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Wang X, Wang X, Cai L, Zhang C, Li Y. Clinical characteristics and prognostic analysis of metachronous bilateral breast carcinoma: a retrospective study based on propensity score matching. Clin Transl Oncol 2024:10.1007/s12094-024-03528-y. [PMID: 38801511 DOI: 10.1007/s12094-024-03528-y] [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: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND To investigate clinical characteristics, treatment, outcomes, and prognostic risk factors of metachronous bilateral breast carcinoma (MBBC) and provide a theoretical basis for clinical management of MBBC. METHODS This was a retrospective study. From January 1, 2010 to March 31, 2022, a total of 23,010 patients with breast cancer underwent surgical treatment at the Breast Center of the Fourth Hospital of Hebei Medical University, including 386 patients with MBBC. Propensity score matching (PSM) was performed on MBBC patients and unilateral breast cancer (UBC) patients in a 1:1 ratio, and 210 UBC patients and 210 MBBC patients were finally matched. Clinical medical records of all patients were collected, including age of onset, family history of breast cancer, tumor size, lymph node status, TNM stage, mode of surgery, menstruation, pathological type, immunohistochemical (IHC) typing, treatment, disease-free survival (DFS), and overall survival (OS). RESULTS The result showed that age of onset of the second primary cancer (SPC) was significantly older than that of the first primary cancer (FPC) (P = 0.024). Baseline data from MPPC patients showed that the tumor size of FPC was significantly larger than that of SPC (P = 0.043), and the proportion of PR ( +) in FPC is significantly higher than that in SPC (P = 0.045). Among MBBC patients with FPC for estrogen receptor (ER) or progesterone receptor (PR) ( +) and Her-2 (-), clinical characteristics and treatment results showed that the proportion of PR ( +) in the drug-resistant group was significantly lower than that in the non-drug-resistant group. The 2-year OS rate of SPC in the drug-resistant group was significantly shorter than those of the non-drug-resistant group (78.9% vs 100%, P < 0.05). The result of PSM-based comparison between MBBC patients and UBC patients showed significantly lower proportion of MBBC patients with SPC received chemotherapy compared to UBC patients (P = 0.026), and there was no significant difference in OS and DFS between SPC course of MBBC patients and UBC patients (P > 0.05). The univariate analysis showed that high TNM stage was a risk factor for death and disease progression in MBBC patients, with the risk of death in stage III MBBC patients being about 5 times higher than that in stage I MBBC patients (HR = 4.97, 95%CI = 1.42-17.31, P = 0.012), and the risk of disease recurrence being about 3.5 times higher than that in stage I MBBC patients (HR = 3.55, 95%CI = 1.07-11.81, P = 0.039). CONCLUSION In summary, this study presented clinical characteristics, treatment options, and outcomes of MBBC patients and patients with MBBC who were resistant to endocrine therapy have a worse SPC survival prognosis. The course of SPC in MBBC patients was similar to that of UBC in terms of prognosis and survival, which suggested that SPC can be treated according to UBC treatment regimen. High TNM stage was a prognostic risk factor for SPC patients.
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Affiliation(s)
- Xinle Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Xinrui Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Lijing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cong Zhang
- Scientific Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuntao Li
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China.
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Mishra A, Oberoi AS, Deo S, Sharma J, Gogia A, Sharma DN, Mathur S, Dhamija E. Bilateral Breast Cancer: Clinical Profile and Management. Indian J Surg Oncol 2023; 14:651-658. [PMID: 37900630 PMCID: PMC10611650 DOI: 10.1007/s13193-023-01731-x] [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: 07/28/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
There is paucity of literature regarding the demography, histopathology, management, and outcomes of bilateral breast cancer (BBC). We present our experience of treating 127 BBC with multimodality management. An audit of prospectively maintained computerized breast cancer database of the department of surgical oncology at a tertiary care center was performed. Demography, clinical profile, molecular sub-types, treatment patterns, and outcomes were analyzed. A total 127 patients presented with BBC between 1992 and 2019. Ninety-four had metachronous (MBBC) and 33 had synchronous breast cancer (SBBC). Most contralateral breast cancer (CBC) patients had early-stage breast cancer in comparison to the index side cancer (37% vs 32%). Ninety-four patients underwent bilateral mastectomy and only 18 patients underwent bilateral breast conservation. Seventy-one patients undergoing BCS and surgery for LABC were given postoperative radiotherapy. All patients received adjuvant chemo- and/or hormonal therapy both for index and CBC based on the stage and hormone receptor status. Thirty-three percent of patients had either locoregional or distant relapse. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) of the entire cohort were 86.6% and 68.4% respectively. There was no difference in the OS and DFS between SBBC and MBBC. The incidence of BBC is expected to increase with effective diagnostic and therapeutic interventions and improving survival. Patients require individualized treatment planning in a multidisciplinary treatment setting.
