years of age or older diagnosed with a first or second invasive breast cancer between 2000 and 2013 and followed for at least 5 years were identified from the US Surveillance, Epidemiology, and End Results (SEER) database. Model calibration of Predict was evaluated by comparing predicted and observed 5-year breast cancer-specific mortality separately by estrogen receptor status for first vs second breast cancer. Receiver operating characteristic curves and areas under the curve were used to assess model discrimination. Model performance was also evaluated for various races and ethnicities. RESULTS The study population included 6729 women diagnosed with a second breast cancer and 357 204 women with a first breast cancer. Overall, Predict demonstrated good discrimination for first and second breast cancers (areas under the curve ranging from 0.73 to 0.82). Predict statistically significantly underestimated 5-year breast cancer mortality for second estrogen receptor-positive breast cancers (predicted-observed = ‒6.24%, 95% CI = ‒6.96% to ‒5.49%). Among women with a first estrogen receptor-positive cancer, model calibration was good (predicted-observed = ‒0.22%, 95% CI = ‒0.29% to ‒0.15%), except in non-Hispanic Black women (predicted-observed = ‒2.33%, 95% CI = ‒2.65% to ‒2.01%) and women 80 years of age or older (predicted-observed = ‒3.75%, 95% CI = ‒4.12% to ‒3.41%). Predict performed well for second estrogen receptor-negative cancers overall (predicted-observed = ‒1.69%, 95% CI = ‒3.99% to 0.16%) but underestimated mortality among those who had previously received chemotherapy or had a first cancer with more aggressive tumor characteristics. In contrast, Predict overestimated mortality for first estrogen receptor-negative cancers (predicted-observed = 4.54%, 95% CI = 4.27% to 4.86%). CONCLUSION The Predict tool underestimated 5-year mortality after a second estrogen receptor-positive breast cancer and in certain subgroups of women with a second estrogen receptor-negative breast cancer.
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Affiliation(s)
| | - Miranda R Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Antonio C Wolff
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Kim H, Yoon TI, Kim S, Lee SB, Kim J, Chung IY, Ko BS, Lee JW, Son BH, Gwark S, Kim JK, Kim HJ. Survival After Development of Contralateral Breast Cancer in Korean Patients With Breast Cancer. JAMA Netw Open 2023; 6:e2333557. [PMID: 37707815 PMCID: PMC10502526 DOI: 10.1001/jamanetworkopen.2023.33557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Contralateral breast cancer (CBC) is the most frequently diagnosed primary cancer in patients with breast cancer. Although many studies have reported survival after the development of CBC, results have been inconsistent. Objective To investigate whether the development of CBC is associated with survival among patients with breast cancer. Design, Setting, and Participants This cohort study was conducted at the Asan Medical Center, Korea, among patients who were diagnosed with primary unilateral, nonmetastatic, stage 0 to III breast cancer between 1999 and 2013 and followed up through 2018. The median (IQR) follow-up was 107 (75-143) months. Patients were categorized into CBC and no-CBC groups by whether they developed CBC during the follow-up period. Data were analyzed from November 2021 to March 2023. Exposure Development of CBC. Main outcomes and measures Survival rates of CBC and no-CBC groups were compared using a time-dependent Cox proportional hazard model in the entire study population and in subgroup analyses by interval of CBC development and subtype of the primary breast cancer. Results Among 16 251 patients with breast cancer (all Asian, specifically Korean; mean [SD] age, 48.61 [10.06] years), 418 patients developed CBC. There was no significant difference in overall survival between CBC and no-CBC groups (hazard ratio, 1.166; 95% CI, 0.820-1.657). Patients who developed CBC within 1.5 years after the surgery of the primary breast cancer had a higher risk for overall death during the study period (hazard ratio, 2.014; 95% CI, 1.044-3.886), and those who developed CBC after 1.5 years showed no significant difference in survival compared with the no-CBC group. Patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (ERBB2, formerly HER2)-negative breast cancer had a higher risk for overall death in the CBC group (hazard ratio, 1.882; 95% CI, 1.143-3.098) compared with the no-CBC group. Conclusions and Relevance This study found that development of CBC in patients with breast cancer was not associated with survival but that early development of CBC after diagnosis of the primary breast cancer or development of CBC in patients with HR-positive/ERBB2-negative breast cancer was associated with survival. These results may provide valuable information for patients seeking advice on opting for contralateral prophylactic mastectomy.
