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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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Nationwide Trends in Contralateral Prophylactic Mastectomies: An Analysis of 55,060 Unilateral Breast Cancer Patients. Plast Reconstr Surg Glob Open 2022; 10:e4344. [PMID: 35646492 PMCID: PMC9132527 DOI: 10.1097/gox.0000000000004344] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
Background: The effects of recent initiatives to better educate unilateral breast cancer (UBC) patients about contralateral prophylactic mastectomy (CPM) have not been fully examined. The purpose of this study was to update and examine recent annual CPM trends by evaluating 2015–2020 data from a large administrative claims database. We also sought to determine if there were any variations in trends among different age groups and reconstructive modalities. Methods: Patients diagnosed with UBC between 2015 and 2019 were identified in Optum Clinformatics DataMart. Patients were then categorized by age group, whether they underwent CPM, whether they underwent breast reconstruction (BR), timing of any BR (immediate or delayed), and type of BR (implant-based or autologous). Results: Of 55,060 patients who were diagnosed with UBC, 2625 (4.8%) underwent CPM. After a slight decline from 2015 to 2016, the CPM rate among UBC patients increased significantly from 3.4% in 2016 to 6.8% in 2019. Although this upward trend remained consistent across all age groups examined, younger UBC patients represented a significantly higher and faster growing percentage of those undergoing CPM. BR rates among those who underwent CPM also increased between 2015 and 2019, with implant-based and immediate BR becoming more heavily favored over autologous and delayed BR. Conclusions: CPM rates continued to rise between 2016 and 2019 and younger women represented a substantially higher and faster growing percentage of UBC patients undergoing CPM than older women. In addition, implant-based and immediate BR are becoming more heavily favored over autologous and delayed BR.
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Gonzalez A, Del Greco F, Vargas-Roig L, Brun B, Tabares G, Mampel A, Montes C, Martin C, Lopez M, Rossi N, Bruno L, Ponce C, Quaglio P, Yanzi A, Acevedo S, Lugo L, Lopez Breccia P, Avila S, Sisterna S, Del Castillo MS, Vazquez M, Nuñez LM. PALB2 germline mutations in a multi-gene panel testing cohort of 1905 breast-ovarian cancer patients in Argentina. Breast Cancer Res Treat 2022; 194:403-412. [PMID: 35610400 DOI: 10.1007/s10549-022-06620-5] [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: 12/17/2021] [Accepted: 04/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE PALB2 variants have been scarcely described in Argentinian and Latin-American reports. In this study, we describe molecular and clinical characteristics of PALB2 mutations found in multi-gene panels (MP) from breast-ovarian cancer (BOC) families in different institutions from Argentina. METHODS We retrospectively identified PALB2 pathogenic (PV) and likely pathogenic (LPV) variants from a cohort of 1905 MP results, provided by one local lab (Heritas) and SITHER (Hereditary Tumor Information System) public database. All patients met hereditary BOC clinical criteria for testing, according to current guidelines. RESULTS The frequency of PALB2 mutations is 2.78% (53/1905). Forty-eight (90.5%) are PV and five (9.5%) are LPV. Most of the 18 different mutations (89%) are nonsense and frameshift types and 2 variants are novel. One high-rate recurrent PV (Y551*) is present in 43% (23/53) of the unrelated index cases. From the 53 affected carriers, 94% have BC diagnosis with 14% of bilateral cases. BC phenotype is mainly invasive ductal (78%) with 62% of hormone-receptor positive and 22% of triple negative tumors. Self-reported ethnic background of the cohort is West European (66%) and native Latin-American (20%) which is representative of Buenos Aires and other big urban areas of the country. CONCLUSION This is the first report describing molecular and clinical characteristics of PALB2 carriers in Argentina. Frequency of PALB2 PV in Argentinian HBOC families is higher than in other reported populations. Y551* is a recurrent mutation that seems to be responsible for almost 50% of PALB2 cases.
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Affiliation(s)
| | | | | | | | | | | | - Cecilia Montes
- Instituto Modelo de Ginecología Y Obstetricia, Córdoba, Argentina
| | - Claudia Martin
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Norma Rossi
- Fundación Para el Progreso de La Medicina, Córdoba, Argentina
| | - Luisina Bruno
- Instituto de Oncología Alexander Fleming, Buenos Aires, Argentina
| | - Carolina Ponce
- Instituto de Oncología Alexander Fleming, Buenos Aires, Argentina
| | | | | | | | - Lilia Lugo
- Clínica San Gerónimo, Santa Fe, Argentina
| | | | - Silvia Avila
- Facultad de Ciencias Médicas, Universidad Nacional del Comahue, Neuquén, Argentina.,Heritas - CONICET, Rosario, Argentina.,Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Lina M Nuñez
- Hospital Alemán de Buenos Aires, Buenos Aires, Argentina.
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Addae JK, Genuit T, Colletta J, Schilling K. Case of second primary breast cancer in ectopic breast tissue and review of the literature. BMJ Case Rep 2021; 14:14/4/e241361. [PMID: 33832937 PMCID: PMC8039241 DOI: 10.1136/bcr-2020-241361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Accessory breast tissue (ABT) is found in approximately 2%-6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.
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Affiliation(s)
- Jamin Kweku Addae
- General Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Thomas Genuit
- General Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Joseph Colletta
- Breast Surgery, Lynn Women's Health and Wellness Institute, Boca Raton, Florida, USA
| | - Kathy Schilling
- Breast Imaging, Lynn Women's Health and Wellness Institute, Boca Raton, Florida, USA
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Ramin C, Withrow DR, Davis Lynn BC, Gierach GL, Berrington de González A. Risk of contralateral breast cancer according to first breast cancer characteristics among women in the USA, 1992-2016. Breast Cancer Res 2021; 23:24. [PMID: 33596988 PMCID: PMC7890613 DOI: 10.1186/s13058-021-01400-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background Estimates of contralateral breast cancer (CBC) risk in the modern treatment era by year of diagnosis and characteristics of the first breast cancer are needed to assess the impact of recent advances in breast cancer treatment and inform clinical decision making. Methods We examined CBC risk among 419,818 women (age 30–84 years) who were diagnosed with a first unilateral invasive breast cancer and survived ≥ 1 year in the US Surveillance, Epidemiology, and End Results program cancer registries from 1992 to 2015 (follow-up through 2016). CBC was defined as a second invasive breast cancer in the contralateral breast ≥ 12 months after the first breast cancer. We estimated standardized incidence ratios (SIRs) of CBC by year of diagnosis, age at diagnosis, and tumor characteristics for the first breast cancer. Cumulative incidence of CBC was calculated for women diagnosed with a first breast cancer in the recent treatment era (2004–2015, follow-up through 2016). Results Over a median follow-up of 8 years (range 1–25 years), 12,986 breast cancer patients developed CBC. Overall, breast cancer patients had approximately twice the risk of developing cancer in the contralateral breast when compared to that expected in the general population (SIR = 2.21, 95% CI = 2.17–2.25). SIRs for CBC declined by year of first diagnosis, irrespective of age at diagnosis and estrogen receptor (ER) status (p-trends < 0.001), but the strongest decline was after an ER-positive tumor. The 5-year cumulative incidence of CBC ranged from 1.01% (95% CI = 0.90–1.14%) in younger women (age < 50 years) with a first ER-positive tumor to 1.89% (95% CI = 1.61–2.21%) in younger women with a first ER-negative tumor. Conclusion Declines in CBC risk are consistent with continued advances in breast cancer treatment. The updated estimates of cumulative incidence inform breast cancer patients and clinicians on the risk of CBC and may help guide treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01400-3.
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Affiliation(s)
- Cody Ramin
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Diana R Withrow
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brittny C Davis Lynn
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gretchen L Gierach
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy Berrington de González
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer 2020; 28:1195-1211. [PMID: 32959120 DOI: 10.1007/s12282-020-01157-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this article is to overview the existing breast cancer screening guidelines for women at high risk from world-leading specialty societies. Accumulation of evidence and development of accessible genetic testing strategies have changed the idea of breast cancer screening for high-risk women. Personalized tailor-made screening adjusted for risk factors has been conducted in accordance with guidelines. The use of imaging modalities other than mammography including contrast-enhanced MRI and other various strategies for improving screening are discussed. The present review also mentions the existing challenges in high-risk screening and the latest information based on two large-scale studies.