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Affiliation(s)
- Ashutosh Mishra
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | | | - Jyoti Sharma
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - D. N. Sharma
- Department of Radiation Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | - Ekta Dhamija
- Department of Radiology, AIIMS, New Delhi, India
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Mallory MA, Whiting K, Park A, Gönen M, Gilbert E, King TA, Pilewskie ML. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat 2022; 194:137-148. [PMID: 35488092 PMCID: PMC11325477 DOI: 10.1007/s10549-022-06532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Lobular carcinoma in situ (LCIS) confers increased cancer risk in either breast, but it remains unclear if this population is at increased risk for bilateral breast cancer (BC) development. Here we report bilateral BC incidence among women with a history of LCIS. METHODS Women with classic-type LCIS diagnosed from 1980 to 2017 who developed unilateral BC (UBC) or bilateral BC were identified. Bilateral BC was categorized as synchronous (bilateral BC diagnosed < 6 months apart; SBBC) or metachronous (bilateral BC diagnosed ≥ 6 months apart; MBBC). Five-year incidence rates of bilateral BC among this population were evaluated. Comparisons were made to identify factors associated with bilateral BC. RESULTS At 7 years' median follow-up, 249/1651 (15%) women with LCIS developed BC; 34 with bilateral BC (2%). There were no clinicopathologic feature differences between those with UBC and bilateral BC. SBBC occurred in 18 without significant differences versus UBC. Among 211 with UBC and a contralateral breast at risk, 16 developed MBBC at a median follow-up of 3 years. MBBC patients were less likely to receive endocrine therapy and more likely to receive chemotherapy versus UBC. Tumor histology was not associated with MBBC. Estimated 5-year MBBC risk was 6.4%. Index estrogen/progesterone receptor positivity and endocrine therapy were the only factors associated with MBBC risk. CONCLUSION Bilateral BC occurred in 2% of women with LCIS history at median follow-up of 7 years. Similar to the general BC population, a decrease in MBBC is seen among women with a history of LCIS who develop hormone receptor-positive disease and those who receive endocrine therapy, highlighting the protective effects of this treatment.
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Affiliation(s)
- Melissa Anne Mallory
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karissa Whiting
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Park
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Gilbert
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Melissa L Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer, 300 East 66th Street, New York, NY, 10065, USA.
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Jiang H, Zhang R, Liu X, Ran R, Zhang J, Liu Y, Gui X, Chen Y, Li K, Shao B, Yan Y, Liang X, Song G, Di L, Li H. Bilateral breast cancer in China: A 10-year single-center retrospective study (2006-2016). Cancer Med 2021; 10:6089-6098. [PMID: 34346560 PMCID: PMC8419776 DOI: 10.1002/cam4.4141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/09/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023] Open
Abstract
Bilateral breast cancer (BBC) is an uncommon subset of breast cancer (BC), and it may present as synchronous bilateral breast cancer (sBBC) or metachronous bilateral breast cancer (mBBC). Through this study, we aimed to evaluate the proportion of BBC in BC and compare the clinicopathological characteristics, treatment, and outcomes of sBBC and mBBC at an academic cancer center in China. Patients with BC consecutively treated between 2006 and 2016 were retrospectively reviewed. Patients with BBC were included. In total, 3924 patients with BC were analyzed and 127 patients with BBC (28 sBBC, 99 mBBC) with a median follow-up of 98 months were identified. The proportion of BBC was 3.2% (0.7%, sBBC; 2.5%, mBBC). The median age at the first diagnosis of mBBC was significantly younger than that at the first diagnosis of sBBC (p = 0.027). Patients diagnosed as having sBBC were more likely to have a positive family history (p = 0.047). The first tumors of mBBC were detected at a significantly earlier tumor stage compared with those of sBBC (p = 0.028). The concordance rates of histopathologic type in the first and second tumors were 60.7% and 58.0% in sBBC and mBBC, respectively. sBBC had a significantly poorer disease-free survival than mBBC did (p = 0.001). BBC is a rare disease affecting the Chinese population. sBBC is associated with a greater prevalence of a family history of breast cancer and poorer prognosis, compared with mBBC.
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Affiliation(s)
- Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ruyan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ran Ran
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiayang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yaxin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinyu Gui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yifei Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Shao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijun Di
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Ding S, Sun X, Lu S, Wang Z, Chen X, Shen K. Association of molecular subtype concordance and survival outcome in synchronous and metachronous bilateral breast cancer. Breast 2021; 57:71-79. [PMID: 33774461 PMCID: PMC8027898 DOI: 10.1016/j.breast.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to analyze the association of molecular subtype concordance and disease outcome in patients with synchronous bilateral breast cancer (SBBC) and metachronous breast cancer (MBBC). Patients and methods Patients diagnosed with SBBC or MBBC in the Surveillance, Epidemiology, and End Results (SEER) database or Comprehensive Breast Health Center (CBHC) Ruijin Hospital, Shanghai were retrospectively reviewed and included. Clinicopathologic features, molecular subtype status concordance, and prognosis were compared in patients with SBBC and MBBC. Other prognostic factors for breast cancer-specific survival (BCSS) and overall survival (OS) were also identified for bilateral breast cancer patients. Results Totally, 3395 and 115 patients were included from the SEER and Ruijin CBHC cohorts. Molecular subtype concordance rate was higher in the SBBC group compared to MBBC in both SEER cohort (75.8% vs 57.7%, p < 0.001) and Ruijin CBHC cohort (76.2% vs 45.2%, p = 0.002). Survival analyses indicated that SBBC was related to worse BCSS than MBBC (p = 0.015). Molecular subtype discordance was related to worse BCSS (hazard ratio (HR), 1.64, 95% confidential interval (CI), 1.18–2.27, p = 0.003) and OS (HR, 1.59, 95% CI, 1.24–2.04, p < 0.001) in the SBBC group, but not for the MBBC group (p = 0.650 for BCSS, p = 0.669 for OS). Conclusions Molecular subtype concordance rate was higher in the SBBC group than MBBC group. Patients with discordant molecular subtype was associated with worse disease outcome in the SBBC patients, but not in MBBC, which deserves further clinical evaluation. SBBC was associated with higher concordance rates of ER, PR, HER2, and molecular subtype status compared to MBBC. SBBC had worse BCSS than MBBC. Molecular subtype discordance was independently related to worse prognosis in SBBC but has no impact on prognosis of MBBC.
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Affiliation(s)
- Shuning Ding
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Xi Sun
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Shuangshuang Lu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Zheng Wang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China.
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China.
