Heterogeneity in hormone-receptor status and survival outcomes among women with synchronous and metachronous bilateral breast cancers

Baretta, Zora; Olopade, Olufunmilayo I.; Huo, Dezheng

doi:10.1016/j.breast.2014.12.001

Cited by 20 publications

(24 citation statements)

References 23 publications

(22 reference statements)

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“…Two studies have tried to analyse the prognosis incorporating information from both tumours, one by describing the effect of concordance in tumour stage on prognosis, 23 and another describing the effect of concordance in oestrogen receptor status on prognosis. 24 These studies showed that characteristics of both tumours are of importance in determining the prognosis for a SBBC patient, and the present study further adds to this assumption by showing that the two tumours each has the same effect on the excess mortality as an equivalent unilateral cancer. The reason why the 'worst tumour model' only gives a 30% higher excess mortality and not a double risk, is because SBBC patients usually present with a large index tumour and a smaller contralateral tumour as supported by the present data.…”

Section: Discussionsupporting

confidence: 66%

Breast cancer mortality in synchronous bilateral breast cancer patients

et al. 2019

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BACKGROUND: Evidence suggests that patients with synchronous bilateral breast cancer (SBBC), diagnosed within 4 months, have an inferior prognosis compared to unilateral breast cancer (UBC) patients. Using data from nationwide Danish clinical databases, this cohort study investigated whether the inferior prognosis could be explained by SBBC patients having a more aggressive disease, or whether the prognosis could be explained by the fact that they have two simultaneous cancers. METHODS: Patients were diagnosed from 1999-2015. The main outcome was excess mortality, subtracting background population mortality from observed mortality. Differences between SBBC and UBC patients were evaluated by rate ratios (RR) and estimated by Poisson regression. RESULTS: In total, 1214 SBBC and 59 177 UBC patients were included. SBBC patients had a significantly higher excess mortality than UBC patients after adjustment for age and period (RR = 1.73; 95% CI:1.44-2.08; p < 0.01) and after adjusting for characteristics of the worst tumour as traditionally done (RR = 1.31; 95% CI:1.08-1.57; p = 0.01). However, adjusting for characteristics of both tumours, using a more advanced competing risks model, no difference was observed (RR = 1.01; 95% CI:0.83-1.22; p = 0.93). CONCLUSIONS: Our study does not support that the inferior prognosis in SBBC patients is due to having more aggressive tumours per se, but rather the combined effect of having two simultaneous cancers.

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Section: Discussionsupporting

confidence: 66%

Breast cancer mortality in synchronous bilateral breast cancer patients

et al. 2019

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“…Phenotypically synchronous tumors have been shown to have a greater degree of concordance than phenotypically metachronous tumors (30). The rate of discordant ER expression between primary and secondary cancer has been shown to be as high as 29-37% in MBBC (29,31). Some researchers have suggested that MBBC may have different genetic signatures and origins.…”

Section: Discussionmentioning

confidence: 99%

“…Based on SEER data, oncologists found that heterogeneity in hormone receptor status could be used to predict the overall survival and breast cancer-specific survival in the first 5 years. The ER status had a better prognostic value than the PR status (31). The hormone receptor statuses of both tumors were recorded in this study to explore the relationship between outcome and receptor variation.…”

Section: Discussionmentioning

confidence: 99%

Concordance of Hormone Receptor Status and BRCA1/2 Mutation Among Women With Synchronous Bilateral Breast Cancer

et al. 2020

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Goals: BRCA1/2 mutations are associated with bilateral breast cancer. The extent of concordance between synchronous bilateral breast cancer (SBBC) tumors with respect to hormone receptor expression and BRCA1/2 mutations is unknown. We investigated the distribution of BRCA1/2 mutations and bilateral estrogen receptor (ER) status in SBBC.Methods: A retrospective analysis was performed on 15,337 patients with primary breast cancer who underwent surgical treatment at the Fudan University Shanghai Cancer Center between 2007 and 2014. We included 163 patients with synchronous bilateral breast cancer who had germline BRCA1/2 mutations testing. BRCA1/2 pathogenic/likely pathogenic mutations and other clinicopathological characteristics were studied in further analyses.Results: Patients with SBBC developed breast cancer at an older age and had a higher rate of ER positivity than patients with UBC (p < 0.001, separately). In contrast, 14.1% of SBBC patients had carcinomas with a lobular component in either breast based on pathological reports (p < 0.001). Twelve patients had BRCA1 mutations, and 14 patients had BRCA2 mutations, while no patients had mutations in both genes. The BRCA1/2 mutation rate was higher in younger patients (23.4 vs. 11.1%, p = 0.036). SBBC patients with a family history of breast cancer or bilateral ER-negative disease had a higher frequency of BRCA1/2 mutations than the cohort without a history of these conditions. SBBC with a bilateral ER-discordant status had a very low frequency of BRCA1/2 mutations (5.6%). Patients with an ER-positive (concordant or discordant) status had better 3-year disease-free survival than patients with a concordant ER-negative status (HR = 0.324, 95% CI: 0.126-0.837, P = 0.020). However, the outcomes were similar during long-term follow-up. Pathological lymph node stage was the only prognostic factor for SBBC in both univariate and multivariate Cox analyses.Conclusions: Our study shows that Chinese women with SBBC have different characteristics from their UBC counterparts. SBBC patients with a younger age, family Huang et al.HR and BRCA1/2 in SBBC history of breast cancer, or bilateral ER-negative disease are more likely to have BRCA1/2 mutations. SBBC patients with a concordant ER-negative status had worse early outcomes. Our results suggest that there may be additional factors underlying the tumor biology and genetics of SBBC.

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“…However, the report noted that a discordance in ER of each cancer was an independent prognostic factor in each group. 16 …”

Section: Discussionmentioning

confidence: 99%

Breast-Conserving Surgery in Bilateral Breast Cancer

O’Brien

Wright

et al. 2015

Ann Surg Oncol

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Background Bilateral breast cancer (BBC) may present as synchronous(SBC) or metachronous breast cancer(MBC). Optimal surgical management of BBC patients is not well defined. Here we report on histopathology, treatment, and outcomes in BBC patients. Methods Upon IRB approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999–2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed. Factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease; tumor considered too large for BCS; patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs(binary variables) or the paired t-test(continuous variables) was used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival(OS). Results 203 BBC patients(119 SBC,84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and in molecular profiles. 57% of MBC patients underwent breast-conserving surgery at initial diagnosis versus 34% of patients with SBC. BCS contraindications were similar in both groups: 16(34%) of MBC and 28(36%) of SBC patients. Kaplan-Meier OS estimates at 5yrs/10yrs were 86%/78% for MBC, and 87%/77% for SBC patients, respectively. Conclusions OS was excellent for both MBC and SBC groups. Contraindications to breast-conserving surgery did not differ between groups. However, patients with SBC were less likely to undergo BCS compared to patients with MBC at time of initial diagnosis.

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Heterogeneity in hormone-receptor status and survival outcomes among women with synchronous and metachronous bilateral breast cancers

Cited by 20 publications

References 23 publications

Breast cancer mortality in synchronous bilateral breast cancer patients

Breast cancer mortality in synchronous bilateral breast cancer patients

Concordance of Hormone Receptor Status and BRCA1/2 Mutation Among Women With Synchronous Bilateral Breast Cancer

Breast-Conserving Surgery in Bilateral Breast Cancer

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