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Affiliation(s)
- Hakyoung Kim
- Department of Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Tae In Yoon
- Division of Breast Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sungchan Gwark
- Department of Surgery, Ewha Woman’s University College of Medicine, Ewha Woman’s University Mokdong Hospital, Seoul, Republic of Korea
| | | | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Ramin C, Veiga LHS, Vo JB, Curtis RE, Bodelon C, Aiello Bowles EJ, Buist DSM, Weinmann S, Feigelson HS, Gierach GL, Berrington de Gonzalez A. Risk of second primary cancer among women in the Kaiser Permanente Breast Cancer Survivors Cohort. Breast Cancer Res 2023; 25:50. [PMID: 37138341 PMCID: PMC10155401 DOI: 10.1186/s13058-023-01647-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Breast cancer survivors are living longer due to early detection and advances in treatment and are at increased risk for second primary cancers. Comprehensive evaluation of second cancer risk among patients treated in recent decades is lacking. METHODS We identified 16,004 females diagnosed with a first primary stage I-III breast cancer between 1990 and 2016 (followed through 2017) and survived ≥ 1 year at Kaiser Permanente (KP) Colorado, Northwest, and Washington. Second cancer was defined as an invasive primary cancer diagnosed ≥ 12 months after the first primary breast cancer. Second cancer risk was evaluated for all cancers (excluding ipsilateral breast cancer) using standardized incidence ratios (SIRs), and a competing risk approach for cumulative incidence and hazard ratios (HRs) adjusted for KP center, treatment, age, and year of first cancer diagnosis. RESULTS Over a median follow-up of 6.2 years, 1,562 women developed second cancer. Breast cancer survivors had a 70% higher risk of any cancer (95%CI = 1.62-1.79) and 45% higher risk of non-breast cancer (95%CI = 1.37-1.54) compared with the general population. SIRs were highest for malignancies of the peritoneum (SIR = 3.44, 95%CI = 1.65-6.33), soft tissue (SIR = 3.32, 95%CI = 2.51-4.30), contralateral breast (SIR = 3.10, 95%CI = 2.82-3.40), and acute myeloid leukemia (SIR = 2.11, 95%CI = 1.18-3.48)/myelodysplastic syndrome (SIR = 3.25, 95%CI = 1.89-5.20). Women also had elevated risks for oral, colon, pancreas, lung, and uterine corpus cancer, melanoma, and non-Hodgkin lymphoma (SIR range = 1.31-1.97). Radiotherapy was associated with increased risk for all second cancers (HR = 1.13, 95%CI = 1.01-1.25) and soft tissue sarcoma (HR = 2.36, 95%CI = 1.17-4.78), chemotherapy with decreased risk for all second cancers (HR = 0.87, 95%CI = 0.78-0.98) and increased myelodysplastic syndrome risk (HR = 3.01, 95%CI = 1.01-8.94), and endocrine therapy with lower contralateral breast cancer risk (HR = 0.48, 95%CI = 0.38-0.60). Approximately 1 in 9 women who survived ≥ 1 year developed second cancer, 1 in 13 developed second non-breast cancer, and 1 in 30 developed contralateral breast cancer by 10 years. Trends in cumulative incidence declined for contralateral breast cancer but not for second non-breast cancers. CONCLUSIONS Elevated risks of second cancer among breast cancer survivors treated in recent decades suggests that heightened surveillance is warranted and continued efforts to reduce second cancers are needed.
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Affiliation(s)
- Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA.