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Huber A, Seidler SJ, Huber DE. Clinicopathological Characteristics, Treatment and Outcome of 123 Patients with Synchronous or Metachronous Bilateral Breast Cancer in a Swiss Institutional Retrospective Series. Eur J Breast Health 2020; 16:129-136. [PMID: 32285035 DOI: 10.5152/ejbh.2020.5297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/09/2020] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the prognosis, the patient and tumor characteristics, and the treatment of bilateral breast cancer (BBC) and to compare synchronous (sBBC) and metachronous BBC (mBBC). Materials and Methods For this retrospective study, data from 123 consecutive BBC patients (56 sBBC and 67 mBBC) that were presented at the Sion Hospital tumor board between 2007 and 2018 were collected retrospectively. Results Mean follow-up was 85 months. 2nd tumors in both groups were more often diagnosed radiologically. Mean time interval between mBBC was 115 months. A shorter interval was positively correlated with a negative hormonal receptor (HR) status and higher grade for the 2nd tumor. There was no difference in overall survival (OS) and relapse-free survival (RFS) between sBBC and mBBC. OS was longer if both tumors were hormonal receptor (HR) positive. mBBC exhibited a higher local recurrence rate than sBBC (p=0.03). Conclusion sBBC and mBBC patients did not show any difference in OS or RFS, although mBBC patients were more prone to local relapses.
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Affiliation(s)
- Alexandre Huber
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Daniela E Huber
- Gynecology Department, Hôpital du Valais, Sierre, Switzerland
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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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Pan B, Xu Y, Zhou YD, Yao R, Wu HW, Zhu QL, Wang CJ, Mao F, Lin Y, Shen SJ, Sun Q. The prognostic comparison among unilateral, bilateral, synchronous bilateral, and metachronous bilateral breast cancer: A meta-analysis of studies from recent decade (2008-2018). Cancer Med 2019; 8:2908-2918. [PMID: 31038845 PMCID: PMC6558468 DOI: 10.1002/cam4.2198] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 01/04/2023] Open
Abstract
Background The incidence of bilateral breast cancer (BBC) is increasing nowadays comprising 2%‐11% of all breast cancer (BC). According to the interval time between the first and second cancer, BBC could be divided into synchronous (SBBC) and metachronous (MBBC). However, this interval time is quite different across studies. It remains controversial whether the survival of BBC, SBBC, and MBBC is similar or worse compared to that of unilateral breast cancer (UBC), and whether the survival of SBBC is similar or worse compared to MBBC. To better understand the survival of UBC, BBC, SBBC, and MBBC and how the interval time would influence the prognosis of SBBC and MBBC, we performed this meta‐analysis on studies from recent 10 years (2008‐2018). Methods Databases of PubMed, Embase, and Web of Science were searched for relevant studies within recent 10 years. Hazard ratio (HR) was adopted to evaluate the difference of overall survival (OS) of UBC, BBC, SBBC, and MBBC. HR of OS comparisons were performed between BBC vs UBC, SBBC vs UBC, MBBC vs UBC, and SBBC vs MBBC with 3, 6, 12 months as the interval time, respectively. Results There were 15 studies of 72 302 UBC and 2912 BBC included in the meta‐analysis. The summary HR of OS comparison between BBC vs UBC was 1.68 (95% CI: 1.28‐2.20), SBBC vs UBC was 2.01 (95% CI: 1.14‐3.55), MBBC vs UBC was 3.22 (95% CI: 0.75‐13.78). When 3, 6, 12 months were used as the interval time, the summary HR of the OS comparison between of SBBC vs MBBC were 0.64 (95% CI: 0.44‐0.94), 1.17 (95% CI: 0.84‐1.63) and 1.45 (95% CI: 1.10‐1.92), respectively. Conclusion BBC and SBBC showed worse prognosis in terms of OS compared to UBC while MBBC manifested similar or non‐superior survival as UBC. The OS comparison between SBBC and MBBC changed with different interval time used. The longer the interval time used, the worse the survival of SBBC. SBBC with interval of 3‐12 months between the two cancers had the worst prognosis. When 6 months was used to differentiate SBBC from MBBC, these two clinical entities showed similar OS.
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Affiliation(s)
- Bo Pan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Ying Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Yi-Dong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Ru Yao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Huan-Wen Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Qing-Li Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Chang-Jun Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Song-Jie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
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9
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Qiu R, Zhao W, Yang J, Shen Y, Wang B, Li P, Zhao A, Tian Q, Zhang M, Yi M, Yang J, Dong D. Comparative Analysis of Outcomes and Clinicopathological Characteristics of Synchronous and Metachronous Contralateral Breast Cancer: A Study of the SEER Database. J Breast Cancer 2019; 22:297-310. [PMID: 31281731 PMCID: PMC6597405 DOI: 10.4048/jbc.2019.22.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 03/15/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose Numerous previous studies have reported inconsistent results about the differences between synchronous contralateral breast cancer (sCBC) and metachronous contralateral breast cancer (mCBC). This study aimed to compare the clinical characteristics and outcomes between sCBC and mCBC and determine predictive factors for the survival of sCBC and mCBC patients. Methods Using the Surveillance, Epidemiology, and End Results Program database, we identified sCBC or mCBC patients from 2000 to 2010. The Kaplan-Meier method and Cox proportional hazards regression analysis were used to analyze overall survival and breast cancer-specific survival (BCSS) rates of sCBCs and mCBCs, respectively. Results Overall, 14,057 sCBC (n = 8,139, 57.9%) and mCBC (n = 5,918, 42.1%) patients were included. The first tumors of sCBC were more likely to have higher stage and more lymph and distant metastases, whereas those of mCBC were more often infiltrating ductal carcinoma (IDC), had localized stage, were estrogen receptor (ER) and progesterone receptor (PR) negative, and had less axillary nodal involvement. The second tumors of mCBC tended to be IDC and have higher grade, adverse stage, ER and PR-negativity; and more axillary nodal involvement, compared to the second tumors of sCBC. mCBC patients had significantly favorable 5-year BCSS but worse long-term BCSS compared with sCBC patients. Moreover, subgroup analysis revealed no significant difference of BCSS between sCBC and mCBC among patients aged 18-60 years. Multivariate analysis indicated that age, grade, and stage of 2 tumors; surgery for second tumor; and ER status of the second tumor were independent prognostic factors for BCSS of contralateral breast cancer (CBC). Conclusion The characteristics and outcomes of sCBCs and mCBCs were substantially different. sCBC and mCBC patients may have different prognosis, and the prognosis of CBC depends on the first and second tumors.
