Survival impact of adjuvant tamoxifen on competing causes of mortality in breast cancer survivors, with analysis of mortality from contralateral breast cancer, cardiovascular events, endometrial cancer, and thromboembolic episodes.

PURPOSE This study provides estimates of the effect of tamoxifen treatment on mortality from four conditions known to be affected by tamoxifen in women who survive their breast cancer: contralateral breast cancer, cardiovascular events, endometrial cancer, and thromboembolic events. These estimates are in addition to tamoxifen's impact on primary breast cancer mortality. METHODS The effects of tamoxifen were calculated by the use of the published relative risk (RR) rates of the four conditions as affected by adjuvant tamoxifen and their application to the respective Canadian age-specific mortality rates for the same conditions. The final mortality impact of tamoxifen was expressed as net mortality difference between users and nonusers of tamoxifen. RESULTS At 10 years of follow-up, the sum of avoided deaths (contralateral breast cancer, cardiovascular events) and excess deaths (uterine cancer, thromboembolic episodes) resulted in an overall (net) mortality reduction because of tamoxifen use, with 3 to 41 avoided deaths per 1,000 tamoxifen-treated patients who were 50 to 80 years of age. With the follow-up projected until the age of 90 years, the numbers of avoided late deaths attributed to tamoxifen ranged from 38 to 56 per 1,000 patients. CONCLUSION Our calculations that pertain to late breast cancer survivors indicate that there is a more substantial mortality reduction as a result of deaths avoided from contralateral breast cancer and cardiovascular events, despite the moderately increased mortality from endometrial cancer and thromboembolic episodes. The overall tamoxifen-associated mortality reduction occurs, in different magnitudes, in patients of all ages from 50 to 80 years at diagnosis of the primary breast cancer.

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Risk factors for contralateral breast cancer in postmenopausal breast cancer survivors in the NIH-AARP Diet and Health Study

Cancer Causes & Control ◽

10.1007/s10552-021-01432-2 ◽

2021 ◽

Author(s):

Cody Ramin ◽

Maeve Mullooly ◽

Sara J. Schonfeld ◽

Pragati G. Advani ◽

Clara Bodelon ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Contralateral Breast Cancer ◽

Postmenopausal Breast Cancer ◽

Contralateral Breast ◽

Health Study

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Nomogram to predict contralateral breast cancer risk in breast cancer survivors

Medicine ◽

10.1097/md.0000000000027595 ◽

2021 ◽

Vol 100 (46) ◽

pp. e27595

Author(s):

Jiaci Tong ◽

Dewei Tan ◽

Jing Ma ◽

Ye Hu ◽

Man Li

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Contralateral Breast Cancer ◽

Contralateral Breast

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Tumor Stage Affects Risk and Prognosis of Contralateral Breast Cancer: Results From a Large Swedish-Population–Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2011.39.3645 ◽

2012 ◽

Vol 30 (28) ◽

pp. 3478-3485 ◽

Cited By ~ 36

Author(s):

Voralak Vichapat ◽

Hans Garmo ◽

Marit Holmqvist ◽

Göran Liljegren ◽

Fredrik Wärnberg ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Primary Tumor ◽

Primary Breast Cancer ◽

Contralateral Breast Cancer ◽

Cox Regression ◽

Short Interval ◽

Contralateral Breast ◽

Increased Risk

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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Relationship Between Potentially Modifiable Lifestyle Factors and Risk of Second Primary Contralateral Breast Cancer Among Women Diagnosed With Estrogen Receptor–Positive Invasive Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.23.1597 ◽

2009 ◽

Vol 27 (32) ◽

pp. 5312-5318 ◽

Cited By ~ 83

Author(s):

Christopher I. Li ◽

Janet R. Daling ◽

Peggy L. Porter ◽

Mei-Tzu C. Tang ◽

Kathleen E. Malone

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Survivors ◽

Invasive Breast Cancer ◽

Breast Cancer Survivors ◽

Contralateral Breast Cancer ◽

Contralateral Breast ◽

Alcoholic Beverages ◽

Second Primary

Purpose An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited. We evaluated the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors. Methods Utilizing a population-based nested case-control study design, we enrolled 365 patients diagnosed with an estrogen receptor–positive (ER+) first primary invasive breast cancer and a second primary contralateral invasive breast cancer, and 726 matched controls diagnosed with only an ER+ first primary invasive breast cancer. Obesity, alcohol use, and smoking data were ascertained from medical record reviews and participant interviews. Using conditional logistic regression we evaluated associations between these three exposures and second primary contralateral breast cancer risk. Results Obesity, consumption of ≥ 7 alcoholic beverages per week, and current smoking were all positively related to risk of contralateral breast cancer (odds ratio [OR], 1.4; 95% CI, 1.0 to 2.1; OR, 1.9; 95% CI, 1.1 to 3.2; and OR, 2.2; 95% CI, 1.2 to 4.0, respectively). Compared with women who consumed fewer than seven alcoholic beverages per week and were never or former smokers, women who consumed ≥ 7 drinks per week and were current smokers had a 7.2-fold (95% CI, 1.9 to 26.5) elevated risk of contralateral breast cancer. Conclusion Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

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Adherence to follow-up recommendation guidelines in long term breast cancer survivors, a SURBCAN cohort analysis using administrative databases