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Heather Spencer Feigelson
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
- Division of Genetics and Epidemiology, ICR, London, UK
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Deng Z, Jones MR, Wang MC, Visvanathan K. Mortality after second malignancy in breast cancer survivors compared to a first primary cancer: a nationwide longitudinal cohort study. NPJ Breast Cancer 2022; 8:82. [PMID: 35835760 PMCID: PMC9283416 DOI: 10.1038/s41523-022-00447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Limited information exists about survival outcomes after second primary cancers (SPCs) among breast cancer survivors. Studies suggest that mortality after certain SPCs may be higher than mortality after first primary cancers (FPCs) of the same type. A cohort study was conducted among 63,424 US women using the Surveillance, Epidemiology, and End Results 18 database (2000–2016) to compare mortality after a SPC among breast cancer survivors to mortality among women after a FPC using Cox proportional hazard regression. Propensity scores were used to match survivors with SPCs to women with FPCs 1:1 based on cancer type and prognostic factors. During a median follow-up of 42 months, 11,532 cancer deaths occurred after SPCs among survivors compared to 9305 deaths after FPCs. Cumulative cancer mortality was 44.7% for survivors with SPCs and 35.2% for women with FPCs. Survivors with SPCs had higher risk of cancer death (hazard ratio (HR): 1.27, 95% CI: 1.23–1.30) and death overall (HR: 1.18, 95% CI: 1.15–1.21) than women with FPCs. Increased risk of cancer death after SPCs compared to FPCs was observed for cancer in breast, lung, colon and/or rectum, uterus, lymphoma, melanoma, thyroid, and leukemia. Estrogen receptor status and treatment of the prior breast cancer as well as time between prior breast cancer and SPC significantly modified the mortality difference between women with SPC and FPC. A more tailored approach to early detection and treatment could improve outcomes from second cancer in breast cancer survivors.
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Affiliation(s)
- Zhengyi Deng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Division of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA. .,Women's Malignancies Program, Sidney Kimmel Comprehensive Cancer at Johns Hopkins, Baltimore, MD, USA.
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Fornecker L, Golfier F, Grosclaude P, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard CM, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Non-genetic indications for risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:107-120. [PMID: 34920167 DOI: 10.1016/j.gofs.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the value of performing a risk-reducting mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer. DESIGN The CNGOF Commission of Senology, composed of 26 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The Commission of Senology considered 8 questions on 4 topics, focusing on histological, familial (no identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's disease) risk. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival. RESULTS The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1±) and 5 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the Commission of Senology members on recommendations to improve practice for performing or not performing RRM in the clinical setting.
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Affiliation(s)
- Carole Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | | | | | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Susie Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | | | - Charles Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France.
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, 4, rue de la Chine, 75020 Paris, France.
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - Martha Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France.
| | - Marc Espié
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Luc Fornecker
- Département d'onco-hématologie, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - François Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | | | | | - Edith Kermarrec
- Hôpital Tenon, service de radiologie, 4, rue de la Chine, 75020 Paris, France.
| | - Vincent Lavoué
- CHU, service de gynécologie, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | | | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz, France.