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Affiliation(s)
- Ruiyue Qiu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wen Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiao Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanwei Shen
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Biyuan Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pan Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Andi Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mi Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Yi
- Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jin Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Danfeng Dong
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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10
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Wadasadawala T, Lewis S, Parmar V, Budrukkar A, Gupta S, Nair N, Shet T, Badwe R, Sarin R. Bilateral Breast Cancer After Multimodality Treatment: A Report of Clinical Outcomes in an Asian Population. Clin Breast Cancer 2018; 18:e727-e737. [DOI: 10.1016/j.clbc.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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11
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Motuzyuk I, Sydorchuk O, Kovtun N, Palian Z, Kostiuchenko Y. Analysis of Trends and Factors in Breast Multiple Primary Malignant Neoplasms. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018. [PMID: 29531473 PMCID: PMC5843092 DOI: 10.1177/1178223418759959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The study aims to evaluate the current state and tendencies in multiple primary breast cancer incidence, behavior, and treatment in Ukraine. Methods A total of 2032 patients who received special treatment at the Department of Breast Tumors and Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 were included in the study. Among them, there were 195 patients with multiple primary malignant neoplasms: 54.9% patients with synchronous cancer and 45.1% patients with metachronous cancer. The average age of patients was 46.6 years, and the percentage of postmenopausal women was 63.1%. Among patients with synchronous cancer, there were 56.1% patients with only breast localizations and 43.9% with combination of breast and other localizations, and among patients with metachronous cancer, there were 46.6% patients with only breast localizations and 53.4% with combination of breast and other localizations. All the patients were evaluated in terms of aggressiveness of the disease, survival rates, as well as risk factors and treatment options. Results A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chernobyl accident under the age of 30 years (P < .01). The clinical course of disease in patients with synchronous cancer is worse and prognostically unfavorable compared with metachronous cancer (P < .01). The course of the disease in patients who underwent mastectomy is worse compared with patients who underwent breast-conserving surgery (P < .01). Plastic and reconstructive surgery in patients with synchronous cancer was proven to be reasonable in terms of increase in survival (P < .01). Conclusions The patients with multiple primary breast cancer should have attentive management and treatment. Multidisciplinary team should concern all the risk factors and provide the most sufficient option of management. This is crucial to continue research in this oncological area.
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Affiliation(s)
- Igor Motuzyuk
- Department of Oncology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Oleg Sydorchuk
- Department of Oncology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natalia Kovtun
- Chiltern Clinical Research Ukraine LLC, Kyiv, Ukraine.,Department of Statistics and Demography, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Zinaida Palian
- Department of Statistics and Demography, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
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12
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Santiago L, Whitman G, Wang C, Dogan BE. Clinical and Pathologic Features of Clinically Occult Synchronous Bilateral Breast Cancers. Curr Probl Diagn Radiol 2017; 47:305-310. [PMID: 28935459 DOI: 10.1067/j.cpradiol.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate clinicopathologic breast cancer characteristics associated with the identification of synchronous bilateral breast cancer (SBBC) on dynamic contrast-enhanced breast magnetic resonance imaging. METHODS We performed a retrospective review of 311 consecutive patients newly diagnosed with breast cancer who underwent diagnostic mammography, ultrasonography, and dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI) at our institution. Tumor histology, grade, biomarker status (estrogen receptor, progesterone receptor, and HER2), TNM staging, and unifocal or multifocal/multicentric status were compared between the index tumors in the unilateral disease and the SBBC groups, as well as between the index tumors in the unilateral disease group and the synchronous contralateral tumors (SCT) in the SBBC group, using the Fisher exact test. RESULTS A total of 326 cancers in 311 patients were reviewed. Fifteen (4.8%) patients were diagnosed with SBBC. The index tumors in patients with SBBC were more frequently lower T stage (p = 0.007), lower grade (p = 0.04), and multifocal/multicentric (p = 0.004) compared with the index tumors in the unilateral group. Biomarkers, N status, and M status did not significantly differ between the index tumors in both groups. CONCLUSIONS SBBC was more likely to be identified in women with lower T stage, lower tumor grade and multifocal/multicentric tumors. Multimodality imaging including DCE-MRI is essential in detection and diagnosis of SBBC.
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Affiliation(s)
- Lumarie Santiago
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Gary Whitman
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cuiyan Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX; Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
| | - Basak E Dogan
- Department of Diagnostic Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
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13
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Surridge CA, Goodier MD. An analysis of diagnostic practices in a mammography unit in a tertiary hospital in South Africa. SA J Radiol 2017. [DOI: 10.4102/sajr.v21i1.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Breast cancer is the most common cancer in females in South Africa. The reporting of breast imaging has been standardised internationally using the Breast Imaging and Reporting Data System (BI-RADS), which includes guidelines for reporting of breast lesions and further management. Ultrasound-guided core-needle breast (UGCNB) biopsy is a widely used method of obtaining histological diagnoses of breast lesions to assist with planning definitive management.Objectives: To perform an audit of the UGCNB biopsies performed at the Grey’s Hospital Mammography Department and assess the accuracy of the radiologists’ use of the BI-RADS scoring system.Methods: Records of all patients who underwent UGCNB biopsy between 01 January 2014 and 31 October 2015 were reviewed. A retrospective study was performed.Results: A total of 304 UGCNB biopsies were performed on 291 patients. The mean age was 49.2 (s.d. = 15.9) years. Tissue samples from 303 lesions were adequate for histological assessment, and of these, 51% of the lesions were malignant whilst 49% were benign. The most common malignant and benign diagnoses were invasive ductal carcinoma and fibroadenoma respectively. The BI-RADS scoring of the radiologists demonstrated a positive predictive value of 61.6% for the identification of possible malignant lesions.Conclusion: This study describes the patient and lesion profile and unit practices in a tertiary hospital setting in South Africa. The radiologists’ application of the BI-RADS scoring largely conforms to the BI-RADS guidelines. The study highlights several challenges encountered by a breast imaging programme in an under-resourced setting as well as making recommendations in overcoming these challenges.
