Heightened awareness and ever developing diagnostic methods allow for early diagnosis, increasing 5-year survival up to 98% with the inclusion of contemporary treatment methods [1]. Little is known, however, about incidence trends and prognostic features of bilateral breast cancer. Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC).
Women with metachronous cancer less than 5 years since primary had a more than four-fold higher mortality rate compared with women with unilateral cancer. Bilateral synchronous breast cancer is uncommon (accounting for 1.0%-2.6% of all patients with breast cancer), and most physicians do not accumulate a large personal experience of patients with this disease. [PMC free article] [Google Scholar] 33. Robbins GF, Berg JW: Bilateral primary breast cancer: A prospective clinicopathological study. 2019 Dec;8(18):7890-7902. doi: 10.1002/cam4.2662. Cancer Epidemiol Biomarkers Prev 8:: Chen Y, Semenciw R, Kliewer E, et al: Incidence of second primary breast cancer among women with a first primary in Manitoba, Canada. ‡Reference: unilateral breast cancer diagnosed at that age. Thus, the much stronger increase in mortality over time among women with bilateral cancer younger than age 50 years compared with women with unilateral disease suggests that chemotherapy exerts a stronger selection pressure than adjuvant endocrine treatment. JCO Global Oncology Breast cancer diagnosed during pregnancy.
Conclusion:
Epub 2009 Jul 13. Expression of HIF-1α is related to a poor prognosis and tamoxifen resistance in contralateral breast cancer. JCO OP DAiS, ASCO eLearning Breast Cancer Res Treat 67:: Robinson E, Rennert G, Rennert HS, et al: Survival of first and second primary breast cancer.
Because such treatment reduces the incidence of local recurrences, bilateral cancer, and distant metastasis,11,20-22 it likely explains the substantial reduction in the incidence of metachronous bilateral disease during calendar time. Deaths as a result of breast cancer were ascertained from the Cause of Death Registry with high reported accuracy.9 The mortality rate was calculated with the accumulated person-time at risk as the denominator. Results: The etiology of bilateral breast cancer is uncertain, but most evidence supports independent tumors and not metastasis spread from one of the primary tumors.
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We analyzed a large nationwide cohort of breast cancer patients in Sweden. Shen K, Yao L, Wei J, Luo Z, Yu W, Zhai H, Wang J, Chen L, Fu D. Cancer Med.
Ned Tijdschr Geneeskd. After excluding 2,357 women with a malignant tumor other than breast before the first breast cancer, our validation cohort for analysis comprised 17,089 women, of whom 952 developed contralateral breast cancer during follow-up through 1999. … Globally, increasing breast cancer incidence rates, improved prognosis, and growing life expectancy have resulted in increasing number of women at risk of developing a bilateral primary breast cancer.
Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies. Breast Cancer Res Treat 44:: Verkooijen HM, Chatelain V, Fioretta G, et al: Survival after bilateral breast cancer: Results from a population-based study. 12 months of initial diagnosis was defined as synchronous bilateral breast cancer. Metachronous Second Primary Malignancies in Known Breast Cancer Patients on 18F-Fluoro-2-Deoxyglucose Positron Emission Tomography-Computerized Tomography in a Tertiary Care Center. Holm M(1), Tjønneland A, Balslev E, Kroman N. Author information: (1)Unit of Diet, Genes, and Environment, Danish Cancer Society Research Center, 49 Strandboulevarden, 2100, Copenhagen, … Similar trends have been found in the United States23 but not in Canada.4. USA.gov. This trend was less obvious for metachronous breast cancer diagnosed less than 5 years since unilateral breast cancer. 2008 Nov 15;152(46):2495-500.
Metachronous disease, on the other hand, was much more common in younger patients and incidence rates declined steadily from approximately 1980, most likely due to the expanding use of adjuvant systemic therapy.11 Striking features of the survival analyses included the much higher excess mortality after metachronous than synchronous disease and among younger than older women. The 5-year breast cancer–specific mortality rate was only modestly related to age at diagnosis among women with unilateral disease (Fig 3A). DOI: 10.1200/JCO.2006.10.5056 Journal of Clinical Oncology The studies that reported adjusted effect measures were included in … We observed no excess mortality in women subjected to adjuvant chemotherapy after the second primary cancer. Newest Articles
Fig 2. The pattern persisted but the effect of time since first cancer was weaker in older age groups. Supported by US Army Grant No. In addition, we observed that women diagnosed with a first primary TNM stage 2 and 3 cancer were at a two-fold (mortality rate ratio [MRR], 1.9; 95% CI, 1.0 to 3.9) and five-fold (MRR, 5.4; 95% CI, 2.4 to 12.1) increased risk of death as a result of the disease, respectively, compared with women with stage 1 first primary cancer. TAPUR Study, Survival of Patients With Bilateral Breast Cancer, AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST. Adjuvant chemotherapy therapy has a dual effect on metachronous cancer: it reduces the risk, while at the same time it seems to worsen the prognosis. The multivariate analyses of metachronous bilateral cancer limited to the first 5 years of follow-up revealed a similar and significant decreasing trend during the study period, as seen in Figure 1 (P for trend < .001). Little is known, however, about incidence trends and prognostic features of bilateral breast cancer. To take treatment and stage into consideration, we selected a validation cohort. Concordance of Hormone Receptor Status and BRCA1/2 Mutation Among Women With Synchronous Bilateral Breast Cancer. September 21, 2016. Women age < 50 years diagnosed with synchronous breast cancer in 1970 to 1974 were approximately two times more likely to die as a result of breast cancer than women of the same age with unilateral breast cancer, a difference that varied only modestly over calendar period. Women with synchronous cancer had a 60% higher mortality rate compared with women with unilateral cancer. Among 123,757 women with a primary breast cancer diagnosed in Sweden from 1970 to 2000, a total of 6,550 developed bilateral breast cancer. published online before print Our findings also may be relevant for clinical management of women with breast cancer.
Temporal trends in incidence rates of (A) unilateral, (B) synchronous, and (C) metachronous bilateral breast cancer, in Sweden 1970 to 2000: 95% CIs are presented for all studied groups of breast cancer except metachronous cancer less than 5 years since primary tumor.
†In a validation analysis, a subcohort of women with TNM stage 1-3 primary cancers from the Stockholm-Gotland Health Care Region was used. It is not surprising that women diagnosed with two simultaneous cancers have an increased mortality compared with women with one cancer. The incidence of synchronous breast cancer increased by age and by 40% during the 1970s, whereas the incidence of metachronous cancer decreased by age and by approximately 30% since the early 1980s, most likely due to increasing use of adjuvant therapy. After 10 years of follow-up, the cumulative breast cancer–specific mortality was 56% (95% CI, 53.0% to 58.5%) among women with bilateral cancer diagnosed within 5 years and 34% (95% CI, 28.6% to 39.8%) among those diagnosed with bilateral cancer more than 10 years after their first primary. 2020 Apr 1;16(2):129-136. doi: 10.5152/ejbh.2020.5297. Heron DE, Komarnicky LT, Hyslop T, Schwartz GF, Mansfield CM. Nelson-Aalen estimates of breast cancer specific mortality after (A) unilateral, synchronous bilateral, and (B) metachronous bilateral breast cancer, stratified by time since diagnosis of unilateral breast cancer, with follow-up to age 80 years. Advertisers, Journal of Clinical Oncology
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