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | | | | | - Nicolas Taris
- Oncogénétique, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Charlotte Vaysse
- Service de chirurgie oncologique, CHU Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
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8
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Qian C, Liang Y, Yang M, Bao SN, Bai JL, Yin YM, Yu H. Effect of breast-conserving surgery plus radiotherapy versus mastectomy on breast cancer-specific survival for early-stage contralateral breast cancer. Gland Surg 2021; 10:2978-2996. [PMID: 34804885 DOI: 10.21037/gs-21-413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
Background Breast-conserving surgery followed by radiotherapy is recommended in most women with early-stage unilateral breast cancer. However, its role in contralateral breast cancer (CBC) patients remains unclear. This retrospective study aimed to evaluate the breast cancer-specific survival (BCSS) outcomes after breast-conserving surgery plus radiotherapy compared with mastectomy in women with early-stage (T1-2N0-1M0) CBC. Methods Data were extracted from the Surveillance, Epidemiology, and End Results database. BCSS was analyzed using the log-rank method, competing risks regression model, and propensity score matching method. Results A total of 9,336 early-stage CBC patients were included. After multivariable adjustment, no significant difference in BCSS was found between early-stage CBC patients undergoing breast-conserving surgery plus radiotherapy and those undergoing mastectomy [hazard ratio (HR) 1.11, 95% confidence interval (CI): 0.90-1.37, P=0.329]. BCSS was similar in both treatment groups and in the subgroups stratified by age at first primary breast cancer or CBC diagnosis (≤50, 51-60, and >60 years), time interval between cancers (<0.25, 0.25-4, 5-9, and ≤10 years), stage of first primary breast cancer, T classification of CBC, histology and hormone receptors status of both cancers (all P>0.05). Among patients with N1 disease at CBC diagnosis, breast-conserving surgery plus radiotherapy was associated with a boundary significantly improved BCSS (HR 1.45, 95% CI: 1.00-2.12, P=0.050). Among patients who underwent breast-conserving surgery for first primary cancer, bilateral mastectomy for contralateral cancer did not improve BCSS compared with breast-conserving surgery plus radiotherapy (P>0.05). There was no significant difference in BCSS between breast-conserving surgery plus radiotherapy and mastectomy plus radiotherapy (P>0.05). Stable results were obtained after propensity score matching. Conclusions Breast-conserving surgery plus radiotherapy did not significantly influence BCSS outcomes of patients with early-stage CBC. Bilateral mastectomy and mastectomy plus radiotherapy did not confer a survival advantage over breast-conserving surgery plus radiotherapy in these patients. Future prospective studies are necessary to expand on these results.
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Affiliation(s)
- Chao Qian
- Department of General Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Liang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Yang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Sheng-Nan Bao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian-Ling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yong-Mei Yin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
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9
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Zheng Y, Li J, Hong C, Wu H, Lige W, Qi A, Guo J, Wang J, Zhu L, Li X, Zhang Y. Clinical features, prognosis, and influencing factors of contralateral prophylactic mastectomy in 58 patients with breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1665. [PMID: 33490177 PMCID: PMC7812232 DOI: 10.21037/atm-20-7780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The past two decades have witnessed the increasing application of contralateral prophylactic mastectomy (CPM) for women with breast cancer in the western countries. Over 30% of young patients choose to underwent CPM up to 2015. However, the adoption rate of CPM has not shown a remarkably increasing in Asian countries. In China, only a few centers have introduced CPM, and no relevant literature has been published. In this study, we look forward to identify the clinical features and prognostic factors of women who underwent CPM in our hospital, to inform decision-making processes for both doctors and patients. Methods The clinical data of 58 eligible patients were retrospectively analyzed. Intergroup comparisons were based on independent samples t-test and chi square test. The 5-year disease-free survival (DFS) and overall survival (OS) were obtained by using life tables, and factors affecting the survivals were analyzed by using the Kaplan-Meier method. Results The mean age of these women was 40.14±11.17 years, with 30 patients (51.7%) being ≤40 years; 13 patients (22.4%) had a family history of breast cancer; and 49 (69.0%) had known risk factors for breast cancer. The median follow-up period was 66.77 months, the 5-year OS was 89% and the 5-year DFS was 74%. The average age of onset was 41.53 (±10.964) in the disease-free survival group and 34.18 (±10.4) years in the recurrence/metastasis group, and t-test revealed a significant difference in the average age between these two groups (P=0.049). Chi-square test showed that the disease progression rate significantly differed among the different age subgroups and among subjects with different body mass index (BMI) (all P≤0.05). Moreover, surgical procedure, family history of breast cancer, and some other factors showed no significant correlation with disease progression (all P>0.05). Kaplan-Meier survival analysis and log rank test further confirmed the above findings. Conclusions The majority of patients who choose CPM are young and with known risk factors for breast cancer. Part of the young patients (≤40 years of age) are at a higher risk of disease progression.