The Breast ◽

10.1016/s0960-9776(21)00243-5 ◽

2021 ◽

Vol 56 ◽

pp. S80-S81

Author(s):

P. Santiá ◽

A. Jansana ◽

T. Sanz ◽

I. de la Cura ◽

M. Padilla-Ruiz ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cohort Analysis ◽

Administrative Databases

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Changes in the Semantic Construction of Compassion after the Cognitively-Based Compassion Training (CBCT®) in Women Breast Cancer Survivors

The Spanish Journal of Psychology ◽

10.1017/sjp.2021.31 ◽

2021 ◽

Vol 24 ◽

Author(s):

Edgar González-Hernández ◽

Daniel Campos ◽

Rebeca Diego-Pedro ◽

Rocío Romero ◽

Rosa Baños ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Semantic Differential ◽

Post Intervention ◽

Treatment As Usual ◽

Spanish Speaking ◽

Specific Culture ◽

Differential Categories

Abstract The growing body of research on compassion has demonstrated its benefits for healthcare and wellbeing. However, there is no clear agreement about a definition for compassion, given the novelty of the research on this construct and its religious roots. The aim of this study is to analyze the mental semantic construction of compassion in Spanish-speaking women breast cancer survivors, and the effects of the Cognitively-Based Compassion Training (CBCT®) on the modification of this definition, compared to treatment-as-usual (TAU), at baseline, post-intervention, and six-month follow-up. Participants were 56 women breast cancer survivors from a randomized clinical trial. The Osgood’s Semantic Differential categories (evaluative, potency, and activity scales) were adapted to assess the semantic construction of compassion. At baseline, participants had an undefined idea about compassion. The CBCT influenced subjects’ semantic construction of what it means to be compassionate. Findings could lead to future investigations and compassion programs that adapt to a specific culture or population.

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Mammography Surveillance and Mortality in Older Breast Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.9572 ◽

2007 ◽

Vol 25 (21) ◽

pp. 3001-3006 ◽

Cited By ~ 85

Author(s):

Timothy L. Lash ◽

Matthew P. Fox ◽

Diana S.M. Buist ◽

Feifei Wei ◽

Terry S. Field ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Mortality ◽

Breast Cancer Survivors ◽

Care Delivery ◽

Breast Cancer Mortality ◽

The United States ◽

Stage I ◽

Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

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Impact of Pre-Operative Breast Magnetic Resonance Imaging (MRI) on Contralateral Synchronous and Metachronous Breast Cancer Detection- A Case Control Comparison Study With Mean Follow-Up of 102 Months.

10.21203/rs.3.rs-146986/v1 ◽

2021 ◽

Author(s):

Wen-Pei Wu ◽

Chih-Yu Chen ◽

Chih-Wei Lee ◽

Hwa-Koon Wu ◽

Shou-Tung Chen ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Detection ◽

Contralateral Breast Cancer ◽

Breast Mri ◽

Contralateral Breast ◽

Conventional Imaging ◽

Metachronous Breast Cancer ◽

Group B ◽

Synchronous Breast Cancer

Abstract Background: Women with unilateral breast cancer are at an increased risk for the development of contralateral breast cancers. We hypothesis that combined breast MRI would detect more contralateral synchronous breast cancer than conventional imaging alone, and resulted in less contralateral metachronous breast cancer during follow-up. Methods: In this case control analysis, we retrospectively collected two groups of patients for evaluating the effectiveness and value of adding pre-operative breast MRI to conventional breast images (mammography and sonography) for detection of contralateral synchronous breast cancer. The new metachronous contralateral breast cancer diagnosed during follow-up was prospectively evaluated and compared. Results: Group A (n=733) comprised patients who underwent conventional preoperative imaging and group B (n=735) combined with MRI were enrolled and compared. Seventy (9.5%) of the group B patients were found to have contralateral lesions detected by breast MRI, and 65.7% of these lesions only visible with MRI. The positive predictive value of breast MRI detected contralateral lesions was 48.8%. With the addition of breast MRI to conventional imaging studies, more surgical excisions were performed in contralateral breasts (6% (44/735) versus 1.4% (10/733), P< 0.01), more synchronous contralateral breast cancer detected (2.9% (21/735) versus 1.1% (8/733), P=0.02), and resulted in numerical less (2.2% (16/714) versus 3% (22/725), p=0.3) metachronous contralateral breast cancer during a mean follow-up of 102 months. Conclusions: Combining pre-operative breast MRI evaluation resulted in an increase of contralateral synchronous breast cancer detection, and a numerical less subsequent contralateral metachronous breast cancer occurrence compared to conventional imaging alone.

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Risk of contralateral breast cancer according to first breast cancer characteristics among women in the USA, 1992–2016

Breast Cancer Research ◽

10.1186/s13058-021-01400-3 ◽

2021 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

Cody Ramin ◽

Diana R. Withrow ◽

Brittny C. Davis Lynn ◽

Gretchen L. Gierach ◽

Amy Berrington de González

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cumulative Incidence ◽

Contralateral Breast Cancer ◽

Breast Cancer Treatment ◽

Contralateral Breast ◽

Breast Cancer Patients ◽

Younger Women ◽

Er Positive

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.

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