Patterns of metastasis in women with metachronous contralateral breast cancer

Vichapat, Voralak; Garmo, Hans; Holmberg, Lars; Fentiman, Ian S.; Tutt, Andrew; Gillett, Cheryl; Lüchtenborg, Margreet

doi:10.1038/bjc.2012.273

Cited by 17 publications

(18 citation statements)

References 7 publications

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“…Some studies have suggested that CBCs that develop within a short time interval may actually represent a form of metastatic disease. 28 More studies are needed to determine how CBC affects survival outcomes.…”

Section: Article In Pressmentioning

confidence: 99%

Clinicopathologic features and time interval analysis of contralateral breast cancers

Liederbach

Piro

Hughes

et al. 2015

Surgery

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Section: Article In Pressmentioning

confidence: 99%

Clinicopathologic features and time interval analysis of contralateral breast cancers

Liederbach

Piro

Hughes

et al. 2015

Surgery

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“…The WHO Classification of Tumours of the Breast adopts this definition, which is used frequently in studies (Alkner et al 2011;Hartman et al 2007;Sandberg et al 2012b;Schmid et al 2011), but also mentions the benefit of a longer time interval for epidemiological [10] assessments. Many studies favour a longer cut-off time to distinguish bilateral breast cancers (Bernstein et al 2003;Londero et al 2014;Nichols et al 2011;Rubino et al 2010;Schaapveld et al 2008;Verkooijen et al 2007;Vichapat et al 2011a;Vichapat et al 2012;Vichapat et al 2011b;Yerushalmi et al 2009). As there is no consensus concerning these definitions, we conducted further analyses with different cut-off times.…”

Section: Discussionmentioning

confidence: 99%

“…Information on distant spread at diagnosis would allow for better comparison with other studies, as stage IV index tumours are generally excluded. Whether CBC should be looked at as distant spread or new primary is still open to debate (Rubino et al 2010;Vichapat et al 2012;Yerushalmi et al 2009). Complete data on tumour characteristics and therapies is not available for our All data were used anonymously in this analysis and no approval from the ethical committee of the canton of Zurich was necessary.…”

Section: Discussionmentioning

confidence: 99%

Incidence of metachronous contralateral breast cancer in the Canton of Zurich: a population-based study of the cancer registry

Prater¹,

Valeri

Korol³

et al. 2015

J Cancer Res Clin Oncol

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PURPOSE To examine the incidence and characteristics of metachronous contralateral breast cancer (CBC) among women in the Canton of Zurich, Switzerland. METHODS For 1980-2006 with unilateral invasive breast cancer (UBC) were analysed for metachronous CBC. Poisson's regression was used to estimate incidence rates of metachronous CBC according to age, year of diagnosis, follow-up period since first breast cancer and morphology. RESULTS Of 16,323 patients with UBC, 700 (4.3 %) developed a second malignant tumour of the opposite breast. Median age at first breast cancer was lower in the CBC group than in the full cohort. Median interval time between first and second breast cancer was 5.5 (interquartile range 2.6-10.1) years. Incidence rate at age 20-29 was 1006 (95 % confidence interval, CI, 452-2238) cases per 100,000 person-years and decreased to 299 (199-450) at 80-84. Age-adjusted incidence rates according to period of diagnosis decreased from 618 (530-721) for 1980-1984 to 329 (217-500) cases per 100,000 person-years for [2005][2006]. Incidence rate ratio of CBC for lobular carcinoma was 1.28 (95 % CI 0.99-1.67) adjusted by age group and period of diagnosis compared to ductal carcinoma. CONCLUSIONS In our study, incidence rates for CBC are comparable with findings from the literature. A reduction in the incidence of metachronous CBC, thought to be due to adjuvant therapies, is seen in our data. In our cohort, younger age and lobular carcinoma were associated with an increased risk of CBC. Incidence rate ratio of CBC for lobular carcinoma was 1.28 (95% CI 0.99 -1.67) adjusted by age group and period of diagnosis compared to ductal carcinoma.Conclusions: In our study, incidence rates for CBC are comparable with findings from the literature. A reduction in the incidence of metachronous CBC, thought to be due to adjuvant therapies, is seen in our data. In our cohort, younger age and lobular carcinoma was associated with increased risk for CBC.Keywords Metachronous contralateral breast cancer, lobular carcinoma, incidence rates, year of diagnosis, follow-up period [3]

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“…This view is supported by studies showing frequent discrepancies in conventional histopathologic features such as histologic type, grade or estrogen receptor status between the two primaries, although assignment of histologic grade may vary among pathologists . However, a substantial body of evidence suggests that bilateral metachronous breast cancer is associated with poor prognostic features of the initial cancer . In particular, studies have shown that patients with bilateral cancer more frequently present with advanced disease than those presenting with unilateral cancer .…”

Section: Introductionmentioning

confidence: 98%

“…3 However, a substantial body of evidence suggests that bilateral metachronous breast cancer is associated with poor prognostic features of the initial cancer. [4][5][6][7][8] In particular, studies have shown that patients with bilateral cancer more frequently present with advanced disease than those presenting with unilateral cancer. 9 These findings suggest that some CBCs may represent first site metastases.…”

Section: Introductionmentioning

confidence: 99%

Contralateral breast cancers: Independent cancers or metastases?

Begg

Ostrovnaya

Geyer

et al. 2017

Intl Journal of Cancer

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A cancer in the contralateral breast in a woman with a previous or synchronous breast cancer is typically considered to be an independent primary tumor. Emerging evidence suggests that in a small subset of these cases the second tumor represents a metastasis. We sought to investigate the issue using massively parallel sequencing targeting 254 genes recurrently mutated in breast cancer. We examined the tumor archives at Memorial Sloan Kettering Cancer Center for the period 1995-2006 to identify cases of contralateral breast cancer where surgery for both tumors was performed at the Center. We report results from 49 patients successfully analyzed by a targeted massively parallel sequencing assay. Somatic mutations and copy number alterations were defined by state-of-the-art algorithms. Clonal relatedness was evaluated by statistical tests specifically designed for this purpose. We found evidence that the tumors in contralateral breasts were clonally related in three cases (6%) on the basis of matching mutations at codons where somatic mutations are rare. Clinical data and the presence of similar patterns of gene copy number alterations were consistent with metastasis for all three cases. In three additional cases, there was a solitary matching mutation at a common PIK3CA locus. The results suggest that a subset of contralateral breast cancers represent metastases rather than independent primary tumors. Massively parallel sequencing analysis can provide important evidence to clarify the diagnosis. However, given the inter-tumor mutational heterogeneity in breast cancer, sufficiently large gene panels need to be employed to define clonality convincingly in all cases.

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Patterns of metastasis in women with metachronous contralateral breast cancer

Cited by 17 publications

References 7 publications

Clinicopathologic features and time interval analysis of contralateral breast cancers

Clinicopathologic features and time interval analysis of contralateral breast cancers

Incidence of metachronous contralateral breast cancer in the Canton of Zurich: a population-based study of the cancer registry

Contralateral breast cancers: Independent cancers or metastases?

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