Incidence and Prognosis of Synchronous and Metachronous Bilateral Breast Cancer

2007 ◽  
Vol 25 (27) ◽  
pp. 4210-4216 ◽  
Author(s):  
Mikael Hartman ◽  
Kamila Czene ◽  
Marie Reilly ◽  
Jan Adolfsson ◽  
Jonas Bergh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Bilateral Breast Cancer ◽  
Metachronous Cancer ◽  
Unilateral Breast Cancer ◽  
Dual Effect ◽  
Prognostic Features ◽  
Incidence Trends ◽  
Incidence And Mortality ◽  
Synchronous Breast Cancer

Purpose Because the incidence of breast cancer is increasing and prognosis is improving, a growing number of women are at risk of developing bilateral disease. Little is known, however, about incidence trends and prognostic features of bilateral breast cancer. Patients and Methods 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. We separated synchronous (diagnosed within 3 months after a first breast cancer) and metachronous bilateral cancer, and analyzed incidence and mortality rates of breast cancer using Poisson regression models. Results 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. Women who developed bilateral cancer within 5 years and at age younger than 50 years were 3.9 times (95% CI, 3.5 to 4.5) more likely to die as a result of breast cancer than women with unilateral cancer. Women with a bilateral cancer diagnosed more than 10 years after the first cancer had a prognosis similar to that of a unilateral breast cancer. Adjuvant chemotherapy of primary cancer is a predictor of poor survival after diagnosis of early metachronous cancers. Conclusion We found profound differences in the incidence trends and prognostic outlook between synchronous and metachronous bilateral breast cancer diagnosed at different ages. 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 clinical impact and outcomes of immunohistochemistry-only metastases in breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 613-613
Author(s):  
M. S. Pugliese ◽  
M. M. Stempel ◽  
S. M. Patil ◽  
M. Hsu ◽  
H. S. Cody ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Rare Event ◽  
Axillary Recurrence ◽  
Unilateral Breast Cancer ◽  
Prognostic Features ◽  
Regression Methods ◽  
Kaplan Meier ◽  
History Of

613 Background: Modern surgical and pathologic techniques can detect small volume axillary metastases in breast cancer. The clinical significance of these metastases was evaluated in comparison to patients with negative sentinel lymph nodes (Neg-SN). Methods: Retrospective database review from 1997 through 2003 for eligible patients with unilateral breast cancer and no history of significant non-breast malignancy identified 232 patients with sentinel lymph node (SLN) metastases identified only by immunohistochemical stains (IHC-SN). They were compared to 252 Neg-SN controls selected at random from the same database population. Statistical analysis was performed with 2-sample tests, Kaplan-Meier, and Cox regression methods. Results: IHC-SN patients had worse prognostic features and received more systemic therapy than controls (Table). Age and ER status were similar. In 123 IHC-SN patients treated with axillary dissection (ALND), 16% had macrometastases in the non-SLNs. Only one axillary recurrence occurred in the group of IHC-SN patients without ANLD (n=109). With median follow up of 5 years (range 0.01–12.0), 28 recurrences and 25 deaths occurred. There were no differences between cases and controls for recurrence-free survival (RFS) or overall survival (OS) both by univariate and multivariate models that included variables such as age, tumor size, chemotherapy and hormone therapy [HR 0.99 (95%CI 0.43–2.28, p=0.99) for RFS, HR 2.06 (95%CI 0.79–5.35) p=0.14 for OS]. In IHC-SN patients treated with ALND, patients with positive non-SLNs (n=20) tended to have worse RFS than those with negative non-SLNs (n=103) [RFS 89% vs. 97% at 5 yrs (p=0.06)]. Conclusions: A significant number of IHC-SN patients had a macrometastasis identified at ALND. In patients not undergoing dissection, axillary recurrence was a rare event. However, failure to identify additional metastases by omitting ALND may result in understaging and inadequate systemic treatment in some patients. [Table: see text] No significant financial relationships to disclose.

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

2008 ◽  
Vol 26 (9) ◽  
pp. 1411-1418 ◽  
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.