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14
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Motuzyuk I, Sydorchuk O, Kovtun N, Kostiuchenko Y. Synchronous and metachronous breast cancer in Ukraine. Breast Dis 2017; 37:83-93. [PMID: 29504518 DOI: 10.3233/bd-170285] [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] [Indexed: 11/15/2022]
Abstract
AIM This study aims to describe the current state of multiple primary malignant neoplasms (MPMNs) breast cancer patients management, evaluate the predictive impact of different factors, optimise approaches to diagnosis and treatment of these patients and improve their life quality. METHODS The study included 2,032 patients who received special treatment at the Department of Breast Tumours and it Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 within an open randomized controlled trial. The sample included 195 patients with synchronous cancer or metachronous breast cancer. RESULTS A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chornobyl accident. The clinical course of disease in patients with synchronous breast cancer is worse and prognostically unfavourable comparing to metachronous one. The influence on clinical course of disease of primary localization, type of settlement, blood group and Rh factor, type of special treatment, and age in patients with synchronous and metachronous cancer was not statistically proven. The impact of operative intervention scope in patients with synchronous and metachronous breast cancer was statistically proven, i.e. the course of the underlying disease in patients who underwent mastectomy is worse comparing to patients who underwent conservative surgery. Plastic and reconstructive surgery in patients with synchronous cancer was statistically proven in this study as reasonable. The influence of local recurrence rates on overall survival in patients with synchronous cancer was proven. However, the influence of local recurrence rates in patients with metachronous cancer was not statistically proven. CONCLUSIONS There should be paid a great attention to synchronous and metachronous breast cancer patients in order to find and provide the best options of their management. This is crucial to continue researches in this field of oncology.
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Affiliation(s)
- Igor Motuzyuk
- Oncology Department, Bogomolets National Medical University, 03022, Kyiv, Ukraine
| | - Oleg Sydorchuk
- Oncology Department, Bogomolets National Medical University, 03022, Kyiv, Ukraine
| | - Natalia Kovtun
- Chiltern Clinical Research Ukraine LLC, Department of Statistics and Demography, Taras Schevchenko National University of Kyiv, Kyiv, Ukraine
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15
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Khalil AI, Bendahhou K, Mestaghanmi H, Saile R, Benider A. [Synchronous bilateral breast cancer: experiences in the Mohammed VI Cancer Treatment Center, CHU Ibn Rochd, Casablanca]. Pan Afr Med J 2016; 25:121. [PMID: 28292084 PMCID: PMC5325485 DOI: 10.11604/pamj.2016.25.121.9967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022] Open
Abstract
Synchronous bilateral breast cancers (SBBC) are characterized by extensive clinical and morphological heterogeneity, with an frequency between 1.5 and 3.2%. Women treated for unilateral breast cancer are at higher risk of developing contralateral breast cancer. Screening and advances in breast imaging have improved detection rates of SBBC. Our study aims to analyze the epidemiological, clinical, histological and therapeutic features of bilateral breast cancer. We conducted a cross-sectional study of patients with breast cancer treated at the Mohammed VI Center over a two year period. Statistical analysis of the results was performed using R. software. 31 patients had SBBC, representing 2.4% of breast cancer cases in our Center. The average age was 47.8 ± 8.4 years, 22.6% of patients used oral contraceptives. A family history of breast cancer was observed in 22.6% of cases. The most common histological type was invasive ductal carcinoma (58.1%), SBR grade II and III were common (38.7%). Hormone receptors were positive for progesterone (38.7%) and for estrogen (41.9%). HER2 was overexpressed in 20.0% of cases. 29.0% of patients received hormonal therapy and 3.2% targeted therapies. Our study showed that bilateral breast cancer represents a small percentage of all breast cancers but have specific clinical features that help to differentiate it from unilateral breast cancer.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Contraceptives, Oral/administration & dosage
- Cross-Sectional Studies
- Female
- Humans
- Middle Aged
- Morocco
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | | | - Houriya Mestaghanmi
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Rachid Saile
- Laboratoire de Biologie et Santé, Unité de Recherche Associée au CNRST-URAC 34, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Abdellatif Benider
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd Casablanca, Maroc
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16
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O'Brien JA, Ho A, Wright GP, Stempel M, Patil S, Krause K, Morrow M, Gemignani ML. Breast-Conserving Surgery in Bilateral Breast Cancer. Ann Surg Oncol 2015; 22:3389-96. [PMID: 26265365 DOI: 10.1245/s10434-015-4746-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bilateral breast cancer (BBC) may present as synchronous (SBC) or metachronous breast cancer (MBC). Optimal surgical management of BBC patients is not well-defined. In this study, we report on histopathology, treatment, and outcomes in BBC patients. METHODS Upon Institutional Review Board approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999 and 2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed, and factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease, tumor considered too large for BCS, and a patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs (binary variables) or the paired t test (continuous variables) were used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival (OS). RESULTS A total of 203 BBC patients (119 SBC, 84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and molecular profiles. Overall, 57% of MBC patients underwent breast-conserving surgery (BCS) at initial diagnosis versus 34% of patients with SBC. BCS contraindications were similar in both groups: 16 (34%) MBC patients and 28 (36%) SBC patients. Kaplan-Meier OS estimates at 5 and 10 years were 86 and 78% for MBC, and 87 and 77% for SBC patients, respectively. CONCLUSIONS OS was excellent for both the MBC and SBC groups. Contraindications to BCS did not differ between groups. However, patients with SBC were less likely to undergo BCS compared with patients with MBC at the time of initial diagnosis.