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7
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Jewett PI, Vogel RI, Schroeder MC, Neuner JM, Blaes AH. Parental Status in Treatment Decision Making among Women with Nonmetastatic Breast Cancer. Med Decis Making 2020; 40:540-544. [PMID: 32431228 DOI: 10.1177/0272989x20918606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Having dependent children may affect cancer treatment decisions. We sought to describe women's surgery and chemotherapy decisions in nonmetastatic breast cancer by parental status. Methods. We conducted a secondary analysis of the 2015 cross-sectional Share Thoughts on Breast Cancer Study, conducted in 7 Midwestern states in the United States, restricted to women of prime parenting age (aged 20-50 years) who consented to the use of their medical records (N = 225). We examined treatment decisions using data visualization and logistic regression (adjusted for age, stage, family history of breast cancer, income, education, race, health insurance, and partner status). Results. Women with dependent children received bilateral mastectomy more often than women without dependent children (adjusted odds ratio 3.09, 95% confidence interval 1.44-6.62).We found no differences in the receipt of chemotherapy by parental status. Women reported more active roles in surgery than in chemotherapy decision making. Conclusions. As a likely factor in cancer treatment decisions, parental status should be addressed in clinical practice and research. Future research should assess patients' sense of ownership in treatment decision making by treatment type.
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Affiliation(s)
- Patricia I Jewett
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rachel I Vogel
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Mary C Schroeder
- Division of Health Services Research, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Joan M Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anne H Blaes
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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8
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Corredor J, Woodson AH, Gutierrez Barrera A, Arun B. Multigene panel testing results in patients with multiple breast cancer primaries. Breast J 2020; 26:1337-1342. [DOI: 10.1111/tbj.13762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Corredor
- Clinical Cancer Genetics The University of Texas MD Anderson Cancer Center Houston Texas
| | - Ashley H. Woodson
- Clinical Cancer Genetics The University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Banu Arun
- Clinical Cancer Genetics The University of Texas MD Anderson Cancer Center Houston Texas
- Breast Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas
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Kurian AW, Canchola AJ, Ma CS, Clarke CA, Gomez SL. Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015. Cancer 2019; 126:958-970. [PMID: 31750934 DOI: 10.1002/cncr.32618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increasingly, patients with breast cancer undergo bilateral mastectomy (BLM). To the authors' knowledge, the magnitude of benefit is unknown. METHODS The authors used data from the Surveillance, Epidemiology, and End Results (SEER) program regarding all women diagnosed with American Joint Committee on Cancer stage 0 to stage III unilateral breast cancer in California from 1998 through 2015 and treated with BLM versus breast-conserving therapy including surgery and radiotherapy (BCT) or unilateral mastectomy (ULM). The authors measured relative risks of second contralateral breast cancer (CBC) and breast cancer death using Fine and Gray multivariable regression modeling adjusted for the competing risk of death and death from another cause, respectively, and potential confounding factors. Absolute excess risk of CBC was measured as the observed minus expected number of breast cancers in the general population divided by 10,000 person-years at risk. RESULTS Among 245,418 patients with a median follow-up of 6.7 years, 7784 patients (3.2%) developed CBC. Relative risks were lower after BLM (hazard ratio [HR], 0.10; 95% CI, 0.07-0.14) and higher after ULM (HR, 1.07; 95% CI, 1.02-1.13) versus BCT. Absolute excess risks were higher after BCT and ULM (5.0 and 13.6 more cases, respectively) compared with BLM (28.6 fewer cases). BLM reduced risk more among older women (38.0 fewer cases for women aged ≥50 years vs 17.9 fewer cases among women aged <50 years) but provided similar risk reduction across categories of tumor grade and tumor hormone receptor status. Compared with BCT, the risk of breast cancer death was equivalent after BLM (HR, 1.03; 95% CI, 0.96-1.11) and higher after ULM (HR, 1.21; 95% CI, 1.17-1.25). CONCLUSIONS BLM may reduce second breast cancer risk by 34 to 43 cases per 10,000 person-years compared with other surgical procedures, but is not associated with a lower risk of death. Second breast cancers are rare, and their reduction should be weighed against the harms associated with BLM.
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Affiliation(s)
- Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Cindy S Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christina A Clarke
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,GRAIL, Menlo Park, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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Moskowitz CS, Chou JF, Neglia JP, Partridge AH, Howell RM, Diller LR, Novetsky Friedman D, Barnea D, Morton LM, Turcotte LM, Arnold MA, Leisenring WM, Armstrong GT, Robison LL, Oeffinger KC, Henderson TO. Mortality After Breast Cancer Among Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2120-2130. [PMID: 31260644 DOI: 10.1200/jco.18.02219] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Female survivors of childhood cancer have a high risk of subsequent breast cancer. We describe the ensuing risk for mortality and additional breast cancers. PATIENTS AND METHODS Female participants in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancer diagnosed between 1970 and 1986 before age 21 years, and subsequently diagnosed with breast cancer (n = 274; median age at breast cancer diagnosis, 38 years; range, 20 to 58 years) were matched to a control group (n = 1,095) with de novo breast cancer. Hazard ratios (HRs) and 95% CIs were estimated from cause-specific proportional hazards models. RESULTS Ninety-two childhood cancer survivors died, 49 as a result of breast cancer. Overall survival after breast cancer was 73% by 10 years. Subsequent risk of death as a result of any cause was higher among childhood cancer survivors than among controls (HR, 2.2; 95% CI, 1.7 to 3.0) and remained elevated after adjusting for breast cancer treatment (HR, 2.4; 95% CI, 1.7 to 3.2). Although breast cancer-specific mortality was modestly elevated among childhood cancer survivors (HR, 1.3; 95% CI, 0.9 to 2.0), survivors were five times more likely to die as a result of other health-related causes, including other subsequent malignant neoplasms and cardiovascular or pulmonary disease (HR, 5.5; 95% CI, 3.4 to 9.0). The cumulative incidence of a second asynchronous breast cancer also was elevated significantly compared with controls (P < .001). CONCLUSION Mortality after breast cancer was higher in childhood cancer survivors than in women with de novo breast cancer. This increased mortality reflects the burden of comorbidity and highlights the need for risk-reducing interventions.
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Affiliation(s)
| | - Joanne F Chou
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P Neglia
- 2University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | | | | | | | | | - Dana Barnea
- 5Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | | | | | | | | - Tara O Henderson
- 11The University of Chicago Medicine Comer Children's Hospital, Chicago, IL
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11
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Age-related risk factors associated with primary contralateral breast cancer among younger women versus older women. Breast Cancer Res Treat 2018; 173:657-665. [PMID: 30377870 DOI: 10.1007/s10549-018-5031-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/27/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Contralateral prophylactic mastectomy is increasing, despite unclear evidence of improving survival. To investigate the age-related risk factors for contralateral breast cancer (CBC). METHODS This study included 8716 patients diagnosed with non-metastatic unilateral invasive breast cancer between 1989 and 2008. Data on primary tumor size, node metastasis, grade and subtype using individual matching were used to adjust for differences in the primary tumor and treatment between younger and older age groups. CBC risk factors, CBC-free survival, and annual CBC risk were analyzed by age. RESULTS The younger group included 652 patients aged under 35 years, and the older group included 2608 women aged 35 years or older. The median time to CBC development was 6.1 years. CBC was detected in 6.6% of the women in the younger group and 2.5% of those in the older group. Multivariable analysis revealed a relative CBC risk of 2.48 in younger women compared to older women. The risk was significantly higher among women with human epidermal growth factor receptor 2 (HER2)-overexpressing tumors (hazard ratio [HR] 4.98), a family history of breast cancer (HR 7.79), and anti-hormone therapy (HR 3.46). In younger women with HER2-positive cancer, CBC occurrence peaked at 4.6 years after surgery, in those with hormone receptor-positive cancer, it peaked at 7.1 years after surgery, and in triple-negative disease cases, and it increased steadily over time. CONCLUSIONS After adjusting for primary breast tumor characteristics, patients < 35 years old had 2.5 times the risk of CBC development compared to the older women. CBC occurrence peaked within 5 years after primary breast cancer in younger women with the HER2-positive subtype and after 5 years in cases with the hormone receptor-positive subtype.