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Affiliation(s)
- Yiqiong Zheng
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jie Li
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chenyan Hong
- School of Medicine, Naikai University, Tianjin, China
| | - Huan Wu
- Big Data Center, PLA General Hospital, Beijing, China
| | - Wuri Lige
- Big Data Center, PLA General Hospital, Beijing, China
| | - Aiying Qi
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jin Guo
- Gaojing Clinic, Jingxi Unit, PLA General Hospital, Beijing, China
| | - Jiandong Wang
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Li Zhu
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China
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10
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Giardiello D, Hauptmann M, Steyerberg EW, Adank MA, Akdeniz D, Blom JC, Blomqvist C, Bojesen SE, Bolla MK, Brinkhuis M, Chang-Claude J, Czene K, Devilee P, Dunning AM, Easton DF, Eccles DM, Fasching PA, Figueroa J, Flyger H, García-Closas M, Haeberle L, Haiman CA, Hall P, Hamann U, Hopper JL, Jager A, Jakubowska A, Jung A, Keeman R, Koppert LB, Kramer I, Lambrechts D, Le Marchand L, Lindblom A, Lubiński J, Manoochehri M, Mariani L, Nevanlinna H, Oldenburg HSA, Pelders S, Pharoah PDP, Shah M, Siesling S, Smit VTHBM, Southey MC, Tapper WJ, Tollenaar RAEM, van den Broek AJ, van Deurzen CHM, van Leeuwen FE, van Ongeval C, Van't Veer LJ, Wang Q, Wendt C, Westenend PJ, Hooning MJ, Schmidt MK. Prediction of contralateral breast cancer: external validation of risk calculators in 20 international cohorts. Breast Cancer Res Treat 2020; 181:423-434. [PMID: 32279280 PMCID: PMC8380991 DOI: 10.1007/s10549-020-05611-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Three tools are currently available to predict the risk of contralateral breast cancer (CBC). We aimed to compare the performance of the Manchester formula, CBCrisk, and PredictCBC in patients with invasive breast cancer (BC). METHODS We analyzed data of 132,756 patients (4682 CBC) from 20 international studies with a median follow-up of 8.8 years. Prediction performance included discrimination, quantified as a time-dependent Area-Under-the-Curve (AUC) at 5 and 10 years after diagnosis of primary BC, and calibration, quantified as the expected-observed (E/O) ratio at 5 and 10 years and the calibration slope. RESULTS The AUC at 10 years was: 0.58 (95% confidence intervals [CI] 0.57-0.59) for CBCrisk; 0.60 (95% CI 0.59-0.61) for the Manchester formula; 0.63 (95% CI 0.59-0.66) and 0.59 (95% CI 0.56-0.62) for PredictCBC-1A (for settings where BRCA1/2 mutation status is available) and PredictCBC-1B (for the general population), respectively. The E/O at 10 years: 0.82 (95% CI 0.51-1.32) for CBCrisk; 1.53 (95% CI 0.63-3.73) for the Manchester formula; 1.28 (95% CI 0.63-2.58) for PredictCBC-1A and 1.35 (95% CI 0.65-2.77) for PredictCBC-1B. The calibration slope was 1.26 (95% CI 1.01-1.50) for CBCrisk; 0.90 (95% CI 0.79-1.02) for PredictCBC-1A; 0.81 (95% CI 0.63-0.99) for PredictCBC-1B, and 0.39 (95% CI 0.34-0.43) for the Manchester formula. CONCLUSIONS Current CBC risk prediction tools provide only moderate discrimination and the Manchester formula was poorly calibrated. Better predictors and re-calibration are needed to improve CBC prediction and to identify low- and high-CBC risk patients for clinical decision-making.
