Excessive milk production during breast-feeding prior to breast cancer diagnosis is associated with increased risk for early events

Background: The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Patients and Methods: Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Results: Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80–4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64–2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10–6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26–3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67–2.61). Nonreceipt of mammography was associated with younger age (40–49 vs 50–59 years; OR, 1.69; 95% CI, 1.45–1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03–1.07). Conclusions: In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.

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Oral Contraceptives, Postmenopausal Hormones, and Risk of Asynchronous Bilateral Breast Cancer: The WECARE Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.3081 ◽

2008 ◽

Vol 26 (9) ◽

pp. 1411-1418 ◽

Cited By ~ 11

Author(s):

Jane C. Figueiredo ◽

Leslie Bernstein ◽

Marinela Capanu ◽

Kathleen E. Malone ◽

Charles F. Lynch ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Conditional Logistic Regression ◽

Bilateral Breast Cancer ◽

Breast Cancer Diagnosis ◽

Breast Cancer Risk Factor ◽

Population Based ◽

Unilateral Breast Cancer ◽

Increased Risk ◽

Rate Ratios

Purpose To investigate whether oral contraceptive (OC) use and postmenopausal hormones (PMH) are associated with an increased risk of developing asynchronous bilateral breast cancer among women diagnosed with breast cancer younger than 55 years. Patients and Methods The WECARE (Women's Environment, Cancer, and Radiation Epidemiology) study is a population-based, multicenter, case-control study of 708 women with asynchronous bilateral breast cancer and 1,395 women with unilateral breast cancer. Risk factor information collected during a telephone interview focused on exposures before and after the first breast cancer diagnosis. Treatment and tumor characteristics were abstracted from medical records. Multivariable conditional logistic regression was used to estimate rate ratios (RR) and 95% CIs. Results OC use before the first breast cancer diagnosis was not associated with risk of asynchronous bilateral breast cancer (RR = 0.88; 95% CI, 0.67 to 1.16). OC use after breast cancer diagnosis was also not significantly associated with risk (RR = 1.56; 95% CI, 0.71 to 3.45). Risk did not increase with longer duration of use or among women who had begun using OCs at a younger age. No evidence of an increased risk of asynchronous bilateral breast cancer was observed with PMH use before (RR = 1.21; 95% CI, 0.90 to 1.61) or after breast cancer diagnosis (RR = 1.10; 95% CI, 0.67 to 1.77). Neither duration nor type of PMH were associated with risk. Age at and time since first breast cancer diagnosis did not substantially affect these results. Conclusion This study provides no strong evidence that OC or PMH use increases the risk of a second cancer in the contralateral breast.

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Sarcoidosis as a paraneoplastic syndrome for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e12587 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e12587-e12587

Author(s):

