Prognosis of metachronous contralateral breast cancer: importance of stage, age and interval time between the two diagnoses

Abstract

Studies comparing the prognosis after contralateral breast cancer (CBC) with that after unilateral breast cancer (UBC) shows conflicting results. We assessed the risk of breast cancer-specific death for women with metachronous CBC compared to those with a UBC in 8,478 women with invasive primary breast cancer registered in the Guy's and St. Thomas' Breast Cancer Tissue and Data Bank. Risk factors associated with breast cancer-specific death for women with CBC were estimated using Cox proportional hazards modelling. Prognoses after UBC and CBC were compared, with survival time for women with CBC calculated: (i) from CBC, (ii) from the initial cancer with CBC as a time-dependent covariate. Women diagnosed with CBC within 5 years after the initial primary breast cancer had a worse prognosis than those with CBC after 5 years and those with UBC. Women with CBC who had positive lymph nodes at the initial breast cancer diagnosis were at an increased risk of dying from breast cancer compared to those without [HR 2.5 (95% CI 1.5-4.0)]. For all stages of the initial breast cancer, a worse prognosis was observed after CBC. CBC increased the hazard originating from the initial cancer at any follow-up time, but the highest hazards were associated with a short interval to CBC. Metachronous CBC adds to the risk of dying from breast cancer. The risk increases substantially when it occurs shortly after the initial cancer, indicating a CBC in some instances may be an indicator of active distant disease. The occurrence of CBC implies a new surveillance and therapeutic situation.

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

“…2008; Verkooijen et al 2007;Vichapat et al 2011a). In the Canton of Vaud, the age incidence pattern of CBC was examined as it was not comparable to the pattern of incidence for most cancers or breast cancer.…”

“…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.…”

Utility of Regular Radiological Follow-up on Early Detection of Contralateral Malignancy and Long-term Outcomes in Metachronous Bilateral Breast Cancer Patients

“…15,16 Bilateral breast cancer is known to be associated with a higher risk of mortality than unilateral breast cancer, with poorer outcomes recorded in a subgroup of patients that exhibited younger-onset and shorter durations between the first and second cancer diagnosis. 11,[17][18][19] Several studies have reported mean durations between the occurrence of the primary breast cancer and CBC as being > 5 years, which means patients need to pay careful attention to their contralateral breast for a significant amount of time after receiving treatment for the primary breast cancer. 17,20 In these patients, an annual MMG and physical examination are recommended as routine practice.…”

Contralateral Prophylactic Mastectomy: Current Perspectives

“…Although many studies have shown that CBCs tend to have more favorable tumor characteristics, studies have shown that patients who develop CBCs in a short interval from their primary cancer have worse survival than those who develop a CBC at a longer interval. [43][44][45][46][47] Patients who had worse survival with CBC were young patients, patients with large tumors, and node-positive patients. [44][45][46] It is not clear if the reported worse survival is because these CBCs represent aggressive biology of the primary tumor, distant metastatic disease, or perhaps just older, inferior systemic treatments.…”

“…[43][44][45][46][47] Patients who had worse survival with CBC were young patients, patients with large tumors, and node-positive patients. [44][45][46] It is not clear if the reported worse survival is because these CBCs represent aggressive biology of the primary tumor, distant metastatic disease, or perhaps just older, inferior systemic treatments. Studies have also examined how CPM affects survival in those patient cohorts who are at higher risk for CBC.…”