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12
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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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13
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Corso G, Maisonneuve P, Santomauro G, De Scalzi A, Toesca A, Bassi F, Farante G, Caldarella P, Intra M, Galimberti V, Veronesi P. Ipsilateral Breast Tumor Reappearance and Contralateral Breast Cancer after Primary Breast Cancer Treatment: A Comprehensive Retrospective Study of 15,168 Patients. Oncology 2018; 95:147-155. [DOI: 10.1159/000488764] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/22/2018] [Indexed: 01/29/2023]
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14
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Jacob LA, Anand A, Lakshmaiah KC, Babu GK, Lokanatha D, Suresh Babu MS, Lokesh KN, Rudresha AH, Rajeev LK, Koppaka D. Clinicopathological Profile and Treatment Outcomes of Bilateral Breast Cancer: A Study from Tertiary Cancer Center in South India. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_56_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Bilateral breast cancer (BBC) is a rare clinical entity with limited data regarding clinicopathological aspects and treatment guidelines. Materials and Methods: This was an observational study of patients diagnosed with BBC from August 2012 to July 2014. Synchronous breast cancers (SBCs) was defined as two tumors diagnosed within an interval of 6 months and metachronous breast cancer (MBC) as second cancer diagnosed after 6 months. Results: Out of 750 breast cancer patients seen during a 2-year period, 35 had BBC. Ten patients were diagnosed as SBC whereas 25 patients as MBC. Among patients with MBC, the average time for development of contralateral breast cancer was 5 years. In 8 patients, the contralateral breast cancer was detected mammography whereas rest 27 patients were detected by clinical breast examination. At a median follow-up of 24 months, 23 (66%) patients were disease free, 9 (26%) patients had disease relapse, and 3 (8%) patients succumbed to the progressive disease. Conclusions: Every patient with breast cancer should be regularly followed up with clinical breast examination at a more frequent interval. The role of frequent clinical breast examination appears more than mammography especially beyond 5 years for early detection of contralateral breast cancer.
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Affiliation(s)
- Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Abhishek Anand
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Govind K. Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Dasappa Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - M.C. Suresh Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Kadabur N. Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - L K. Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Deepak Koppaka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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15
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See MH, Bhoo-Pathy N, Jamaris S, Kiran A, Evans DG, Yip CH, Taib NA. Low Lifetime Risk of Contralateral Breast Cancer in a Middle-Income Asian Country: Evidence to Guide Post-treatment Surveillance. World J Surg 2017; 42:1270-1277. [PMID: 29124356 DOI: 10.1007/s00268-017-4319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The rate of contralateral risk-reducing mastectomy (CRRM) is increasing in the West with controversial evidence of improved survival in early breast cancer patients. Although uptake of CRRM in Asia appears low, the trends may rise, and there is currently an urgent need to provide evidence for informed decision-making in clinical practice. This study aims to determine the risk of contralateral breast cancer (CBC) and its associated factors in an Asian setting. METHOD A total of 2937 newly diagnosed patients with stage I and stage II breast cancer in University Malaya Medical Centre between Jan 1993 to Dec 2012 were included in the study. Multinomial logistic regression analysis allowing death to compete with CBC as a study outcome was used; patients with unilateral breast cancer who were alive were taken as reference. A stepwise backward regression analysis including age at diagnosis, ethnicity, family history of breast cancer, TNM stage, hormonal receptor status, HER2 status, chemotherapy, radiotherapy, and hormone therapy was conducted. RESULTS Fifty women developed CBC, over a median follow-up of 6 years. The 5- and 10-year cumulative risk of contralateral breast cancer was 1.0% (95% CI 0.6-1.4%) and 2.8% (95% CI 2.0-3.6%), respectively. Young age at diagnosis of first cancer, positive family history, and stage I disease were independent predictors of CBC. DISCUSSION The current study suggests that the risk of CBC is very low in a Southeast Asian setting. Any recommendations or practice of CRRM should be reviewed with caution and patients must be counseled appropriately.
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Affiliation(s)
- M H See
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - N Bhoo-Pathy
- Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - S Jamaris
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - A Kiran
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - D G Evans
- Division of Evolution and Genomic Sciences, St Mary's Hospital, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C H Yip
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - N A Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia.
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16
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Miller ME, Muhsen S, Olcese C, Patil S, Morrow M, Van Zee KJ. Contralateral Breast Cancer Risk in Women with Ductal Carcinoma In Situ: Is it High Enough to Justify Bilateral Mastectomy? Ann Surg Oncol 2017; 24:2889-2897. [PMID: 28766208 DOI: 10.1245/s10434-017-5931-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Women with ductal carcinoma in situ (DCIS) are increasingly choosing bilateral mastectomy. We sought to quantify rates of contralateral breast cancer (CBC) and ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) for DCIS, and to compare risk factors for CBC and IBTR. METHODS From 1978 to 2011, DCIS patients undergoing BCS with a contralateral breast at risk were identified from a prospectively maintained database. The association of clinicopathologic and treatment factors with CBC and IBTR were evaluated using Kaplan-Meier analysis, multivariable Cox regression, and competing risk regression (CRR). RESULTS Of 2759 patients identified, 151 developed CBC and 344 developed IBTR. Five- and 10-year Kaplan-Meier CBC rates were 3.2 and 6.4%. Overall, 10-year IBTR rates were 2.5-fold higher than CBC rates, and, without radiation, 4-fold higher. On CRR, 5- and 10-year rates were 2.9 and 5.8% for CBC, and 7.8 and 14.5% for IBTR. CBC risk and invasive CBC risk were not significantly associated with age, family history, presentation, nuclear grade, year of surgery, or radiation. By multivariable Cox regression, endocrine therapy was associated with lower CBC risk (hazard ratio 0.57, p = 0.03). Ten-year risk of subsequent CBC in the subset of patients who developed IBTR was similar to the cohort as a whole (8.1 vs. 6.4%). CONCLUSIONS CBC rates were low across all groups, including those who experienced IBTR. CBC was not associated with factors that increase IBTR risk. While factors associated with IBTR risk are important in decision making regarding management of the index DCIS, they are not an indication for contralateral prophylactic mastectomy.
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Affiliation(s)
- Megan E Miller
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Muhsen
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Olcese
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Medical College at Cornell University, 300 East 66th Street, New York, NY, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Medical College at Cornell University, 300 East 66th Street, New York, NY, USA.
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17
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Jmour O, Belaïd A, Mghirbi F, Béhi K, Doghri R, Benna F. Gastric metastasis of bilateral breast cancer. J Gastrointest Oncol 2017; 8:E16-E20. [PMID: 28280631 DOI: 10.21037/jgo.2016.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Breast cancer is the most common malignancy in women. The most frequent metastatic sites are lung, bone, liver and brain. On the other hand, gastric metastases are rare. Synchronous bilateral breast cancer (SBBC) occurs rarely. Lobular carcinoma is the histological type most often associated with bilateral breast carcinomas and gastric metastases. We made a retrospective study including four patients followed in the Salah Azaiez Institute, for a bilateral breast cancer with gastric metastases. We analyzed the epidemiological, anatomoclinical and therapeutic particularities of this rare entity. Symptoms were unspecific. The diagnosis of gastric metastasis of the SBBC was confirmed by a histopathological examination of an endoscopic biopsy. The median age was 46.2 years (range, 36-51 years) and the median time until the gastric involvement was 19 months (range, 0-41 months). None of patients had a surgical treatment for the gastric location. All Patients received at least one line of chemotherapy and radiotherapy. Median survival following the detection of gastric involvement was 22 months (range, 1-56 months). Gastric metastases from breast cancer are rare and frequently associated with other distant metastasis. Symptoms are unspecific and endoscopy may not be contributive. Therefore, gastric involvement is underestimated. Lobular infiltrating carcinoma (LIC) is the most histological type incriminated in its occurrence. The supply of immunohistochemistry is crucial to distinguish between primary or metastatic gastric cancer.
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Affiliation(s)
- Omar Jmour
- Department of Radiation Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Asma Belaïd
- Department of Radiation Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Fahmi Mghirbi
- Department of Medical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Khalil Béhi
- Department of Medical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Raoudha Doghri
- Department of Pathology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Farouk Benna
- Department of Radiation Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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18
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Dellapasqua S. Systemic Treatment for Specific Medical Situations. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Shanmugalingam T, Bosco C, Ridley AJ, Van Hemelrijck M. Is there a role for IGF-1 in the development of second primary cancers? Cancer Med 2016; 5:3353-3367. [PMID: 27734632 PMCID: PMC5119990 DOI: 10.1002/cam4.871] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 06/08/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022] Open
Abstract
Cancer survival rates are increasing, and as a result, more cancer survivors are exposed to the risk of developing a second primary cancer (SPC). It has been hypothesized that one of the underlying mechanisms for this risk could be mediated by variations in insulin-like growth factor-1 (IGF-1). This review summarizes the current epidemiological evidence to identify whether IGF-1 plays a role in the development of SPCs. IGF-1 is known to promote cancer development by inhibiting apoptosis and stimulating cell proliferation. Epidemiological studies have reported a positive association between circulating IGF-1 levels and various primary cancers, such as breast, colorectal, and prostate cancer. The role of IGF-1 in increasing SPC risk has been explored less. Nonetheless, several experimental studies have observed a deregulation of the IGF-1 pathway, which may explain the association between IGF-1 and SPCs. Thus, measuring serum IGF-1 may serve as a useful marker in assessing the risk of SPCs, and therefore, more translational experimental and epidemiological studies are needed to further disentangle the role of IGF-1 in the development of specific SPCs.