Pamela Barletta ◽

Mukunthan Murthi ◽

Douglas Salguero ◽

Mehdi Mirsaeidi

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Case Series ◽

Breast Cancer Diagnosis ◽

Pulmonary Sarcoidosis ◽

Unknown Etiology ◽

Time Interval ◽

Case Series Study ◽

Increased Risk ◽

Study Population

e12587 Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The pathogenesis of sarcoidosis is believed to be a result from a cellular immune reaction from exposure to occupational, environmental, or infectious elements that lead to the formation of noncaseating granulomas. Non-caseating granulomas are also present in cancer , and it is well known that the cancer cells carry neo-antigens, leading to a possible association between cancer and sarcoidosis. Several studies have shown an increased risk of breast cancer , in particular, in patients with sarcoidosis, but only a few studies have analyzed the incidence of sarcoidosis following breast cancer diagnosis. The present study aimed to identify patients with sarcoidosis following a diagnosis of breast cancer in our cohort of sarcoidosis. Methods: This is a retrospective case-series study between 2008-2018 of patients with sarcoidosis in the University of Miami Sarcoidosis Program. Sarcoidosis was defined per the World Association for Sarcoidosis and other Granulomatous Disorders guidelines. Breast cancer diagnosis was confirmed through pathology. We collected demographic data of age, gender, ethnicity and the time between diagnosis of breast cancer and sarcoidosis by chart review. Clincial data including clinical manifestations, laboratories, staging, and treatment were also collected. Results: Among 125 patients in our registry, 26 patients had a diagnosis of both cancer and sarcoidosis. In this, 12 (46%) developed sarcoidosis after the diagnosis of breast cancer and are the study population. Among them, 12(100%) were female. The most common ethnic group in the study population was European American with 8(67%) followed by African Americans 2(16.7%) and Hispanic 2(16.7%). Eight (67%) patients were treated with chemotherapy, 7(58%) with radiotherapy, of this, 6 (50%) received both. Mean (SD) age of onset of sarcoidosis was 61.9 ( 10.8) years . The mean time interval between breast cancer diagnosis and the onset of sarcoidosis was 5.58 ( 5.24) years ( (see Figure 1). Nine (75%) had pulmonary sarcoidosis and 3(25%) cardiac sarcoidosis. Among the subjects with pulmonary sarcoidosis 1(11.1%) had Stage 4, 4(44.4%) had Stage 2 and 4(44.4%) had stage 1. Conclusions: Our findings suggest sarcoidosis may be a paraneoplastic characteristic of breast cancer. The mechanism of granuloma development remains unclear. Cancer mediated immune dysregulation could be a potential contributing factor. Further studies are warranted to establish a definitive association.

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Clinical and Imaging Surveillance Following Breast Cancer Diagnosis

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.220 ◽

2012 ◽

pp. 59-64 ◽

Cited By ~ 3

Author(s):

Chris I. Flowers ◽

Blaise P. Mooney ◽

Jennifer S. Drukteinis

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Clinical Symptoms ◽

Breast Conservation ◽

High Specificity ◽

Breast Cancer Diagnosis ◽

Breast Conservation Therapy ◽

Physical Exam ◽

Definitive Treatment ◽

Increased Risk

Overview: Breast cancer is the most common malignancy affecting women worldwide. Women have a 1 in 8 lifetime risk of breast cancer. Breast conservation therapy (BCT) is the most common method of definitive treatment. Patients who previously have had to undergo mastectomy may be now eligible for BCT or a multitude of options for reconstruction, either immediate or delayed. Surveillance imaging after a breast cancer diagnosis is important because there is an increased risk of recurrence developing in patients, and early detection has been shown to improve survival. There is currently no consensus on a protocol for imaging the postoperative breast. In patients who have undergone mastectomy, detection of recurrence has mostly been via clinical symptoms and physical exam, often at a later stage. New imaging modalities, such as magnetic resonance imaging (MRI), ultrasound (US), and positron emission mammography (PEM) are changing the way we image the postsurgical breast. MRI, coupled with physical exam and mammography, approaches 100% sensitivity and high specificity for the identification of recurrent disease. We present a review of major academic institutions' imaging protocols and discuss the advantages of including MRI in traditional mammographic and clinical exams.

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Secondary primary cancers in male breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.129 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 129-129 ◽

Cited By ~ 1

Author(s):

Raji Shameem ◽

Muhammad S Hamid ◽

Gaurang P Mavani ◽

Nakul Singhal ◽

Dana Shani ◽

...

Keyword(s):