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Affiliation(s)
- Daniele Giardiello
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Muriel A Adank
- Family Cancer Clinic, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Delal Akdeniz
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jannet C Blom
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mariël Brinkhuis
- Laboratory for Pathology, East-Netherlands, Hengelo, The Netherlands
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Medical Center Hamburg-Eppendorf, Cancer Epidemiology, University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Diana M Eccles
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California At Los Angeles, Los Angeles, CA, USA
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Jonine Figueroa
- The University of Edinburgh Medical School, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Edinburgh, UK
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Montserrat García-Closas
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Lothar Haeberle
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Audrey Jung
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renske Keeman
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Iris Kramer
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Diether Lambrechts
- VIB Center for Cancer Biology, Leuven, Belgium
- Laboratory for Translational Genetics, Department of Human Genetics, University of Leuven, Leuven, Belgium
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Mehdi Manoochehri
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hester S A Oldenburg
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Saskia Pelders
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Clinical Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra J van den Broek
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chantal van Ongeval
- Leuven Cancer Institute, Leuven Multidisciplinary Breast Center, Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Laura J Van't Veer
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Camilla Wendt
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Maartje J Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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11
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Shen K, Yao L, Wei J, Luo Z, Yu W, Zhai H, Wang J, Chen L, Fu D. Worse characteristics can predict survival effectively in bilateral primary breast cancer: A competing risk nomogram using the SEER database. Cancer Med 2019; 8:7890-7902. [PMID: 31663683 PMCID: PMC6912037 DOI: 10.1002/cam4.2662] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 12/18/2022] Open
Abstract
Objective There is limited information from population‐based cancer registries regarding prognostic features of bilateral primary breast cancer (BPBC). Methods Female patients diagnosed with BPBC between 2004 and 2014 were randomly divided into training (n = 7740) and validation (n = 2579) cohorts from the Surveillance, Epidemiology, and End Results Database. We proposed five various models. Multivariate Cox hazard regression and competing risk analysis were to explore prognosis factors in training cohort. Competing risk nomograms were constructed to combine significant prognostic factors to predict the 3‐year and the 5‐year survival of patients with BPBC. At last, in the validation cohort, the new score performance was evaluated with respect to the area under curve, concordance index, net reclassification index and calibration curve. Results We found out that age, interval time, lymph nodes invasion, tumor size, tumor grade and estrogen receptor status were independent prognostic factors in both multivariate Cox hazard regression analysis and competing risk analysis. Concordance index in the model of the worse characteristics was 0.816 (95% CI: 0.791‐0.840), of the bilateral tumors was 0.819 (95% CI: 0.793‐0.844), of the worse tumor was 0.807 (0.782‐0.832), of the first tumor was 0.744 (0.728‐0.763) and of the second tumor was 0.778 (0.762‐0.794). Net reclassification index of the 3‐year and the 5‐year between them was 2.7% and −1.0%. The calibration curves showed high concordance between the nomogram prediction and actual observation. Conclusion The prognosis of BPBC depended on bilateral tumors. The competing risk nomogram of the model of the worse characteristics may help clinicians predict survival simply and effectively. Metachronous bilateral breast cancer presented poorer survival than synchronous bilateral breast cancer.
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Affiliation(s)
- Kaiwen Shen
- Yangzhou University Medical Academy, Yangzhou, Jiangsu, China
| | - Longdi Yao
- The Second Clinical College of Dalian Medical University, Dalian, Liaoning, China
| | - Jinli Wei
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Zhou Luo
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Wang Yu
- Department of Thyroid and Breast Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huamin Zhai
- Yangzhou University Medical Academy, Yangzhou, Jiangsu, China
| | - Jianwen Wang
- Yangzhou University Medical Academy, Yangzhou, Jiangsu, China
| | - Luhong Chen
- Yangzhou University Medical Academy, Yangzhou, Jiangsu, China
| | - Deyuan Fu
- Yangzhou University Medical Academy, Yangzhou, Jiangsu, China.,Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
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