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Affiliation(s)
- Thurkaa Shanmugalingam
- Division of Cancer StudiesCancer Epidemiology GroupKing's College LondonLondonUnited Kingdom
| | - Cecilia Bosco
- Division of Cancer StudiesCancer Epidemiology GroupKing's College LondonLondonUnited Kingdom
| | - Anne J. Ridley
- Randall Division of Cell and Molecular BiophysicsKing's College LondonLondonUnited Kingdom
| | - Mieke Van Hemelrijck
- Division of Cancer StudiesCancer Epidemiology GroupKing's College LondonLondonUnited Kingdom
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20
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Delcoigne B, Hagenbuch N, Schelin ME, Salim A, Lindström LS, Bergh J, Czene K, Reilly M. Feasibility of reusing time-matched controls in an overlapping cohort. Stat Methods Med Res 2016; 27:1818-1829. [PMID: 27659169 DOI: 10.1177/0962280216669744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The methods developed for secondary analysis of nested case-control data have been illustrated only in simplified settings in a common cohort and have not found their way into biostatistical practice. This paper demonstrates the feasibility of reusing prior nested case-control data in a realistic setting where a new outcome is available in an overlapping cohort where no new controls were gathered and where all data have been anonymised. Using basic information about the background cohort and sampling criteria, the new cases and prior data are "aligned" to identify the common underlying study base. With this study base, a Kaplan-Meier table of the prior outcome extracts the risk sets required to calculate the weights to assign to the controls to remove the sampling bias. A weighted Cox regression, implemented in standard statistical software, provides unbiased hazard ratios. Using the method to compare cases of contralateral breast cancer to available controls from a prior study of metastases, we identified a multifocal tumor as a risk factor that has not been reported previously. We examine the sensitivity of the method to an imperfect weighting scheme and discuss its merits and pitfalls to provide guidance for its use in medical research studies.
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Affiliation(s)
- Bénédicte Delcoigne
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niels Hagenbuch
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Ec Schelin
- 2 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agus Salim
- 3 Department of Mathematics and Statistics, La Trobe University, Victoria, Australia
| | - Linda S Lindström
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,4 Department of Surgery, University of California, San Francisco, CA, USA
| | - Jonas Bergh
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Reilly
- 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Prater J, Valeri F, Korol D, Rohrmann S, Dehler S. Incidence of metachronous contralateral breast cancer in the Canton of Zurich: a population-based study of the cancer registry. J Cancer Res Clin Oncol 2015; 142:365-71. [DOI: 10.1007/s00432-015-2031-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/15/2015] [Indexed: 10/23/2022]
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22
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Jobsen JJ, van der Palen J, Ong F, Riemersma S, Struikmans H. Bilateral breast cancer, synchronous and metachronous; differences and outcome. Breast Cancer Res Treat 2015; 153:277-83. [DOI: 10.1007/s10549-015-3538-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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23
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Basu NN, Barr L, Ross GL, Evans DG. Contralateral risk-reducing mastectomy: review of risk factors and risk-reducing strategies. Int J Surg Oncol 2015; 2015:901046. [PMID: 25692038 PMCID: PMC4322656 DOI: 10.1155/2015/901046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 12/24/2022] Open
Abstract
Rates of contralateral risk-reducing mastectomy have increased substantially over the last decade. Surgical oncologists are often in the frontline, dealing with requests for this procedure. This paper reviews the current evidence base regarding contralateral breast cancer, assesses the various risk-reducing strategies, and evaluates the cost-effectiveness of contralateral risk-reducing mastectomy.
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Affiliation(s)
- N. N. Basu
- Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK
- Department of Breast Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - L. Barr
- Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - G. L. Ross
- The Institute of Cancer Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - D. G. Evans
- Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK
- University of Manchester Department of Genomic Medicine, Institute of Human Development, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
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24
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Risk of second cancers cancer after a first primary breast cancer: a systematic review and meta-analysis. Gynecol Oncol 2014; 136:158-71. [PMID: 25448459 DOI: 10.1016/j.ygyno.2014.10.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the scientific evidence and the risk of second primary cancers in women diagnosed with a first primary breast cancer. METHODS The literature was searched in Pubmed and Embase and included studies published up to June 2013, using population-based data and IARC/AICR codification rules for multiple primary cancers. A qualitative synthesis was carried out and the methodological quality of the studies evaluated. Standardised incidence ratios (SIRs) on second cancer risk, weighted by the standard error of each study, were pooled using fixed and random effects models. SIRs were also pooled by age at diagnosis (<50 and ≥ 50 years), and time since diagnosis of the first breast cancer (<10 and ≥ 10 years). RESULTS 15 out of 710 articles fulfilled the inclusion criteria. All of them were retrospective cohort studies either population-based (13 studies) or hospital-based studies (2 studies). The studies varied with respect to number of cases, selection criteria, definition of multiple primary cancers, and the second cancer sites included. SIRs reported in these studies for all cancers combined varied from 1.0 to 1.4. The pooled SIR estimate for second cancer risk was 1.17 (95% CI: 1.10-1.25). By age groups, SIR estimates were 1.51 (95% CI: 1.35-1.70) for women younger than 50 years and 1.11 (95% CI: 1.02-1.21) for those who were older. Women with breast cancer are at risk of second cancers within the first 10 years after the first breast cancer diagnosis (SIR: 1.19; 95% CI: 1.06-1.33), and thereafter (SIR: 1.26; 95% CI: 1.05-1.52). CONCLUSION This higher risk of second cancers in women diagnosed with a first primary breast cancer with respect to the general population emphasises the importance of prevention and control policies aimed at reducing incidence of second cancers.
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25
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Rasmussen CB, Kjær SK, Ejlertsen B, Andersson M, Jensen MB, Christensen J, Langballe R, Mellemkjær L. Incidence of metachronous contralateral breast cancer in Denmark 1978–2009. Int J Epidemiol 2014; 43:1855-64. [DOI: 10.1093/ije/dyu202] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Xia C, Schroeder MC, Weigel RJ, Sugg SL, Thomas A. Rate of contralateral prophylactic mastectomy is influenced by preoperative MRI recommendations. Ann Surg Oncol 2014; 21:4133-8. [PMID: 24934585 DOI: 10.1245/s10434-014-3852-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Women with breast cancer increasingly undergo contralateral prophylactic mastectomy (CPM). We evaluated the relationship between preoperative magnetic resonance imaging (MRI) findings and CPM. Other clinicopathologic variables associated with CPM choice and the pathology found in the contralateral breast are also reported. METHODS Newly diagnosed breast cancer patients were prospectively enrolled in the University of Iowa Breast Molecular Epidemiology Resource. Patients with stages 0-III breast cancer who underwent mastectomy for the index cancer were eligible for this analysis. Univariate logistic regression and a multivariate model were used to identify factors predictive of CPM. RESULTS Among 134 patients (mean age 54.9 years), 53 (39.6 %) chose CPM. On univariate analysis, patients undergoing CPM were more likely to have a preoperative breast MRI (64.2 vs. 39.5 %, p = 0.006) and to have follow-up testing recommended for the contralateral breast (28.3 vs. 4.9 %, p = 0.001). Univariate analysis also associated CPM with younger age (p < 0.0001), BRCA testing (p < 0.0001), BRCA mutation (p = 0.034) and reconstruction performed (p = 0.001). Median age of youngest child at diagnosis varied significantly between the CPM (15.9 years) and non-CPM (24.3 years) groups (p = 0.0018). On multivariate analysis, MRI follow-up recommendation, young age, reconstruction and human epidermal growth factor receptor 2 (HER2) positivity of the index cancer were significantly associated with CPM. Of the CPM specimens, one (1.8 %) had ductal carcinoma-in situ, which had not been identified on MRI. CONCLUSIONS Abnormal findings in the contralateral breast on preoperative MRI, as well as young age, reconstruction and HER2-positive status correlated with CPM choice in this cohort. Occult malignancy was rare.
