Breast cancer mortality in synchronous bilateral breast cancer patients

Mejdahl, Mathias Kvist; Wohlfahrt, Jan; Holm, Marianne; Balslev, Eva; Knoop, Ann; Tjønneland, Anne; Melbye, Mads; Kroman, Niels

doi:10.1038/s41416-019-0403-z

Cited by 23 publications

(29 citation statements)

References 25 publications

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“…The impacts of bilateral breast cancer on adverse prognosis such as disease recurrence, distant metastasis, and overall survival have been reported with conflicting results [ 9 , 10 ]. Because appropriate treatment and surveillance are required to reduce the risk and potential adverse prognosis, understanding of the clinical course of bilateral breast cancer is very important [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and the associated risk factors of the development of bilateral breast cancers: A case-control study

Anwar

Prabowo

Avanti

et al. 2020

Annals of Medicine and Surgery

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Background The clinical impacts of bilateralism on prognosis and clinical decision-making remain contradictory particularly in areas with low incidence and delayed diagnosis of primary breast cancer. Identification of women at risk of bilateral breast cancer is required to improve patient management and to design the appropriate surveillance. Methods A total of 1083 women were enrolled and analyzed for the presence of synchronous and metachronous bilateral breast cancer as cases and unilateral breast cancer as controls during the median follow-up of 4.8 years. Results The incidence of bilateral breast cancer was 7.5% (81 of 1083). In comparison with unilateral breast cancers, bilateral cases were significantly diagnosed in younger women ( P = 0.037, mean age was 35.6 years) who had a larger tumor size ( P = 0.012, mean tumor size was 8 cm in diameter). Histological type of lobular cancer was identified as one of the risk factors for the development of contralateral breast cancer (OR 5.564, 95% CI: 3.219–9.620) and synchronous bilateral breast cancer (OR 2.561, 95% CI: 1.182–5.550). Bilateral breast cancer had significantly shorter progression-free survival (Mean survival was 26.6 vs 52.5 months for bilateral and unilateral breast cancers, respectively; P = 0.001) and shorter time to develop distant metastasis (Mean survival was 41.7 vs 104 months for bilateral and unilateral breast cancers, respectively; P = 0.001). Conclusion Patients with first primary breast tumors with lobular histological type and advanced stages were observed to have higher risks for the development of contralateral breast cancers.

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Section: Introductionmentioning

confidence: 99%

Clinical characteristics and the associated risk factors of the development of bilateral breast cancers: A case-control study

Anwar

Prabowo

Avanti

et al. 2020

Annals of Medicine and Surgery

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“…The proportion of bilateral breast cancer among all breast cancers is modest and ranges, for example, from 2.2% in a Dutch screening population to 4.4% in a population derived from the National University of Ireland Galway breast cancer database in Ireland 1‐4 . A worse survival has been reported for women with bilateral breast cancer than for women diagnosed with unilateral breast cancer 5‐11 …”

Section: Introductionmentioning

confidence: 99%

Frequency and diagnostic outcome of bilateral recall at screening mammography

Lameijer

Voogd

Tjan‐Heijnen

et al. 2020

Intl Journal of Cancer

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Our study was performed to determine the frequency of recall for bilateral breast lesions at screening mammography and compare its outcome with respect to unilateral recall. We included 329 132 screening mammograms (34 889 initial screens and 294 243 subsequent screens) from a Dutch screening mammography program between January 2013 and January 2018. During a 2-year follow-up, we collected radiological data, pathology reports and surgical reports of all recalled women. At bilateral recall, the lesion with the highest Breast Imaging Reporting and Data System score was used as the index lesion when comparing screening mammography characteristics at bilateral vs unilateral recall. A total of 9806 women were recalled at screening (recall rate, 3.0%). Bilateral recall comprised 2.8% (271/9806) of all recalls. Biopsy was more frequently performed after bilateral recall than unilateral recall (54.6% [148/271] vs 44.1% [4201/9535], P < .001), yielding a lower positive predictive value (PPV) of biopsy after bilateral recall (42.6% vs 51.7%, P = .029). The PPV of recall was comparable for both groups (23.2% [63/271] vs 22.8% [2173/9535], P = .85). Invasive cancers after bilateral recall were larger than those diagnosed after unilateral recall (P = .02), but histological subtype, histologic grading, receptor status and proportions of lymph node positive cancers were comparable. Bilateral recall infrequently occurs at screening mammography. Biopsy is more frequently performed following bilateral recall, but the PPV of recall is similar for unilateral and bilateral recall. Invasive cancers of both groups show comparable pathological features except of a larger tumor size after bilateral recall.

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“…SBBC accounts for 2-11% of all breast cancer cases, and the estimated risk of SBBC development is 2-6 times higher in patients already diagnosed with breast cancer 2,3 . Several clinical studies have found that compared to patients with unilateral breast cancer (UBC), SSBC patients have higher rates of distant metastasis and lower overall survival [2][3][4][5][6][7] . In 2015, Jobsen and colleagues reported that the aggressiveness of primary tumors in SBBC patients does not appear to differ from UBC patients, as measured by malignancy grading, mitotic activity index, hormone receptor status, and the presence of positive lymph nodes 2 .…”

Section: Introductionmentioning

confidence: 99%

Molecular imaging reveals a high degree of cross-seeding of spontaneous metastases in a novel mouse model of synchronous bilateral breast cancer

Liu

Nyström

Kelly

et al. 2020

Preprint

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Synchronous bilateral breast cancer (SBBC) patients present with cancer in both breasts at the time of diagnosis or within a short time interval. They show higher rates of metastasis and lower overall survival compared to women with unilateral breast cancer. However, the lack of a preclinical model has led to a dearth in knowledge regarding the patterns of SBBC metastasis. Here we established an SBBC model and used molecular imaging to visualize the development of spontaneous lung metastases arising from each primary tumor. We engineered human breast cancer cells to express either Akaluc or Antares2 for bioluminescence imaging (BLI), and tdTomato or zsGreen for ex vivo fluorescence microscopy. Both cell populations were implanted into contralateral mammary fat pads of mice (n=10) and BLI was performed weekly for up to day 29 (n=3), 38 (n=4), or 42 (n=3). Signal from both Antares2 and Akaluc was first detected in the lungs on day 28 and was present in 9 of 10 mice at endpoint. Ex vivo fluorescence microscopy of the lungs revealed that for mice sacrificed on day 38, a significant percentage of micrometastases were composed of cancer cells from both primary tumors (mean 37%; range 27% to 45%), while two mice sacrificed on day 42 showed percentages of 51% and 70%. These results reveal a high degree of metastatic cross-seeding which may contribute to faster metastatic growth and intratumoral heterogeneity. We posit our work will help understand treatment resistance and optimal planning of treatment for SBBC patients.

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Breast cancer mortality in synchronous bilateral breast cancer patients

Cited by 23 publications

References 25 publications

Clinical characteristics and the associated risk factors of the development of bilateral breast cancers: A case-control study

Clinical characteristics and the associated risk factors of the development of bilateral breast cancers: A case-control study

Frequency and diagnostic outcome of bilateral recall at screening mammography

Molecular imaging reveals a high degree of cross-seeding of spontaneous metastases in a novel mouse model of synchronous bilateral breast cancer

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