Breast Cancer ◽

Solid Tumors ◽

Male Breast Cancer ◽

Cancer Diagnosis ◽

Latency Period ◽

Breast Cancer Diagnosis ◽

Initial Diagnosis ◽

Male Breast ◽

Age At Diagnosis ◽

Increased Risk

129 Background: Male Breast Cancer (MBC) survivors have an increased risk of developing secondary contralateral breast cancer. However, the risk of developing other solid tumors and hematological malignancies is not well understood. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to detect MBC cases diagnosed up to 12/31/2011. The Standardized Incidence Ratio (SIR) was calculated as the ratio of observed to expected cases of second primary malignancy based on incidence data in the general United States population. The latency exclusion period from the date of diagnosis was 5 years. We also investigated for any modifying effects such as radiation therapy, age at diagnosis, and latency period after initial diagnosis (5-10 years and >10 years) that may have increased the risk for secondary cancer. Results: A total of 1,239 men with an initial diagnosis of primary breast cancer were included in our analysis. Overall, there was an increased SIR of secondary solid tumors of the pharynx (SIR: 8.39, P<0.05), hypopharynx (SIR: 15.77, P<0.05), and brain (SIR: 4.40, p<0.05), and Non-Hodgkin Lymphoma (NHL) (SIR: 2.49, P<0.05), that was also seen in MBC cases that received radiation (24.1%), (SIR: 4.51, P<0.05). For MBC diagnoses in patients >40 years, there was an increased incidence for these malignancies and for “all solid tumors” (SIR: 1.30, P<0.05) as well. In the period ranging from 5-10 years after initial breast cancer diagnosis increased incidence for tumors of the pharynx (SIR: 8.95, P<0.05) and hypopharynx (SIR: 16.70, P<0.05) were seen. In contrast, there was no significant increased incidence of secondary cancers >10 years after initial diagnosis. Conclusions: MBC survivors are at increased risk for secondary malignancies of the pharynx, hypopharynx, brain, and NHL. Older age at diagnosis and radiation treatment appear to be risk factors. Risk of secondary tumors of the pharynx and hypopharynx is greatest 5-10 years after initial breast cancer diagnosis but optimal surveillance for MBC survivors requires further clarification.

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Risk of colon adenoma in patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1541 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1541-1541

Author(s):

Yinghong Wang ◽

Hamzah Abu-Sbeih ◽

Faisal Ali ◽

Phillip S. Ge ◽

Carlos Hernando Barcenas ◽

...

Keyword(s):

Breast Cancer ◽

Logistic Regression ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Screening Colonoscopy ◽

Multivariate Logistic Regression ◽

Colon Adenoma ◽

Adenoma Detection ◽

Increased Risk ◽

History Of

1541 Background: In our clinical practice at a tertiary cancer center, we have observed increased adenoma detection rate (ADR) in patients with breast cancer. Here, we describe ADR in patients with breast cancer to define the appropriate timing to initiate colonoscopy screening in these patients. Methods: We conducted a retrospective study of patients with breast cancer who underwent a colonoscopy after their diagnosis of breast cancer between 2000 and 2017. A control group ( n = 3295) comprised patients without any type of cancer who underwent their first screening colonoscopy between 2008 and 2017 was used in the logistic regression. Results: Of the 62,820 patients who had a diagnosis of breast cancer, 3304 were included. The mean age was 59 years. Regarding ADR, 1803 patients (55%) had adenomas. High-grade dysplasia was evident in 28% of polyps and invasive adenocarcinoma in 172 (5%). The median time from breast cancer diagnosis to adenoma detection was 3 years (IQR 1-6). The ADR was 21% in patients younger than 40 years ( n=63), 39% in patients between 40 and 50 years ( n=314), 54% in patients between 50 and 60 years ( n=1420), and 60% in patients older than 60 years ( n=1507). ADR in patients younger than 50 years of age who do not have a family history of colorectal cancer or a body mass index (BMI) higher than 30 kg/m2 was 26%. A subsequent colonoscopy was performed in 831 patients who had colonic adenoma in the initial colonoscopy. The ADR was 40% in patients who had a repeat colonoscopy within 3 years, 50% within 3-5 years, and 53% > 5 years. Multivariate logistic regression analyses revealed an increased risk of colon adenoma with older age, male sex, higher BMI, and personal history of breast cancer ( P<0.05). Conclusions: In patients with breast cancer, ADR was higher than that of patients without history of cancer. Notably, breast cancer was an independent risk factor for colon adenoma. In patients who are younger than 40 years of age, screening colonoscopy should be considered within five years of breast cancer diagnosis. Multivariate logistic regression: risk factors of adenoma. [Table: see text]

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British Menopause Society consensus statement: The risks and benefits of HRT before and after a breast cancer diagnosis