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Affiliation(s)
- Chang Xia
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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27
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Bleicher RJ. Breast magnetic resonance imaging as it is, in contrast to how we wish it to be. J Clin Oncol 2014; 32:370-2. [PMID: 24395864 DOI: 10.1200/jco.2013.54.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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28
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Yao K, Winchester DJ, Czechura T, Huo D. Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998-2002. Breast Cancer Res Treat 2013; 142:465-76. [PMID: 24218052 DOI: 10.1007/s10549-013-2745-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022]
Abstract
The use of contralateral prophylactic mastectomy (CPM) has been increasing despite questionable survival benefit. We examined the effect of CPM on survival using the National Cancer Data Base. We examined overall survival on 219,983 mastectomy patients diagnosed with unilateral AJCC Stage 1-III invasive breast cancer between 1998 and 2002 of which 14,994 (7 %) underwent CPM at the time of their index mastectomy. Median follow up time was 5 years. Neoadjuvant and locally advanced breast cancers were excluded. Approximately 4 % underwent CPM in 1998 compared to 9.4 % in 2002, an ~125 % increase. CPM patients were significantly younger than non-CPM patients, on managed care plans, and were treated at high volume centers. The unadjusted hazard ratio (HR) of death was 0.55 (95 % CI 0.52-0.57) for CPM compared to unilateral mastectomy. In a multivariable Cox model adjusting for age, race, stage, grade, histology, insurance, facility characteristics, use of adjuvant hormonal, chemotherapy, and radiotherapy, and year of diagnosis, the adjusted HR was 0.88 (95 % CI 0.83-0.93; p < 0.001) which translated into an absolute 5-year benefit of 2 %. There was a differential effect of CPM by stage and age: HR = 0.88 (95 % CI 0.82-0.94; p < 0.001) in women younger than 70 with stage I/II, and HR = 0.95 (95 % CI 0.88-1.04; p = 0.28) in women with stage III or older than age 69 which translated into an absolute 5-year benefit of 1.3 %. Utilization of hormonal therapy or chemotherapy had no effect on the HR. After adjusting for confounding, the overall survival benefit for CPM is minimal at best.
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Affiliation(s)
- Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA,
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29
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Abstract
PURPOSE To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population. METHODS Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months. RESULTS Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service. CONCLUSIONS The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.
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30
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Lizarraga IM, Sugg SL, Weigel RJ, Scott-Conner CEH. Review of risk factors for the development of contralateral breast cancer. Am J Surg 2013; 206:704-8. [PMID: 24016706 DOI: 10.1016/j.amjsurg.2013.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/29/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Women treated for breast cancer have an increased risk for developing metachronous contralateral breast cancer (CBC). Patient perception of this risk is often overestimated and has been found to contribute to the decision to undergo contralateral prophylactic mastectomy. An individual's risk is dependent on both patient and tumor characteristics. This review examines and summarizes the current literature on the factors that affect CBC risk. DATA SOURCES English-language publications with the keyword "contralateral breast cancer" were identified through a MEDLINE literature search. CONCLUSIONS The global incidence of CBC is decreasing, a trend that is attributed to more effective adjuvant therapies. Patients with BRCA germ-line mutations demonstrate the highest risk for CBC. In the absence of known genetic mutations, patients with strong family histories who are diagnosed at young ages (<35 years) with estrogen receptor-negative index tumors appear to have a higher incidence of CBC.
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Affiliation(s)
- Ingrid M Lizarraga
- Department of Surgery, University of Iowa Hospitals and Clinics, 4622 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA
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31
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Vichapat V, Garmo H, Holmqvist M, Liljegren G, Wärnberg F, Lambe M, Fornander T, Adolfsson J, Lüchtenborg M, Holmberg L. Tumor Stage Affects Risk and Prognosis of Contralateral Breast Cancer: Results From a Large Swedish-Population–Based Study. J Clin Oncol 2012; 30:3478-85. [DOI: 10.1200/jco.2011.39.3645] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The number of breast cancer survivors at risk of developing contralateral breast cancer (CBC) is increasing. However, ambiguity remains regarding risk factors and prognosis for women with CBC. Patients and Methods In a cohort of 42,670 women with breast cancer in the Uppsala/Örebro and Stockholm regions in Sweden in 1992 to 2008, we assessed risk factors for and prognosis of metachronous CBC by using survival analysis. Breast cancer–specific survival for women with CBC was evaluated and compared with results for women with unilateral breast cancer (UBC) by using time-dependent Cox-regression modeling. Results An increased risk for CBC was observed among women who had primary breast cancer with ≥ 10 involved lymph nodes compared with node-negative women (adjusted hazard ratio [HR], 1.8; 95% CI, 1.2 to 2.7). The prognosis was poorer in women with CBC than with UBC. The hazard of dying from breast cancer was especially high for women with a short interval time to CBC (adjusted HR, 2.3; 95% CI, 1.8 to 2.8 for CBC diagnosed ≤ 5 years v UBC) and gradually decreased with longer follow-up time but remained higher than the hazard originating from the primary tumor for ≥ 10 years. Conclusion Women with advanced-stage primary breast cancer had an increased risk of developing CBC. CBC is associated with an increased risk of dying from breast cancer throughout a long period of follow-up after the primary tumor. Our findings suggest that the event of CBC marks a new clinical situation in terms of investigations for metastases, treatment considerations, and follow-up strategy.
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Affiliation(s)
- Voralak Vichapat
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Garmo
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Marit Holmqvist
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Liljegren
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Wärnberg
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lambe
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Fornander
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Adolfsson
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Margreet Lüchtenborg
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Holmberg
- Voralak Vichapat, Hans Garmo, Margreet Lüchtenborg, and Lars Holmberg, King's College London, London, United Kingdom; Hans Garmo, Marit Holmqvist, Mats Lambe, and Lars Holmberg, Regional Cancer Centre, Uppsala University Hospital; Fredrik Wärnberg and Lars Holmberg, Uppsala Academic Hospital, Uppsala University, Uppsala; Göran Liljegren, University Hospital, Örebro; and Mats Lambe, Tommy Fornander, and Jan Adolfsson, Karolinska University Hospital, Stockholm, Sweden
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Estrogen receptor, progesterone receptor, and HER2-neu expression in first primary breast cancers and risk of second primary contralateral breast cancer. Breast Cancer Res Treat 2012; 135:849-55. [PMID: 22903686 DOI: 10.1007/s10549-012-2183-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
Breast cancer survivors have a 60 % higher risk of developing a second primary asynchronous contralateral breast cancer (CBC) compared to women's risk of developing a first primary breast cancer (FBC). However, little is known about how expression of tumor markers in first breast cancers influences CBC risk. We conducted a population-based nested case-control study among women 20-74 years of age diagnosed with a first breast cancer between 1996 and 2008 in western Washington State to evaluate the association between their tumor's estrogen receptor (ER), progesterone receptor (PR) and HER2-neu (HER2) expression, and risk of CBC. The study included 482 cases diagnosed with both a FBC and a CBC and 1,506 control women diagnosed only once with breast cancer identified through our local Surveillance, Epidemiology and End Results (SEER) cancer registry. Compared to the women whose FBC was ER+/PR+, those with ER-/PR- first tumors had a 1.6-fold (95 % confidence interval (CI): 1.2-2.3) increased risk of developing a CBC. When evaluated by joint ER/PR/HER2 status, compared to women with ER+/HER2- first cancers, those with HER2-overexpressing (ER-/HER2+) and triple-negative disease (ER-/PR-/HER2-) had 2.0-fold (95 % CI: 1.1-3.8) and 1.4-fold (95 % CI: 0.9-2.3) elevated risks of developing CBC, respectively. Beyond the known higher risks of mortality among patients diagnosed with more aggressive BC subtypes, here, we observe that they may also have increased risks of developing CBC.
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Schairer C, Brown LM, Mai PL. Inflammatory breast cancer: high risk of contralateral breast cancer compared to comparably staged non-inflammatory breast cancer. Breast Cancer Res Treat 2011; 129:117-24. [PMID: 21390499 PMCID: PMC3139759 DOI: 10.1007/s10549-010-1324-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/20/2010] [Indexed: 11/25/2022]
Abstract
Inflammatory breast cancer (IBC), the most lethal form of breast cancer, has characteristics linked to higher risk of contralateral breast cancer. However, no large studies have examined risk of contralateral breast cancer following IBC. We calculated absolute risk of invasive contralateral breast cancer among 5,631 IBC and 174,634 comparably staged non-IBC first breast cancer cases who survived at least 2 months following diagnosis and were reported to 13 Surveillance, Epidemiology, and End Results (SEER) registries between January 1, 1973 and December 31, 2006. We considered that contralateral cancers occurring within 2-23 months of first cancer diagnosis may more likely be metastatic/recurrent disease and those occurring 2 or more years after diagnosis independent primaries. Absolute risk of contralateral breast cancer was generally greater following IBC than regional/distant non-IBC, regardless of age and hormone receptor status of first cancer diagnosis. Much of the increase in absolute risk following IBC occurred within 2-23 months of first cancer diagnosis, while the risk for non-IBC occurred more gradually over time since diagnosis. For instance, among women first diagnosed before age 50, absolute risks following IBC and non-IBC were 4.9 vs. 1.1% at 2 years, 6.0 vs. 2.2% at 5 years, and 7.7 vs. 6.1% at 20 years after diagnosis. However, patterns of higher risk following IBC than non-IBC were also evident for at least 10-15 years in the subcohort of women who survived at least 24 months without a contralateral cancer. In conclusion, our results suggest that IBC has higher risk of cancer in the contralateral breast than comparably staged non-IBC, possibly due to both metastatic/recurrent disease and independent primaries.