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Affiliation(s)
- Julie A O'Brien
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Liederbach E, Piro R, Hughes K, Watkin R, Wang CH, Yao K. Clinicopathologic features and time interval analysis of contralateral breast cancers. Surgery 2015; 158:676-85. [PMID: 26067460 DOI: 10.1016/j.surg.2015.03.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We hypothesized that most contralateral breast cancers (CBCs) develop ≥5 years after the primary breast cancer (PBC) and that CBCs have more favorable tumor characteristics. METHODS This is a single-institution retrospective review of 323 patients who were diagnosed with CBC from 1990 to 2014. CBCs were diagnosed at least 1 year after the diagnosis of PBC. Χ(2) tests and one-way analysis of variance were used to examine the time interval and pathologic features between the PBC and CBC. RESULTS The median time interval between the PBC and CBC was 6.2 years (average: 7.1, range: 1.01-23.0), and 189 (58.5%) patients had a time interval ≥5 years. Patients ≥70 years old developed a CBC sooner than patients <50 years (median: 4.3 vs 6.6 years, P < .001). Patients with infiltrating lobular carcinoma developed their CBC in 9.0 years versus 6.2 years for infiltrating ductal carcinoma histology (P = .028). In comparison with the PBC, a greater proportion of CBCs were stage I (50.8%), T1 (72.1%), node negative (67.5%), and estrogen receptor positive (68.7%). Of the 252 patients with available tumor size information for both cancers, only 54 (21.4%) patients developed a CBC that was >1 cm larger than their PBC, and only 25 (9.9%) patients developed a CBC that was >2 cm larger than their PBC. Only 28 of 201 (13.9%) node-negative PBCs developed a node-positive CBC. CONCLUSION A majority of CBCs develop ≥5 years after the diagnosis of the PBC. CBCs have more favorable tumor characteristics than the PBC and tend to be smaller and node negative.
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Affiliation(s)
- Erik Liederbach
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Rita Piro
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Katie Hughes
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Rachel Watkin
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
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18
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Kwok AC, Goodwin IA, Ying J, Agarwal JP. National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012. Am J Surg 2015; 210:512-6. [PMID: 26054659 DOI: 10.1016/j.amjsurg.2015.03.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study's purpose was to examine the national rate of breast cancer patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) and their associated complication rates. METHODS Using the National Surgical Quality Improvement Program database, breast cancer patients undergoing mastectomy between 2005 and 2012 were identified. Rates in BM and IBR as well as associated complication rates were evaluated. Logistic regression was used to identify predictors of BM, IBR, and complications. RESULTS A total of 56,905 breast cancer patients underwent mastectomy. The rate of BM tripled (9.14% vs 25.44%, P < .0001) and the rate of IBR increased by 50% (29.73% vs 44.68%, P < .0001). Complication rates were higher in patients undergoing BM compared with unilateral mastectomy (11.49% vs 9.52%, P < .0001) and in patients undergoing IBR compared with mastectomy alone (11.62% vs 8.91%, P < .0001). White race and age less than 40 years were predictors of patients undergoing BM and IBR. CONCLUSIONS The rates of BM and associated IBR have increased significantly since 2005 despite higher complication rates. Further research is needed to understand the reasons for these trends.
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Affiliation(s)
- Alvin C Kwok
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Isak A Goodwin
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Jian Ying
- Division of Epidemiology, Department of Family and Preventative Medicine, University of Utah, School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
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Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies. Breast Cancer Res Treat 2014; 146:461-75. [DOI: 10.1007/s10549-014-3045-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/23/2014] [Indexed: 12/20/2022]
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Synchronous and metachronous breast malignancies: a cross-sectional retrospective study and review of the literature. BIOMED RESEARCH INTERNATIONAL 2014; 2014:250727. [PMID: 24877073 PMCID: PMC4022260 DOI: 10.1155/2014/250727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/22/2014] [Indexed: 11/17/2022]
Abstract
Objective. There is increasing interest in patients with metachronous (MBC) and synchronous breast cancer (SBC). The objective of this study was to evaluate the occurrence and outcome of MBCs and SBCs. Methods. A retrospective study on women operated in our department for breast cancer between 2002 and 2005 was carried out. Patients were divided into three groups: women with MBC, SBC, and unilateral breast cancer (UBC). Moreover, we performed a meta-analysis of the English literature about multiple breast cancers between 2000 and 2011 taking into consideration their prevalence and overall survival (OS). Results. We identified 584 breast cancer patients: 16 women (3%) presented SBC and 40 MBC (7%, second cancer after 72-month follow-up IQR 40–145). Although the meta-analysis showed significant OS differences between MBC or SBC and UBC, we did not observe any significant OS difference among the three groups of our population. Anyway, we found a significant worse disease-free survival in MBC than UBC and a significant higher prevalence of radical surgery in MBC and SBC than UBC. Conclusions. Despite the low prevalence of MBC and SBC, the presence of a long time risk of MBC confirms the crucial role of ipsi- and contralateral mammographies in the postoperative follow-up.
