Skip to main content

Patient and tumor characteristics of bilateral breast cancer at screening mammography in the Netherlands, a population-based study

Abstract

Few data are available on bilateral breast cancer in the screening population. The aim of this study was to determine patient and tumor characteristics of women with bilateral breast cancer at screening mammography. We included all 350,637 screening mammography examinations of women participating in a biennial screening program in a southern screening region of the Netherlands between May 1998 and January 2010. For referred women, all breast imaging reports, biopsy results, and surgery reports during one year after referral were collected. We compared patient and tumor characteristics of referred women with a diagnosis of bilateral breast cancer or unilateral breast cancer at workup. Bilateral or unilateral breast cancer had been diagnosed in respectively 40 (2.2%) and 1766 (97.8%) of 1806 referred women. Women with bilateral or unilateral breast cancer did not differ significantly in mean age, mammographic breast density, family history of breast cancer, or use of hormone replacement therapy. Compared with index cancers, contralateral cancers comprised significantly more lobular cancers (P = 0.02). Tumor size, mitotic activity, and estrogen receptor status were comparable for both groups, but contralateral cancers had a significantly lower risk of lymph node metastases (P = 0.03). Compared to unilateral breast cancer, contralateral malignancies in women with bilateral breast cancer comprised significantly more lobular cancers (P = 0.004) and lymph node negative cancers (P = 0.01). Contralateral breast cancers detected at screening comprise more lobular cancers and show less nodal involvement than index cancers or unilateral cancers. No differences are observed with respect to other patient and tumor characteristics.

This is a preview of subscription content, access via your institution.

References

  1. Otto SJ, Fracheboud J, Looman CW, Broeder MJ, Boer R, Hendriks JH, Verbeek AL, de Koning H (2003) National evaluation team for breast cancer screening. Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review. Lancet 361:1411–1417

    PubMed  Article  Google Scholar 

  2. Hellquist BN, Duffy SW, Abdsaleh S, Björneld L, Bordás P, Tabár L, Viták B, Zackrisson S, Nyström L, Jonsson H (2011) Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. Cancer 117:714–722

    PubMed  Article  Google Scholar 

  3. Heron DE, Kormarnicky LT, Hyslop T, Schwartz GF, Mansfield CM (2000) Bilateral breast carcinoma: risk factors and outcomes for patients with synchronous and metachronous disease. Cancer 88:2739–2750

    PubMed  Article  CAS  Google Scholar 

  4. Intra M, Rotmensz N, Viale G, Mariani L, Bonanni B, Mastropasqua MG, Galimberti V, Genarri R, Veronesi P, Colleoni M, Rousimis E, Galli A, Goldhirsch A, Veronesi U (2004) Clinicopathological characteristics of 143 patients with synchronous bilateral breast carcinomas treated in a single institution. Cancer 101:905–912

    PubMed  Article  Google Scholar 

  5. Kheirelseid EAH, Jumustafa H, Miller N, Curran C, Sweeney K, Malone C, Mclauglin R, Newell J, Kerin MJ (2011) Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics. Breast Cancer Res Treat 126:131–140

    PubMed  Article  Google Scholar 

  6. Schaapveld M, Visser O, Louman WJ, Willemse PH, de Vries EG, van der Graaf WT, Otter R, Coebergh JW, van Leeuwen FE (2008) The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: a population-based study in The Netherlands. Breast Cancer Res Treat 110:189–197

    PubMed  Article  CAS  Google Scholar 

  7. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ (2005) Cancer Intervention and Surveillance Modeling Network (CISNET) collaborators effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353:1784–1792

    PubMed  Article  CAS  Google Scholar 

  8. Duijm LEM, Groenewoud JH, Fracheboud J, Plaisier ML, van Ineveld BM, Roumen RMH, van Beek M, de Koning HJ (2008) Utilization and cost of diagnostic imaging and biopsies following positive screening mammography 2000–2005. Eur Radiol 18:2390–2397

    PubMed  Article  Google Scholar 

  9. Dowling EC, Klabunde C, Patnick J, Ballard-Barbash R (2010) International Cancer Screening Network (ICSN). Breast and cervical cancer screening programme implementation in 16 countries. J Med Screen 17:139–146

    PubMed  Article  Google Scholar 

  10. Hartman M, Czene K, Reilly M, Adolfsson J, Bergh J, Adami HO, Dickman PW, Hall P (2007) Incidence and prognosis of synchronous and metachronous bilateral breast cancer. J Clin Oncol 25:4210–4216

    PubMed  Article  Google Scholar 

  11. Pediconi F, Catalano C, Roselli A, Padula S, Altomari F, Moriconi E, Pronio AM, Kirchin MA, Passariello R (2007) Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral cancer or high-risk lesions. Radiology 243:670–680