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Affiliation(s)
- Catherine Schairer
- Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, MD 20852-7244, USA.
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34
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Bosetti C, Scelo G, Chuang SC, Tonita JM, Tamaro S, Jonasson JG, Kliewer EV, Hemminki K, Weiderpass E, Pukkala E, Tracey E, Olsen JH, Pompe-Kirn V, Brewster DH, Martos C, Chia KS, Brennan P, Hashibe M, Levi F, La Vecchia C, Boffetta P. High constant incidence rates of second primary cancers of the head and neck: a pooled analysis of 13 cancer registries. Int J Cancer 2011; 129:173-9. [PMID: 20824702 PMCID: PMC3037425 DOI: 10.1002/ijc.25652] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/27/2010] [Indexed: 11/08/2022]
Abstract
Scanty data are available on the incidence (i.e., the absolute risk) of second cancers of the head and neck (HN) and its pattern with age. We investigated this issue using data from a multicentric study of 13 population-based cancer registries from Europe, Canada, Australia and Singapore for the years 1943-2000. A total of 99,257 patients had a first primary HN cancer (15,985 tongue, 22,378 mouth, 20,758 pharyngeal, and 40,190 laryngeal cancer), contributing to 489,855 person-years of follow-up. A total of 1,294 of the patients (1.3%) were diagnosed with second HN cancers (342 tongue, 345 mouth, 418 pharynx and 189 larynx). Male incidence rates of first HN cancer steeply increased from 0.68/100,000 at age 30-34 to 46.2/100,000 at age 70-74, and leveled off at older age; female incidence increased from 0.50/100,000 at age 30-34 to 16.5/100,000 at age 80-84. However, age-specific incidence of second HN cancers after a first HN cancer in men was around 200-300/100,000 between age 40-44 and age 70-74 and tended to decline at subsequent ages (150/100,000 at age 80-84); in women, incidence of second HN cancers was around 200-300/100,000 between age 45-49 and 80-84. The patterns of age-specific incidence were consistent for different subsites of second HN cancer and sexes; moreover, they were similar for age-specific incidence of first primary HN cancer in patients who subsequently developed a second HN cancer. The incidence of second HN cancers does not increase with age, but remains constant, or if anything, decreases with advancing age.
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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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Vichapat V, Gillett C, Fentiman IS, Tutt A, Holmberg L, Lüchtenborg M. Risk factors for metachronous contralateral breast cancer suggest two aetiological pathways. Eur J Cancer 2011; 47:1919-27. [PMID: 21658939 DOI: 10.1016/j.ejca.2011.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
Although many studies show an increased risk of metachronous contralateral breast cancer (CBC) in women with a positive family history and young age at diagnosis of the initial breast cancer, the aetiological pathways are still enigmatic. In a cohort of 8478 primary breast cancer patients diagnosed between 1975 and 2006, 558 cases of metachronous CBC were identified. Using multivariate Cox proportional hazards models, we analysed risk factors assessed at the time of the first primary tumour, including patient demographics, tumour characteristics and treatment among 4681 breast cancer patients for whom data on key variables were available. The analysis was performed separately in patients who developed CBC without and with prior recurrence(s). Risk of CBC without prior recurrent disease was increased by a positive family history [adjusted relative risk (RR) 2.8 (95% confidence interval (CI) 1.4-5.5)]; and decreased by endocrine treatment [RR 0.6 (95% CI 0.4-1.0)]. We found an increased risk of CBC with prior recurrent disease with younger age [RR 1.2 (95% CI 1.4-3.0)]; positive family history [RR 2.1 (95%CI 0.8-5.0)]; and extensive lymph node involvement [RR 2.0 (95% CI 1.2-3.6)]. Our results suggest that nodal status of the primary tumour may be as important a risk factor as family history or age, which indicates a high susceptibility to breast cancer or an impaired host defence mechanism. It may also imply that some CBCs are metastases from the first primary tumour, particularly in patients who present with recurrent disease before CBC.
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Affiliation(s)
- Voralak Vichapat
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK.
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37
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Nichols HB, Berrington de González A, Lacey JV, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol 2011; 29:1564-9. [PMID: 21402610 DOI: 10.1200/jco.2010.32.7395] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Contralateral breast cancer (CBC) is the most frequent new malignancy among women diagnosed with a first breast cancer. Although temporal trends for first breast cancers have been well studied, trends for CBC are not so well established. PATIENTS AND METHODS We examined temporal trends in CBC incidence using US Surveillance, Epidemiology, and End Results database (1975 to 2006). Data were stratified by estrogen receptor (ER) status of the first breast cancer for the available time period (1990+). We estimated the annual percent change (EAPC) in CBC rates using Poisson regression models adjusted for the age at and time since first breast cancer diagnosis. RESULTS Before 1985, CBC incidence rates were stable (EAPC, 0.27% per year; 95% CI, -0.4 to 0.9), after which they declined with an EAPC of -3.07% per year (95% CI, -3.5 to -2.7). From 1990 forward, the declines were restricted to CBC after an ER-positive cancer (EAPC, -3.18%; 95% CI, -4.2 to -2.2) with no clear decreases after an ER-negative cancer. Estimated current age-specific CBC rates (per 100/year) after an ER-positive first cancer were: 0.45 for first cancers diagnosed before age 30 years and 0.25 to 0.37 for age 30 years or older. Rates after an ER-negative cancer were higher: 1.26 before age 30 years, 0.85 for age 30 to 35 years, and 0.45 to 0.65 for age 40 or older. CONCLUSION Results show a favorable decrease of 3% per year for CBC incidence in the United States since 1985. This overall trend was driven by declining CBC rates after an ER-positive cancer, possibly because of the widespread usage of adjuvant hormone therapies, after the results of the Nolvadex Adjuvant Trial Organisation were published in 1983, and/or other adjuvant treatments.
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Affiliation(s)
- Hazel B Nichols
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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38
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Synchronous and metachronous bilateral breast cancer: a long-term single-institution experience. Med Oncol 2010; 29:16-24. [DOI: 10.1007/s12032-010-9785-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
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Kurian AW, Fish K, Shema SJ, Clarke CA. Lifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups. Breast Cancer Res 2010; 12:R99. [PMID: 21092082 PMCID: PMC3046442 DOI: 10.1186/bcr2780] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/19/2010] [Indexed: 02/13/2023] Open
Abstract
INTRODUCTION Breast cancer comprises clinically distinct subtypes, but most risk statistics consider breast cancer only as a single entity. To estimate subtype-specific lifetime breast cancer risks, we took advantage of population-based data for which information regarding tumor expression of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu (HER2) was newly available. METHODS We included women whose breast cancer was diagnosed in the state of California from 2006 to 2007 and was reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program (N = 40,936). We calculated absolute lifetime and age-specific probabilities (percent, 95% confidence interval) of developing breast cancer subtypes defined by ER, PR, and HER2 status - luminal (ER and/or PR-positive, HER2-negative), HER2-positive (ER and PR-positive or negative, HER2-positive), and triple-negative (ER-negative, PR-negative, and HER2-negative) - separately for white, black, Hispanic, and Asian women. RESULTS The luminal breast cancer subtype predominates across racial/ethnic groups, with lifetime risk lowest in Hispanic women (4.60%, 4.41-4.80%) and highest in white women (8.10%, 7.94-8.20%). HER2-positive breast cancer varies less by race (1.56-1.91%). Lifetime risk of triple-negative breast cancer is highest in black women (1.98%, 1.80-2.17%), compared to 0.77% (0.67-0.88%) for Asians, 1.04% (0.96-1.13%) for Hispanics and 1.25% (1.20-1.30%) for whites. Across racial/ethnic groups, nearly half of all luminal breast cancers occur after age 70. CONCLUSIONS These absolute risk estimates may inform health policy and resource planning across diverse populations, and can help patients and physicians weigh the probabilities of developing specific breast cancer subtypes against competing health risks.
