Second cancers after conservative surgery and radiation for stages I–II breast cancer: identifying a subset of women at increased risk

Fowble, Barbara; Hanlon, Alexandra L.; Freedman, Gary M.; Nicolaou, Nicos; Anderson, Penny R.

doi:10.1016/s0360-3016(01)01665-0

Cited by 129 publications

(90 citation statements)

References 70 publications

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“…5 It has been reported that cigarette smoking and radiotherapy are significant risk factors. [10][11][12][13] It should be also noted, however, that the lung is a major site of metastasis for breast cancer. 14,15 Various studies on surgically resected breast cancers reported an incidence of 8-10.2% of metastases to lung, pleura, or mediastinum.…”

Section: Discussionmentioning

confidence: 99%

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

2010

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The risk of developing a second primary cancer is increased in patients with breast cancer, and the lung is one of the major sites involved. Moreover, the lung is the major metastatic site for breast cancers. A distinction between metastatic breast cancer and primary lung cancer can be histologically difficult, and both show an overlapping CK7 þ /CK20À immunoprofile in a majority of cases. The degree of difficulty increases with poorly differentiated tumors. We investigated differential expressions of TTF-1, Napsin A, surfactant apoprotein A, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 immunostains in 197 pulmonary carcinomas (158 adenocarcinomas, 39 squamous) and 115 invasive mammary carcinomas (91 ductal, 24 lobular type). In mammary carcinomas, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 were expressed in 74, 72, 64, and 62%, respectively, whereas TTF-1, Napsin A, and surfactant apoprotein A were all negative. The expressions were diffuse in estrogen receptor and GATA-3, and variable in mammaglobin and GCDFP-15. For a combination of estrogen receptor/mammaglobin or GATA-3/mammaglobin, 83% of mammary carcinomas were positive, and the detection rate was not improved by using all three markers. All lung squamous cell carcinomas were negative for all markers studied. TTF-1, Napsin A, and surfactant apoprotein A were positive in 80, 77, and 45% of pulmonary adenocarcinomas. None of the TTF-1-negative tumors expressed surfactant apoprotein A. GCDFP-15 was focally expressed in 2.5% of pulmonary adenocarcinomas, and estrogen receptor was focally expressed in one case (1.2%) of pulmonary adenocarcinoma. When metastasis from breast cancer is suspected in the lung, a combination of either estrogen receptor/mammaglobin or GATA-3/mammaglobin as breast markers, and a combination of TTF-1 and Napsin A as lung markers may be helpful for differentiating between the two. Caution should be taken in the interpretation of GCDFP-15 due to its occasional expression in pulmonary adenocarcinomas.

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Section: Discussionmentioning

confidence: 99%

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

2010

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“…The above-mentioned hormonotherapy as well as cytotoxic and radiation therapy used in breast cancer patients can increase the risk of occurrence of second malignancies [3,4,6,20,22,24,26,36,37,[39][40][41][42][43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

The characteristics of breast cancer patients with metachronous primary malignancies

