Effect of breast-conserving surgery plus radiotherapy versus mastectomy on breast cancer-specific survival for early-stage contralateral breast cancer

69 Background: Contralateral breast cancer (CBC) is the most common malignancy among breast cancer survivors. We investigated the impact of CBC on overall survival (OS) after unilateral primary breast cancer (UPBC) in women treated with mastectomy. Methods: Using the Surveillance Epidemiology End Results registry, we identified women age 25-80 diagnosed 1998-2006 with UPBC stage 0-III, treated with mastectomy and free of CBC at 1-year landmark. Subjects were split into test and validation samples. Follow-up continued until the earliest occurrence: death, end of 2008, or age 85. Primary risk factor was incident CBC, a time-dependent variable categorized as advanced-stage (IIB-IV), early-stage (0-IIA), or none. Proportional hazards regression adjusted for primary tumor characteristics, treatment including contralateral prophylactic mastectomy (CPM), demographics, and aging. Results: Subjects (n= 109,411, age 53.7[+12.7] years at UPBC diagnosis) were followed median 51 months. Most UPBC were early stage (63%), moderately/poorly differentiated (78%), ER+PR+ (52%). Few (9.8%) women underwent CPM at primary diagnosis. Incident CBC (n=867, 0.79%) was diagnosed median 23.5 (95% CI 1.2-72) months beyond the 1-year landmark. Test and validation samples did not differ. Only CBC of stage IIB-IV increased mortality; early stage CBC had no effect on OS. Among CBC cases, advanced stage was independently associated with aggressive UPBC (more positive nodes; larger tumor; greater extension), African-American race, and shorter time from UPBC. Conclusions: Among women who undergo mastectomy +/-CPM for UPBC, few develop CBC, which impacts survival only when diagnosed at advanced stage. Efforts to improve survival after UPBC should emphasize earlier detection and prevention of advanced-stage CBC, especially in African-American women and women with more aggressive UPBC. [Table: see text]

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Risk of breast cancer recurrence and contralateral breast cancer in relation to BRCA1 and BRCA2 mutation status following breast-conserving surgery and radiotherapy

European Journal of Cancer ◽

10.1016/j.ejca.2005.02.037 ◽

2005 ◽

Vol 41 (15) ◽

pp. 2304-2311 ◽

Cited By ~ 89

Author(s):

Youlia M. Kirova ◽

Dominique Stoppa-Lyonnet ◽

Alexia Savignoni ◽

Brigitte Sigal-Zafrani ◽

Nicolas Fabre ◽

...

Keyword(s):

Breast Cancer ◽

Contralateral Breast Cancer ◽

Brca2 Mutation ◽

Cancer Recurrence ◽

Breast Conserving Surgery ◽

Contralateral Breast ◽

Breast Cancer Recurrence ◽

Brca1 And Brca2 ◽

Mutation Status

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Risk of Recurrence or Contralateral Breast Cancer More than 5 Years After Diagnosis of Hormone Receptor-Positive Early-Stage Breast Cancer

Clinical Breast Cancer ◽

10.1016/j.clbc.2015.11.002 ◽

2016 ◽

Vol 16 (4) ◽

pp. 284-290 ◽

Cited By ~ 1

Author(s):

Sheridan Wilson ◽

Caroline Speers ◽

Scott Tyldesley ◽

Stephen Chia ◽

Hagen Kennecke ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Receptor ◽

Contralateral Breast Cancer ◽

Early Stage ◽

Contralateral Breast ◽

Early Stage Breast Cancer ◽

Risk Of Recurrence ◽

Hormone Receptor Positive

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Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-Term Follow-Up of CALGB 9343

Journal of Clinical Oncology ◽

10.1200/jco.2012.45.2615 ◽

2013 ◽

Vol 31 (19) ◽

pp. 2382-2387 ◽

Cited By ~ 527

Author(s):

Kevin S. Hughes ◽

Lauren A. Schnaper ◽

Jennifer R. Bellon ◽

Constance T. Cirrincione ◽

Donald A. Berry ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Distant Metastasis ◽

Early Stage ◽

Breast Cancer Specific Survival ◽

Cancer Specific Survival ◽

Er Positive ◽

Long Term Follow Up

Purpose To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age ≥ 70 years with early-stage breast cancer. Patients and Methods Between July 1994 and February 1999, 636 women (age ≥ 70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS). Results Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively. Conclusion With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age ≥ 70 years with ER-positive early-stage breast cancer.

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Survival After Early-Stage Breast Cancer of Women Previously Treated for Depression: A Nationwide Danish Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.8358 ◽

2017 ◽

Vol 35 (3) ◽

pp. 334-342 ◽

Cited By ~ 19

Author(s):

Nis P. Suppli ◽

Christoffer Johansen ◽

Lars V. Kessing ◽

Anita Toender ◽

Niels Kroman ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cohort Study ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Breast Cancer Specific Survival ◽

Regression Analyses ◽

Cancer Specific Survival ◽

Increased Risk ◽

Previously Treated

Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer–specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer–specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer–specific survival.

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