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Chen JJ, Wang Y, Xue JY, Chen Y, Chen YL, Xiao Q, Yang WT, Shao ZM, Wu J. A clinicopathological study of early-stage synchronous bilateral breast cancer: a retrospective evaluation and prospective validation of potential risk factors. PLoS One 2014; 9:e95185. [PMID: 24736632 PMCID: PMC3988153 DOI: 10.1371/journal.pone.0095185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/24/2014] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the present study was to investigate potential risk factors for synchronous bilateral breast cancer sBBC). Methods A retrospective analysis was performed of patients diagnosed and treated with operable bilateral breast cancer (BBC) between June 2007 and December 2011. Risk factors for sBBC were evaluated in this cohort and further validated in a prospective observational validation analysis of patients between January 2012 and December 2012. Patients treated with operable unilateral breast cancer during the same period were used as a control group. Results A total of 11,247 patients with primary breast cancer underwent operations at the Fudan University Shanghai Cancer Center between June 2007 and December 2012. The incidence of sBBC was 1.6%. The age at diagnosis (HR = 2.4, 95% C.I.: 1.4–4.0, p = 0.001), presence of sclerosing adenosis (HR = 11.8, 95% C.I.: 5.3–26.3, p<0.001), lobular carcinoma component involvement (HR = 5.6, 95% C.I.: 2.6–12.1, p<0.001), and family history of first-degree relatives with breast cancer (HR = 2.0, 95% C.I.: 1.1–3.4, p<0.001) were independent risk factors for sBBC. A subsequent validation study failed to confirm the significance of family history. No significant difference on survival was found between patients with early-stage sBBC and control cases. Conclusions Patients with the presence of sclerosing in the affected breast, and lobular carcinoma component involvement may be at high risk for developing sBBC. This study supports the hypothesis that the host-carcinoma biological relationship, especially for the tumor microenvironment, played a critical role in the carcinogenesis of sBBC.
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Affiliation(s)
- Jia-jian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing-yan Xue
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-ling Chen
- Department of Ultrasound, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qin Xiao
- Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-tao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi-min Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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22
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Xing Y, Meng Q, Sun L, Chen X, Cai L. Survival analysis of patients with unilateral and bilateral primary breast cancer in Northeast China. Breast Cancer 2014; 22:536-43. [PMID: 24510639 DOI: 10.1007/s12282-014-0517-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous reports have shown that patients with bilateral primary breast cancer (BPBC) had comparable or moderately poor survival compared with patients experiencing unilateral primary breast cancer (UPBC). However, studies are conflicting in their analyses of correlations between survival and clinicopathological and prognostic characteristics in BPBC patients. The aim of our study was to compare the clinicopathological features and prognoses of BPBC and UPBC patients in Heilongjiang Province, northeast China. METHODS We retrospectively reviewed the records of 2,695 patients who underwent modified radical mastectomy or lumpectomy from 2005 to 2008 in the Tumor Hospital of Harbin Medical University. Eighty-one patients (3.0 %) had BPBC and 2,614 patients had UPBC. Multivariate analysis was performed using Cox's proportional hazards model. RESULTS There were significant differences between patients with BPBC and UPBC in the age of onset (referring to the age when the first tumor in BPBC was diagnosed), T stage, menopause status (referring to the age when the second tumor in BPBC was diagnosed), and breast cancer family history. The overall 5-year survival of patients with BPBC was 70.1 % compared with 87.1 % for patients with UPBC (p = 0.004). Furthermore, multivariate analysis showed that HER-2 status, menopause status, and mammary disease history were significant factors affecting survival among the patients with BPBC. CONCLUSIONS Our results confirmed previous findings that BPBC patients had moderately poor survival. However, when T stages were matched, BPBC patients had a survival rate similar to UPBC patients. Premenopause status, HER-2 positivity and family history of breast cancer were major risk factors for BPBC.
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Affiliation(s)
- Ying Xing
- The Fourth Department of Medicine Oncology, The Tumor Hospital of Harbin Medical University, Haping Road 150, Harbin, 150040, China
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23
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Lebris A, Vildé A, Marret H, Body G, Ouldamer L. [Role of imaging procedures in the diagnosis of synchronous bilateral breast cancer]. ACTA ACUST UNITED AC 2013; 42:14-9. [PMID: 24309024 DOI: 10.1016/j.gyobfe.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC) PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m(2)), preoperative breast imaging modalities used and their findings. RESULTS Of the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions. DISCUSSION AND CONCLUSION Clinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.
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Affiliation(s)
- A Lebris
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - A Vildé
- Département de radiologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France
| | - H Marret
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
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Liang X, Li D, Geng W, Cao X, Xiao C. The prognosis of synchronous and metachronous bilateral breast cancer in Chinese patients. Tumour Biol 2013; 34:995-1004. [PMID: 23296702 DOI: 10.1007/s13277-012-0636-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022] Open
Abstract
This study was undertaken to determine the differences in the clinicopathology and survival between synchronous bilateral breast cancer (sBBC) and metachronous bilateral breast cancer (mBBC). Additionally, we analyzed the risk factors for single tumors to develop as sBBC or mBBC. Of the 190 bilateral breast cancer (BBC) cases, 84 cases were sBBC and 106 were mBBC. We defined sBBC as two tumors that developed within 12 months, while mBBC was defined as two tumors that developed over more than 12 months. The peak age of onset of the first mBBC tumors was significantly younger than that of sBBC tumors (p = 0.001). There was a higher concordance rate of ER/ER positivity and PR/PR positivity in the first and second tumors of sBBC than mBBC. The two sBBC breast cancers had relatively similar hormone conditions because of the low rate of ER and PR transformation from positive to negative or vice versa. We determined that patients who presented with extracapsular extension (p = 0.008) and ER positivity (p = 0.001) tend to have synchronous cancers, while patients with 3+ HER2 were more likely to develop metachronous tumors. The prognosis for mBBC was better than that for sBBC when the survival time of mBBC was measured from the initial observation of the first tumors.