Post Reproductive Health ◽

10.1177/2053369119825716 ◽

2019 ◽

Vol 25 (1) ◽

pp. 33-37 ◽

Cited By ~ 9

Author(s):

Jo Marsden ◽

Keyword(s):

Breast Cancer ◽

Health Care ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Cancer Diagnosis ◽

Hormone Replacement ◽

Breast Cancer Diagnosis ◽

Lifestyle Changes ◽

Short Term Exposure ◽

Increased Risk

In women at population risk of breast cancer (i.e. most), short-term exposure to hormone replacement therapy (i.e. up to five years’ use) for symptom relief exceeds its potential harms, including the associated, increased risk of breast cancer diagnosis. Many women and health care professionals, however, consider this to be unacceptably high, although the degree of risk conferred appears equivalent to, or less than that of, other lifestyle risk factors for this condition. In contrast, it is recommended that symptomatic women at high baseline risk due to a family history or a biopsy-confirmed high-risk benign breast condition and those with previous breast cancer should be managed initially with lifestyle changes and non-hormonal alternatives. In a minority, whose symptoms are refractory, hormone replacement therapy and or topical estrogen can be considered but prescription should only take place after a discussion between the patient, her primary health care and breast specialist teams.

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Characteristics and Outcomes of Breast Cancer in Women With and Without a History of Radiation for Hodgkin's Lymphoma: A Multi-Institutional, Matched Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.4079 ◽

2011 ◽

Vol 29 (18) ◽

pp. 2466-2473 ◽

Cited By ~ 60

Author(s):

Elena B. Elkin ◽

Michelle L. Klem ◽

Anne Marie Gonzales ◽

Nicole M. Ishill ◽

David Hodgson ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Hodgkin’S Lymphoma ◽

Sporadic Breast Cancer ◽

Breast Cancer Diagnosis ◽

Hodgkin's Lymphoma ◽

Increased Risk ◽

History Of ◽

Cancer Specific Mortality

Purpose To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). Patients and Methods Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. Results A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer–specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). Conclusion In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.

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Risk of primary brain tumour after breast cancer

Endocrine Connections ◽

10.1530/ec-19-0498 ◽

2020 ◽

Vol 9 (1) ◽

pp. 28-33

Author(s):

Anne M Drewes ◽

Maria E Møller ◽

Rasmus Hertzum-Larsen ◽

Gerda Engholm ◽

Hans H Storm

Keyword(s):

Breast Cancer ◽

Brain Tumour ◽

Cancer Registry ◽

Cancer Diagnosis ◽

Brain Cancer ◽

Premenopausal Women ◽

Breast Cancer Diagnosis ◽

Study Cohort ◽

Primary Brain Tumour ◽

Increased Risk

Introduction Cancer registry data in the USA indicated that women diagnosed with breast cancer before the age of 40 were at increased risk of a new primary tumour within the brain and women aged 50 years or above were at lower risk than expected. Our aim was to investigate if similar results could be found in Danish population-based data, considering an explanatory role of hormonal status. Methods Our study cohort included all women diagnosed with breast cancer below the age of 60 between 1978 and 2013 in Denmark. A total of 47,920 women were followed up in the Danish Cancer Registry for primary brain cancer. Standardized incidence ratios (observed/expected cases (O/E)) were used to estimate the risk of getting a primary brain tumour in the breast cancer cohort. Results Data indicated an increased tendency of brain cancer following breast cancer at ages below 60 years (O/E = 1.24). For premenopausal women (age <49 at the diagnosis of breast cancer) the O/E was 1.25. Stratifying by time of breast cancer diagnosis, we observed an increased risk of being diagnosed with a brain tumour among women aged 49 years or younger at breast cancer diagnosis between 2004 and 2013. Conclusion The results indicate an increased tendency of developing a primary brain tumour in women with previous breast cancer history. Whereas the finding in premenopausal women is in line with the SEER data, the finding among postmenopausal is not. Primary brain tumours in breast cancer patients call for research in genetics and hormones to establish common risk factors.

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