Sas-Korczyńska¹,

Kamzol²,

Kołodziej-Rzepa³

et al. 2017

Nowotwory. Journal of Oncology

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Introduction. The risk of developing subsequent primary cancers varies from 1% to 18% and it depends on the type of first cancer and treatment methods applied. Considering the time of occurrence, multiple primary cancers generally fall into two categories: synchronous and metachronous. In breast cancer patients, 10.5% developed multiple primary cancers, from which 23.8% had synchronous, 79% had metachronous and the remaining 2.8% had both synchronous and metachronous malignancies. In patients with breast cancer, elevated risk is observed especially in the development of contralateral breast cancer, endometrial cancer, esophageal cancer, ovarian cancer and thyroid cancer. Aim. This paper presented the characteristics of breast cancer patients with metachronous primary malignancies in relation to the type of metachronous primaries (breast versus non-breast) and to analyse the impact of the type of metachronous cancers on survival rate. Material and methods. Among patients treated for breast cancer between 1963 and 2010, 354 patients (2.1%) developed metachronous primary malignancies and these made up 13.8% of all patients with multiple primary cancers. The mean age at diagnosis of the first breast cancer was 53 ± 11.5 years; positive family cancer history was noted in 127 patients (35.9%). Metachronous malignancies are defined as primaries following the diagnosis of breast cancer in a time interval greater than or equal to than 6 months. In our group, the mean time interval between the diagnosis of breast cancer and the appearance of metachronous malignancies was 100.9 ± 74.9 months (range: 6-543 months, median: 83 months). For comparison of the two groups (patients with second breast vs non-breast cancer) we used the Pearson's Chi-square test for independence (for categorized variables) and variance analysis with Student's t-test (for continuous variables). The survival rate was evaluated with the Kaplan-Meier method, and the log rank test was applied to assess the influence of some factors on the evaluated results. The significance level at α = 0.05 was adopted for all statistical analyses. Results. The probability of occurrence of new cancer averaged from 38.1% to 67.8% for 5 and 10 years after diagnosis of first breast cancer, respectively. In our group, 380 cases of metachronous carcinomas were noted in 354 analysed patients. The most frequent metachronous malignancy was breast cancer (194 cases -54.8%), which occurred as second (192 cases) or third (2 cases) cancer. Patients with contralateral breast cancer in comparison to other types of metachronous malignancies were significantly (p < 0.05): younger (under 50 years: 56.2% vs 34.4%), premenopausal (69.6% vs 48.8%), had a lobular type of first breast cancer (6.7% vs 1.3%), and rarely received tamoxifen (25.3% vs 48.2%). The type of metachronous cancers significantly influenced survival rate: 10-year overall survival rates were 80.1% vs 67.8%, (p = 0.0271). Conclusions. The risk of occurrence of second malignancies in breast cancer survivors makes early dete...

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“…For radiotherapy, the most common second cancer types were those of organs located close to the breast, such as the esophagus, lung, thyroid gland and stomach, as well as soft tissue sarcomas of the thorax and upper limbs and leukemia (30)(31)(32)(33)(34)(35)(36). Among radiotherapy-treated patients, certain investigators have reported an increase in the risk of contralateral breast cancer associated with radiotherapy (37,38).…”

Section: Discussionmentioning

confidence: 99%

Risk of second cancer after initial treatment of breast cancer: An Osaka Cancer Registry Database study

Kamigaki

Kawakami

2011

Oncol Lett

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Abstract. In the present study, the association between the incidence of second cancer and initial treatment for primary breast cancer was investigated using the Osaka Cancer Registry in Japan. We selected 45,575 patients diagnosed with breast cancer between January 1975 and December 2003. Information on initial cancer treatment and second cancer was obtained from the Osaka Cancer Registry. Patients were classified according to initial treatment (chemo-, hormone, or radiotherapy, or no treatment). We calculated the incidence rate ratio of second cancers in patients classified by treatment for the first cancer. The effects of treatment adjusted for covariates on second cancers were examined using stratified analyses and a Cox proportional hazard model. The final number of 33,043 subjects had a mean duration of follow-up of 5.2±4.3 years, during which 1,857 second cancers were diagnosed. For hormone therapy, the incidence rate ratio (IRR) of all second cancers was 0.64 [95% confidence interval (CI), 0.58-0.70], and that of corpus uteri cancer was 3.04 (95% CI, 1. 78-5.19). The multivariate analysis revealed that the IRR of corpus uteri cancer associated with hormone therapy was 2.53 (95% CI, 1.41-4.55). The incidence rate of all second cancers associated with initial treatment was lower than that associated with no treatment. Only second corpus uteri cancer may be related to hormone therapy.

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Second cancers after conservative surgery and radiation for stages I–II breast cancer: identifying a subset of women at increased risk

Cited by 129 publications

References 70 publications

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

The characteristics of breast cancer patients with metachronous primary malignancies

Risk of second cancer after initial treatment of breast cancer: An Osaka Cancer Registry Database study

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