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Affiliation(s)
- Xinrui Liang
- The First Department of Breast Cancer, China Tianjin Breast Cancer Prevention, Treatment and Research center, Tianjin Medical University Cancer Institute and Hospital, West Beihuanhu Rd, Tianjin, 300060, People's Republic of China
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Chen SF, Du CW, Yang P, Zhang HW, Kwan M, Zhang GJ. The molecular and clinicopathologic characteristics of bilateral breast cancer. Sci Rep 2013; 3:2590. [PMID: 24005135 PMCID: PMC3763252 DOI: 10.1038/srep02590] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/19/2013] [Indexed: 02/05/2023] Open
Abstract
In this study, we compared the clinicopathologic characteristics between the bilateral breast cancer (BiBC) and unilateral breast cancer (UBC) and investigated the role of CXC chemokine receptor type 4 (CXCR4) in BiBC. 48 BiBC and 1650 UBC were studied. We found BiBC patients were associated with family history of cancer, invasive lobular histology in the first tumor and an advanced nodal status as compared with UBC patients with. Survival analysis indicated that BiBC was not associated with impaired survival. The time interval between the development of first breast cancer and the contralateral cancer did not correlate with the prognosis. Patients with BiBC were more likely to have bone metastasis (P = 0.011) and visceral metastasis (P < 0.001) than those with UBC. However, CXCR4 was not found in any association with poor clinical outcome and increasing visceral metastasis in BiBC patients.
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Affiliation(s)
- S. F. Chen
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou 515031, PR China
- These authors contributed equally to this work
| | - C. W. Du
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou 515031, PR China
- These authors contributed equally to this work
| | - P. Yang
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou 515031, PR China
| | - H. W. Zhang
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou 515031, PR China
| | - M. Kwan
- Department of Pathology, Liver Cancer and Hepatitis Research Laboratory, the University of Hong Kong, Hong Kong
| | - G. J. Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou 515031, PR China
- Cancer Research Center, Shantou University Medical College, No. 22 Xinling Road, Shantou 515041, PR China
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Synchronous bilateral breast carcinoma and axillary non-hodgkin lymphoma: a case report and review of the literature. Case Rep Oncol Med 2012; 2012:685919. [PMID: 23050177 PMCID: PMC3461627 DOI: 10.1155/2012/685919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/29/2012] [Indexed: 11/21/2022] Open
Abstract
The use of staging imaging modalities with increased sensitivity has led to an increase in the incidence of detection of simultaneous malignancies. These cases require careful evaluation and discussion in a multidisciplinary setting to establish a treatment plan that optimizes the outcome with respect to each malignancy, particularly when treatment modalities overlap. We report a case of a patient diagnosed with axillary nodal diffuse large B-cell lymphoma (DLBCL) in a community hospital where staging workup also revealed synchronous bilateral breast carcinomas. To our knowledge, this is only the second case report of a patient with three synchronous primary malignancies: bilateral breast carcinomas and axillary DLBCL. The only other similar case report had no role for radiation or chemotherapy in the management of the indolent follicular lymphoma.
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Shi YX, Xia Q, Peng RJ, Yuan ZY, Wang SS, An X, Cao Y, Tan YT, Jin Y, Cai XY, Sun YL, Teng XY, Liu DG, Jiang WQ. Comparison of clinicopathological characteristics and prognoses between bilateral and unilateral breast cancer. J Cancer Res Clin Oncol 2012; 138:705-14. [DOI: 10.1007/s00432-011-1141-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 12/22/2011] [Indexed: 12/24/2022]
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Fisher CS, Wachtel MS, Margenthaler JA. Outcomes for Patients who Develop Both Breast and Colorectal Cancer. Ann Surg Oncol 2011; 19:242-8. [DOI: 10.1245/s10434-011-1843-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Indexed: 11/18/2022]
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Setz-Pels W, Duijm LEM, Groenewoud JH, Louwman MWJ, Jansen FH, van Beek M, Plaisier ML, Voogd AC. Patient and tumor characteristics of bilateral breast cancer at screening mammography in the Netherlands, a population-based study. Breast Cancer Res Treat 2011; 129:955-61. [PMID: 21553118 DOI: 10.1007/s10549-011-1545-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
Few data are available on bilateral breast cancer in the screening population. The aim of this study was to determine patient and tumor characteristics of women with bilateral breast cancer at screening mammography. We included all 350,637 screening mammography examinations of women participating in a biennial screening program in a southern screening region of the Netherlands between May 1998 and January 2010. For referred women, all breast imaging reports, biopsy results, and surgery reports during one year after referral were collected. We compared patient and tumor characteristics of referred women with a diagnosis of bilateral breast cancer or unilateral breast cancer at workup. Bilateral or unilateral breast cancer had been diagnosed in respectively 40 (2.2%) and 1766 (97.8%) of 1806 referred women. Women with bilateral or unilateral breast cancer did not differ significantly in mean age, mammographic breast density, family history of breast cancer, or use of hormone replacement therapy. Compared with index cancers, contralateral cancers comprised significantly more lobular cancers (P = 0.02). Tumor size, mitotic activity, and estrogen receptor status were comparable for both groups, but contralateral cancers had a significantly lower risk of lymph node metastases (P = 0.03). Compared to unilateral breast cancer, contralateral malignancies in women with bilateral breast cancer comprised significantly more lobular cancers (P = 0.004) and lymph node negative cancers (P = 0.01). Contralateral breast cancers detected at screening comprise more lobular cancers and show less nodal involvement than index cancers or unilateral cancers. No differences are observed with respect to other patient and tumor characteristics.
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Affiliation(s)
- Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands.
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