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Affiliation(s)
- Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
- Department of Health Research and Policy, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Kari Fish
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Sarah J Shema
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Christina A Clarke
- Department of Health Research and Policy, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
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Huo D, Melkonian S, Rathouz PJ, Khramtsov A, Olopade OI. Concordance in histological and biological parameters between first and second primary breast cancers. Cancer 2010; 117:907-15. [PMID: 20945326 DOI: 10.1002/cncr.25587] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with breast cancer are more likely to have a second breast cancer than women in the general population are to have a primary cancer. However, the biological relationship between primary and second breast cancers is not clear. METHODS A total of 30,617 patients diagnosed with bilateral breast cancers between 1990 and 2007 were identified through 17 cancer registries of the Surveillance, Epidemiology, and End Results program. Logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) was used to model strength of association in hormone receptor status, grade, and histology between 2 cancers. RESULTS There was a strong association in estrogen receptor status between 2 bilateral tumors (OR, 7.64; 95% CI, 7.00-8.35). The strength of association in estrogen receptor status depended on the time interval between the first and second tumors and age at diagnosis. The OR was 25.9 for synchronous tumors (within 1 month) and 3.69 for metachronous tumors separated by ≥10 years. The strength of association was stronger in patients whose first cancer was diagnosed before age 50 (OR, 11.7) versus after age 50 (OR, 5.71). A similar pattern was observed for progesterone receptor, grade, and histological type, but with relatively weaker association. CONCLUSIONS The strong concordance in hormone receptor status of primary and second breast cancers suggests that 2 breast cancers arise in a common milieu and that tumor subtypes are predetermined in the early stage of breast carcinogenesis.
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MESH Headings
- Age Factors
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/epidemiology
- Breast Neoplasms, Male/metabolism
- Breast Neoplasms, Male/pathology
- Carcinoma/diagnosis
- Carcinoma/epidemiology
- Carcinoma/metabolism
- Carcinoma/pathology
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Staging
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Odds Ratio
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Time Factors
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Affiliation(s)
- Dezheng Huo
- Department of Health Studies, Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.
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Bouchardy C, Benhamou S, Fioretta G, Verkooijen HM, Chappuis PO, Neyroud-Caspar I, Castiglione M, Vinh-Hung V, Vlastos G, Rapiti E. Risk of second breast cancer according to estrogen receptor status and family history. Breast Cancer Res Treat 2010; 127:233-41. [PMID: 20878464 DOI: 10.1007/s10549-010-1137-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 08/18/2010] [Indexed: 12/13/2022]
Abstract
A recent study reported an increased risk of contralateral estrogen-negative breast cancer after a first primary estrogen-negative breast cancer. Our study aims to confirm this result and to evaluate how the risk of second breast cancer occurrence is affected by family history of breast cancer and anti-estrogen treatment. We included all 4,152 women diagnosed with breast cancer between 1995 and 2007, using data from the population-based Geneva Cancer Registry. We compared the incidence of second breast cancer among patients according to estrogen receptor (ER) status with that expected in the general population by age-period Standardized Incidence Ratios (SIRs). Among the cohort, 63 women developed second breast cancer. Patients with ER-positive first tumors had a decreased risk of second breast cancer occurrence (SIR: 0.67, 95% CI: 0.48-0.90), whereas patients with ER-negative primary tumors had an increased risk (SIR: 1.98, 95% CI: 1.19-3.09) limited to ER-negative second tumors (SIR: 7.94, 95% CI: 3.81-14.60). Patients with positive family history had a tenfold (SIR: 9.74, 95% CI: 3.57-21.12) higher risk of ER-negative second tumor which increased to nearly 50-fold (SIR: 46.18, 95% CI: 12.58-118.22) when the first tumor was ER-negative. Treatment with anti-estrogen decreased the risk of second ER-positive tumors but not ER-negative tumors. The risk of second ER-negative breast cancer is very high after a first ER-negative tumor, in particular among women with strong family history. Surveillance and prevention of second cancer occurrence should consider both ER status of the first tumor and family history.
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Affiliation(s)
- Christine Bouchardy
- Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, 55 Boulevard de la Cluse, 1205 Geneva, Switzerland.
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Punglia RS, Hassett MJ. Using lifetime risk estimates to recommend magnetic resonance imaging screening for breast cancer survivors. J Clin Oncol 2010; 28:4108-10. [PMID: 20697089 DOI: 10.1200/jco.2010.30.0350] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rinaa S Punglia
- Dana-Farber Cancer Institute, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA
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Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in Contralateral Prophylactic Mastectomy for Unilateral Cancer: A Report From the National Cancer Data Base, 1998–2007. Ann Surg Oncol 2010; 17:2554-62. [DOI: 10.1245/s10434-010-1091-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Indexed: 11/18/2022]
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Umeh K, Jones L. Mutually dependent health beliefs associated with breast self-examination in British female university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2010; 59:126-131. [PMID: 20864439 DOI: 10.1080/07448481.2010.484453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Whereas research suggests young women's beliefs about breast cancer (susceptibility/severity) and its early detection (barriers/benefits) reliably distinguish breast self-examiners from nonexaminers, this study assessed whether these impressions are interreliant, especially in the context of familial risk. PARTICIPANTS The sample comprised over 200 female undergraduates from a university in England, United Kingdom. METHODS Participants completed a self-administered survey on their attitudes concerning breast cancer and early detection. Data were analyzed using logistic regression analysis. RESULTS Nonexaminers were distinguished by a combination of greater perceived hindrances to self-examinations and stronger appraisals of breast cancer severity, and also by a permutation of fewer perceived benefits in self-examinations and lower perceived susceptibility to breast cancer. The latter interaction persisted after accounting for family history. CONCLUSIONS Interwoven attitudes may depict sophisticated efforts on the part of nonexaminers to justify inaction. Clinical implications for college health providers are considered.
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Affiliation(s)
- Kanayo Umeh
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
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Kurian AW, McClure LA, John EM, Horn-Ross PL, Ford JM, Clarke CA. Second primary breast cancer occurrence according to hormone receptor status. J Natl Cancer Inst 2009; 101:1058-65. [PMID: 19590058 PMCID: PMC2720990 DOI: 10.1093/jnci/djp181] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 05/06/2009] [Accepted: 05/22/2009] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Contralateral second primary breast cancers occur in 4% of female breast cancer survivors. Little is known about differences in risk for second primary breast cancers related to the estrogen and progesterone receptor (hormone receptor [HR]) status of the first tumor. METHODS We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for contralateral primary breast cancers among 4927 women diagnosed with a first breast cancer between January 1, 1992, and December 31, 2004, using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. RESULTS For women whose first breast tumors were HR positive, risk of contralateral primary breast cancer was elevated, compared with the general population, adjusted for age, race, and calendar year (SIR = 2.22, 95% CI = 2.15 to 2.29, absolute risk [AR] = 13 cases per 10 000 person-years [PY]), and was not related to the HR status of the second tumor. For women whose first breast tumors were HR negative, the risk of a contralateral primary tumor was statistically significantly higher than that for women whose first tumors were HR positive (SIR = 3.57, 95% CI = 3.38 to 3.78, AR = 18 per 10 000 PY), and it was associated with a much greater likelihood of an HR-negative second tumor (SIR for HR-positive second tumors = 1.94, 95% CI = 1.77 to 2.13, AR = 20 per 10 000 PY; SIR for HR-negative second tumors = 9.81, 95% CI = 9.00 to 10.7, AR = 24 per 10 000 PY). Women who were initially diagnosed with HR-negative tumors when younger than 30 years had greatly elevated risk of HR-negative contralateral tumors, compared with the general population (SIR = 169, 95% CI = 106 to 256, AR = 77 per 10 000 PY). Incidence rates for any contralateral primary cancer following an HR-negative or HR-positive tumor were higher in non-Hispanic blacks, Hispanics, and Asians or Pacific Islanders than in non-Hispanic whites. CONCLUSIONS Risk for contralateral second primary breast cancers varies substantially by HR status of the first tumor, age, and race and/or ethnicity. Women with HR-negative first tumors have nearly a 10-fold elevated risk of developing HR-negative second tumors, compared with the general population. These findings warrant intensive surveillance for second breast cancers in women with HR-negative tumors.
