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Tumor Characteristics of Bilateral Breast Cancer Compared with Unilateral Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Bilateral breast cancer (BC) has an incidence of 1 to 3 %. This study aimed to describe the clinicopathologic characteristics and management of bilateral BC, estimate disease-free survival (DFS), and compare DFS with unilateral BC.

Methods

A retrospective analysis was performed for patients who had bilateral invasive BC or unilateral invasive BC and contralateral ductal carcinoma in situ (DCIS) treated at Mayo Clinic Rochester from 2008 to 2022. A 4:1 matched cohort of patients with unilateral invasive BC was used for comparison. The groups were compared using Wilcoxon rank-sum or chi-square tests. Disease-free survival was analyzed using the Kaplan-Meier method and log-rank test, with Cox proportional hazards regression used for multivariable analysis.

Results

The study identified 278 cases of bilateral breast cancer (177 cases of bilateral invasive cancer and 101 cases of unilateral invasive cancer with contralateral DCIS), representing 4.1 % of invasive BCs. Biologic subtype was concordant between sides in 79.8 % of the patients. Initial surgery was bilateral mastectomy for 76.6 %, bilateral lumpectomy for 20.5 %, and unilateral mastectomy with unilateral lumpectomy for 2.9 % of the patients. Pathogenic variants in breast cancer predisposition genes were present in 21.7 % of those tested. The patients who had bilateral BC presented with a higher cT category than the patients who had unilateral BC (p = 0.02), and a higher proportion presented with ILC (17.3 % vs 10.9 %; p = 0.004), estrogen receptor-positive (ER+) disease (89.2 % vs 84.2 %; p = 0.04), multicentric/multifocal disease (37.1 % vs 24.3 %; p < 0.001), breast cancer pathogenic variant (21.7 % vs 12.4 %; p = 0.02), and palpable presentation (48.2 % vs 40.8 %; p = 0.03). The patients with bilateral BC showed DFS similar to that for the unilateral BC cohort (p = 0.71).

Conclusions

Bilateral BCs most commonly are biologically concordant between sides. Bilateral BC presented more commonly with larger tumors, lobular histology, ER+ status, multicentricity or multifocality, pathogenic variant, and palpable disease. Bilateral BC is not associated with worse DFS than unilateral BC.

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Acknowledgment

Dr. Boughey receives research support paid to her institution from Eli Lilly and SymBioSis and is on a DSMC for CairnsSurgical. She has received honoraria for speaking for PER, PeerView, and EndoMag, and has contributed a chapter to UpToDate.

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Authors and Affiliations

  1. Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Amy K. Schulze MD, Dan Moldoveanu MD, Jenna L. Sturz DO & Judy C. Boughey MD

  2. Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS

Authors
  1. Amy K. Schulze MD
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  2. Tanya L. Hoskin MS
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  3. Dan Moldoveanu MD
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  5. Judy C. Boughey MD
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Correspondence to Judy C. Boughey MD.

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Supplementary Information

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10434_2023_14451_MOESM1_ESM.tiff

Supplementary file1 FIG. S1 Disease-free survival by type of surgery in the bilateral breast cancer cohort restricted to the subgroup with a preoperative diagnosis of invasive cancer in both breasts

10434_2023_14451_MOESM2_ESM.tiff

Supplementary file2 FIG. S2 Disease-free survival for the subgroup of bilateral patients with preoperative diagnosis of invasive disease in both breasts versus patients with unilateral invasive breast cancer

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Schulze, A.K., Hoskin, T.L., Moldoveanu, D. et al. Tumor Characteristics of Bilateral Breast Cancer Compared with Unilateral Breast Cancer. Ann Surg Oncol 31, 947–956 (2024). https://doi.org/10.1245/s10434-023-14451-x

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  • DOI: https://doi.org/10.1245/s10434-023-14451-x

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