Detection of Malignant lesion in Contralateral Breast in Newly Diagnosed Patients of Unilateral Carcinoma Breast on MRI

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Ghazala Wahid ◽  
Naila Tamkeen ◽  
Anjum Naz ◽  
Maimoona Afsar ◽  
Amina Ashraf ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Examination ◽  
Bilateral Breast Cancer ◽  
Malignant Lesion ◽  
Contralateral Breast ◽  
Radiology Department ◽  
Newly Diagnosed ◽  
Unilateral Breast Cancer ◽  
Carcinoma Breast ◽  
Increased Risk

Background: Women having unilateral breast cancer have added risk of contralateral breast cancer with an incidence of 1-5% synchronous cancer. There is also increased risk of metachronous cancer in contralateral breast . Female patients with bilateral breast cancer have grave prognosis in comparison to those with unilateral breast cancer. MRI breast is used to assess the multifocality and multicentricity of tumour. Objective: To determine the diagnostic performance of MRI in detecting malignant lesion in contralateral breast in newly diagnosed patients of unilateral carcinoma breast.Material and Methods: In this study total 150 newly diagnosed patients of unilateral breast cancer with normal mammographic and clinical examination of other breast were included. Study was conducted in Radiology department, Hayatabad Medical Complex Peshawar from Jan 2017 to March 2020. MRI scan of normal breast was done on a 1.5 Tesla magnet with multi-channel breast coil. For evaluating the breast lesions, administration of IV contrast and high spatial resolution is necessary .The malignant lesions of breast found on MRI were confirmed histo-pathologically. Results: In 5 out of total 150 women included in study, MRI detected occult breast cancer in the opposite breast in whom clinical examination and mammography was normal (3.3%). 18 women (12.5 %) out of total 150 with positive findings on MRI underwent biopsy, and 5 specimens turned out to be carcinoma (27%). Conclusion: MRI is very useful and helpful to detect occult malignancy in opposite breast which are not detected clinically or by mammography at the time of the initial diagnosis of carcinoma breast.

Infiltrating ductal carcinoma of male breast: A retrospective study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10753-10753
Author(s):  
T. Puri ◽  
M. Malik ◽  
G. Gunabushanam ◽  
D. N. Sharma ◽  
P. K. Julka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Ductal Carcinoma ◽  
Lung Metastases ◽  
Bilateral Breast Cancer ◽  
Radical Mastectomy ◽  
Male Breast ◽  
Single Institution ◽  
Infiltrating Ductal Carcinoma ◽  
Progesterone Receptor Positivity

10753 Background: A single-institution retrospective review of the clinical presentation, treatment and outcome of male breast infiltrating ductal carcinoma (IDC). Methods: Case records of 25 male patients with a histological diagnosis of infiltrating ductal carcinoma (IDC) of breast who were treated in a single institution between 1997 to 2004 were retrospectively reviewed. Results: Patients presented at a mean age of 56 years (range, 34 to 80 years). The presenting complaint was a painless lump in the breast in all the cases. The right breast was involved in 13 cases (52%). There were no cases of bilateral breast cancer. The distribution of patients by stage at presentation are: stage IIA (24%), IIB (20%), IIIA (8%), IIIB (40%), and IV (8%). None of the patients presented with stage I disease. One patient had lung metastases at presentation. Rest of the 24 patients (96%) underwent surgery (modified radical mastectomy, 22 patients; simple mastectomy, 2 patients). Fifteen patients (60%) received adjuvant local radiotherapy. All patients received adjuvant chemotherapy: As per departmental protocol, those presenting before 2000 were treated using a regimen of Cyclophosphamide, Adriamycin and 5-Fluorouracil. After 2000, Ebirubicin was substituted for Adriamycin. Three patients were further administered Docetaxel, the indication being disease progression after first line adjuvant chemotherapy. Estrogen & Progesterone receptor positivity was 64% and 60% respectively. Hormonal therapy (Tamoxifen 14 patients, Anastrozole 2 patients) was administered in these patients. The length of follow-up from time of presentation ranged from 4 to 100 months (mean, 28 months; median, 13 months). At the time of analysis, of the 25 patients, 18 patients (72%) remain disease free, whereas 7 patients (28%) developed progressive disease. Median survival was not reached at the present time. Conclusions: Breast cancer, specifically IDC tends to present at a later stage in males, due to a lack of screening for the disease. In the present series, as a result of the advanced stage of initial presentation, all patients received adjuvant chemotherapy. There is a need to improve awareness among males, of the possibility of a painless breast lump being the first symptom of an underlying malignancy. No significant financial relationships to disclose.