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Affiliation(s)
- Allison W Kurian
- Northern California Cancer Center, 2201 Walnut Ave., Fremont, CA 94538-2334, USA
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Tumor marker phenotype concordance in second primary breast cancer, California, 1999-2004. Breast Cancer Res Treat 2009; 120:217-27. [PMID: 19629680 DOI: 10.1007/s10549-009-0469-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
Breast cancer is the most common cancer among women. It is estimated that 7% of women who have breast cancer will develop a subsequent second independent breast tumor within 10 years of the first. The status of estrogen (ER), progesterone (PR) and human growth hormone (HER2) receptors, individually and as phenotypic combinations, impacts the clinical course of breast cancer and may impact the course of subsequent primary tumors and patient survival. Our aims were to determine tumor marker phenotype concordance between first and second primary breast cancers (FPBC and SPBC), describe demographic and clinical characteristics, and examine first tumor treatments associated with phenotype concordance. A total of 76,209 cases of female invasive breast cancer were identified in the California Cancer Registry from 1999 to 2004. Of those, 1,407 women who had not undergone a prophylactic mastectomy, had information on the status of three tumor markers, and were diagnosed with an SPBC during the study period were selected. SPBCs were significantly smaller, diagnosed at a higher stage and were node positive. Patients whose FPBC was ER(+)/-/PR(+)/-/HER2- and triple negative (TN) (ER-/PR-/HER2-), often had concordant phenotypes for their SPBC. ER(+)/-/PR(+)/-/HER2+ and HER2-positive (ER-/PR-/HER2+) FPBCs, often had discordant phenotypes for their SPBC. ER(+)/-/PR(+)/-/HER2- SPBCs often lacked HER2 expression and were ER and/or PR positive. Tumor laterality and synchronicity significantly predicted concordance as did having a FPBC whose phenotypes were ER(+)/-/PR(+)/-/HER2+, HER2-positive and TN, while first primary tumor treatment with chemotherapy predicted discordance. The relationship between multiple primary breast cancer phenotype concordance and patient prognosis has yet to be determined. Our results indicate that SPBC surveillance strategies include consideration of FPBC phenotype. Although our results are provocative, they may have been influenced by current criteria used to determine tumor independence.
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Age-specific incidence of breast cancer in breast cancer survivors and their first-degree relatives. Epidemiology 2009; 20:175-80. [PMID: 19057388 DOI: 10.1097/ede.0b013e318190eee6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence rate of breast cancer in first-degree relatives of women with breast cancer has been hypothesized to become constant at a predetermined age in accordance with observations of a high, roughly constant incidence rate of contralateral breast cancer by age. We attempted to test this hypothesis in the Danish population with cancer registry data. METHODS We determined the age-specific incidence rates of contralateral breast cancer in Danish women who had a first breast cancer before they were 50 years of age and the rates of breast cancer among their first-degree female relatives during 1943 to 1999. The observed rates were tested for trends chi test or evaluated in Cox proportional hazard models. RESULTS A high incidence rate of contralateral breast cancer was observed in women aged 25-44 years, followed by a decreasing rate, which reached a level corresponding to the rate per breast in the general female population at age 65. At ages older than the index patients age at diagnosis, their first-degree female relatives showed significantly increasing incidence rates of breast cancer by age, with a relatively constant absolute difference of 187 breast cancers per 100,000 person-years between the observed rates and the expected rates. CONCLUSION The rate of contralateral breast cancer is particular high at young ages but the excess ebbs as the cohort ages, perhaps due to elimination of predisposed individuals at early ages from the cohort of survivors. First-degree relatives seem to share breast cancer susceptibility genes with the family proband resulting in a constant excess rate of breast cancer throughout life.
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Mallol N, Desandes E, Lesur-Schwander A, Guillemin F. Disease-specific and event-free survival in breast cancer patients: a hospital-based study between 1990 and 2001. Rev Epidemiol Sante Publique 2006; 54:313-25. [PMID: 17088696 DOI: 10.1016/s0398-7620(06)76727-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In France, as in other countries, breast cancer care has changed due to therapeutic advances and organized screening programs. Can the effect of new therapeutic procedures over time be measured by health care institutions considering these changes? The present study used data from a hospital-based cancer registry to analyze changes in 5-year disease-specific and event-free survival among women with primary breast cancer over three time periods (1990-1993, 1994-1997, and 1998-2001). METHODS All cases of primary invasive breast carcinomas, initially treated in a French Comprehensive Cancer Center between 1990 and 2001, were included. In situ breast carcinoma and male breast cancer were excluded. Cox proportional hazards models were used to analyze disease-specific and event-free survival (DSS and EFS) rates over the three time periods (1990-1993, 1994-1997, and 1998-2001). RESULTS During the 1990-2001 period, 4,165 primary breast cancers were initially treated at the Comprehensive Cancer Center. Out of 1,012 deaths overall, 74.6% were due specifically to primary breast cancer (respectively 98% from cancer itself and 2% from treatment side effects); the cause was unknown for only 3.3% of deaths. Out of 3,810 complete remissions, 18.2% presented local, regional or metastatic relapse and 3.8% presented a second primary breast cancer. Comparison of DSS and EFS rates in a recent reporting period (1998-2001) with those in earlier time periods (1994-1997 and 1990-1993) indicated that substantial survival gains were achieved with respectively 88.4% (95% CI: 86.4-90.5), 83.2% (95% CI: 81.3-85.2), and 79.8% (95% CI: 77.4-82.2) (p<0.01) for 5-year Disease-Specific Survival, and respectively 78.3% (95% CI: 75.7-81.0), 73.9% (95% CI: 71.6-76.3), and 70.1% (95% CI: 67.4-72.8) (p<0.01) for 5-year Event-Free Survival. After adjustment for prognostic factors, period was identified as an independent predictor of survival. CONCLUSION Survival improvement is likely to be due to changes in routine clinical practice such as an increased use of systemic adjuvant therapy over the study periods, dose modification of epirubicin in adjuvant chemotherapy for node-positive breast cancer since 1994, and organized screening programs since 1997. However the effect of possible early diagnosis and over-diagnosis biases due to screening cannot be assessed.
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Affiliation(s)
- N Mallol
- Centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy Cedex
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Abstract
We investigated the predictors of the risk of developing a second primary cancer after breast cancer, this occurring in about 12% of affected women. The analysis included 335 191 females, registered in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database, who had been diagnosed with breast cancer. Observed numbers of subsequent cancers in the SEER database with a first breast cancer diagnosed from 1973 to 2000 were compared with the expected numbers based on age-adjusted incidence rates to calculate standardised incidence ratios. Kaplan-Meier curves were conducted to determine the median time until the second primary cancer diagnosis. Average number of years until diagnosis varied by site and by age as well as median years until second cancer diagnosis. Most cancer risks decreased with age, but there was an increase in aging-related cancers such as lung cancer. The median years of follow-up were well beyond the 5-year mark. Breast cancer survivors should be advised of their increased risk for developing certain cancers in their lifetime.
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Affiliation(s)
- J S Raymond
- Rollins School of Public Health, Emory University, Atlanta, GA 30341, USA.
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Taioli E, Piselli P, Arbustini E, Boschiero L, Burra P, Busnach G, Caldara R, Citterio F, De Juli E, Dissegna D, Gotti E, Marchini F, Maresca MC, Marsano L, Montagnino G, Montanaro D, Sandrini S, Pedotti P, Scalamogna M, Serraino D. Incidence of Second Primary Cancer in Transplanted Patients. Transplantation 2006; 81:982-5. [PMID: 16612272 DOI: 10.1097/01.tp.0000203321.42121.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Solid organ transplanted patients have a three- to fourfold higher lifetime risk of developing a cancer than the general population. However, the incidence of a second primary cancer in transplanted patients has never been studied, despite the fact that the presence of regular follow-ups and the increased survival of these patients make them a very attractive model. METHODS We investigated the incidence of a second primary cancer (SPC) in 7,636 patients who underwent a kidney, liver, lung or heart transplant between 1970 and 2004, and were followed-up for 51,819 person-years. RESULTS During the follow-up, 499 subjects developed a first cancer (annual incidence: 98.6 x 10,000 PY), and 22 of them developed a SPC (annual incidence: 3.9 x 10,000 PY). The annual incidence of a SPC in the transplanted patients who developed a first cancer was 107.8 x 10,000 PY, giving a standardized incidence ratio of 1.1 (95% CI: 0.83-1.41). CONCLUSIONS This result shows that the incidence of the SPC was the same as the incidence of a first cancer. Our study does not indicate an increased risk of SPC in transplanted subjects who already suffered a first malignancy.
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