Bilateral breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17073-17073
Author(s):  
J. Oh ◽  
B. Park
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Bilateral Breast Cancer ◽  
Disease Free Survival ◽  
Unilateral Breast Cancer ◽  
Significant Difference ◽  
History Of ◽  
The Impact

17073 Background: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. The aim of this study is to assess the impact of bilateral breast cancer on the prognosis compared with unilateral breast cancer and examine clinicopathologic characteristics of Bilateral and Unilateral breast cancer. Methods: 108 patients included in this study from Jan 1980 to Dec 2005 and all information regarding medical and family history of breast cancer came from medical records and questionnaires. Results: There were 108 patients with bilateral breast cancer and its incidence was 2.3% of total breast cancer. The incidence of bilateral breast cancer after 1998 was 3.5% (90/2548) compare with the incidence before 1998 (0.9%). The mean age of patients with bilateral and unilateral breast cancer was 45.34 and 47.54 years, respectively. (p=0.032) Compared to unilateral breast cancer, bilateral group did not differ in gravida, marital status, use of HRT, but the number of case which was diagnosed with breast cancer among close relatives was more frequent (7 cases/6.5% vs 126 cases/2.8%, p=0.024). Although the most frequent histopathologic subtype was ductal carcinoma in both groups, the distribution of the histopathologic subtypes was different between the groups as invasive lobular carcinoma was present in a higher percentage of patients with bilateral breast cancer than in patients with unilateral breast cancer (6.5% vs 2.1%, p=0.002). It suggested that risk factors of developing bilateral breast cancer were family history, lobular tumor, use of hormonal therapy based on the result of multivariate regression analysis. There were no statistically significant difference in 5-year disease free survival and overall survival in both groups (bilateral: 83.25%, 89.52% vs unilateral: 82.74%, 88.79%), (p=0.3934, p=0.3114). Conclusion: In lobular carcinoma patients with family history of breast cancer during follow-up, the possibility of contralateral breast cancer should be considered more carefully and the therapeutic strategy for secondary tumor should resemble the treatment procedure for the primary tumor. No significant financial relationships to disclose.

Phase III randomized study of adjuvant treatment with the ANTI-PD-L1 antibody avelumab for high-risk triple negative breast cancer patients: The A-BRAVE trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS598-TPS598
Author(s):  
Pier Franco Conte ◽  
Maria Vittoria Dieci ◽  
Giancarlo Bisagni ◽  
Michelino De Laurentiis ◽  
Carlo Alberto Tondini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Primary Endpoint ◽  
Triple Negative ◽  
Phase Iii ◽  
Considerable Proportion ◽  
Prognostic Features ◽  
Biomarker Analysis

TPS598 Background: Chemotherapy represents, today, the only treatment option for triple negative breast cancer (TNBC) and still a considerable proportion of pts with primary TNBC experience disease relapse. The risk is particularly high in the presence of poor prognostic features, such as more advanced stage and, for pts treated with neoadjuvant chemotherapy, failure to achieve a pCR. Recent evidence suggest that immunotherapy can play a major role in TNBC pts. Methods: The A-BRAVE trial is an investigator-driven trial sponsored by the University of Padova (Dept. of Surgery, Oncology and Gastroenterology). This is a phase III, multicentric, randomized adjuvant study that compares 1 year of treatment with the anti PD-L1 avelumab vs observation for pts who completed treatment with radical intent for primary TNBC including surgery and chemotherapy. The study enrolls pts in two strata: -Stratum A: primary TNBC pts who completed surgery followed by adjuvant, defined according to one of the following stage categories: if pN2, any pT; if pN1, pT > 2 cm; if pN0, pT > 5 cm. -Stratum B: primary TNBC pts who completed neoadjuvant chemotherapy followed by surgery who did not achieve pCR. Pts who also received additional adjuvant chemotherapy for no more than 6 months are eligible in Stratum B, after the completion of the adjuvant chemotherapy. Pts are randomized (1:1, balanced for strata A and B) to receive Avelumab 10 mg/kg I.V. q2w for 1 year or to observation. The first and second co-primary endpoints are disease-free survival (DFS) in all pts and DFS in Stratum B pts. With a planned sample size of n = 474 pts the trial has 90% power to detect a HR = 0.60 for the first co-primary endpoint (n = 172 events required). Taking into account that the percentage of patients enrolled in the stratum B could range from 70 to 80%, there will be 70-79% power to detect a HR = 0.60 at alpha allocated in this patient subgroup (second co-primary endpoint). Secondary objectives include: DFS in PD-L1 positive pts, overall survival, safety, biomarkers. Tumor tissue, plasma samples and fecal samples are collected for biomarker analysis. The study is currently recruiting across 73 sites in Italy and UK. As of February 2020, n = 349 pts have been enrolled. EUDRACT 2016‐000189‐45. The authors present the A-BRAVE trial in progress on behalf of Italian and UK investigators. Clinical trial information: NCT02926196 .

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