    PubMed  Article  Google Scholar 

  12. Diaz R, Munarriz B, Santabell A, Palomar L, Montalar J (2010) Synchronous and metachronous bilateral breast cancer: a long-term single-institution experience. Med Oncol. doi:10.1007/s12032-010-9785-8

  13. Matsuo K, Fukatomi T, Akashi-Tanaka S, Hasegawa T, Tsuda H (2002) Histological grade, p53, HER2 and hormone receptor status of synchronous bilateral breast cancer. Breast Cancer 9:127–133

    PubMed  Article  Google Scholar 

  14. Polednak A (2003) Bilateral synchronous breast cancer: a population-based study of characteristics, method of detection, and survival. Surgery 133:383–389

    PubMed  Article  Google Scholar 

  15. Verkooijen HM, Chatelain V, Fioretta G, Vlastos G (2007) Survival after bilateral breast cancer: results from a population-based study. Breast Cancer Res Treat 105:347–357

    PubMed  Article  Google Scholar 

  16. Carmichael AR, Bendall S, Lockerbie L, Prescott R, Bates T (2002) The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumours. Eur J Surg Oncol 28:388–391

    PubMed  CAS  Google Scholar 

  17. Beckmann KR, Buckingham J, Craft P, Dahlstrom JE, Zhang Y, Roder D, Stuart-Harris R (2010) Clinical characteristics and outcomes of bilateral breast cancer in an Australian cohort. Breast. doi:10.1016/j.breast.2010.10.004

  18. Vuoto HD, García A, Candás GB, Zimmermann AG, Uriburu JL, Isetta JA, Cogorno L, Khoury M, Bernabó OL (2010) Bilateral breast carcinoma: clinical characteristics and its impact on survival. Breast J 16:625–632

    PubMed  Article  Google Scholar 

  19. Setz-Pels W, Duijm LE, Groenewoud JH, Voogd AC, Jansen FH, Hooijen MJ, Louwman MW (2011) Detection of bilateral breast cancer at biennial screening mammography in The Netherlands: a population based study. Radiology. doi:10.1148/radiol.11102117

  20. Duijm LE, Groenewoud JH, Hendriks JH, de Koning HJ (2004) Independent double reading of screening mammograms in The Netherlands: effect of arbitration following reader disagreements. Radiology 231:564–570

    PubMed  Article  Google Scholar 

  21. American College of Radiology (2003) Breast Imaging Reporting and Data System (BI-RADS), 4th edn. American College of Radiology, Reston

    Google Scholar 

  22. Newman LA, Sahin AA, Cunningham JE, Bondy ML, Mirza NQ, Vlastos GS, Whitman GJ, Brown H, Buchholz TA, Lee MH, Singletary SE (2001) A case-control study of unilateral and bilateral breast carcinoma patients. Cancer 91:1845–1853

    PubMed  Article  CAS  Google Scholar 

  23. Lee SG, Orel SG, Woo IJ, Cruz-Jove E, Putt ME, Solin LJ, Czerniecki BJ, Schnall MD (2003) MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology 226:773–778

    PubMed  Article  Google Scholar 

  24. Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, Peacock S, Smazal SF, Maki DD, Julian TB, De Peri ER, Bluemke DA, Schnall MD, ACRIN Trial 6667 Investigators Group (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356:1295–1303

    PubMed  Article  CAS  Google Scholar 

  25. Mertens W, Hilbert V, Makari-Judson G (2004) Contralateral breast cancer: factors associated with stage and size at presentation. Breast J 10:304–312

    PubMed  Article  Google Scholar 

  26. Abdalla I, Thisted R, Heimann R (2000) The impact of contralateral breast cancer on the outcome of breast cancer patients treated by mastectomy. Cancer J 6:266–272

    PubMed  CAS  Google Scholar 

  27. Kim MJ, Kim EK, Kwak JY, Park BW, Kim SI, Oh KK (2008) Bilateral synchronous breast cancer in an Asian population: mammographic and sonographic characteristics, detection methods, and staging. AJR 190:208–213

    PubMed  Article  Google Scholar 

  28. Nagtegaal ID, Allgood PC, Duffy SW, Kearins O, Sullivan EO, Tappenden N, Wallis M, Lawrence G (2011) Prognosis and pathology of screen-detected carcinomas. Cancer 117:1360–1368

    PubMed  Article  Google Scholar 

  29. Kuo WH, Yen AM, Lee Ph, Chen KM, Wang J, Chang KJ, Chen TH, Tsau HS (2009) Cumulative survival in early-onset unilateral and bilateral breast cancer: an analysis of 1907 Taiwanese women. Br J Cancer 100:563–570

    PubMed  Article  Google Scholar 

  30. Irvine T, Allen DS, Gillet C, Hamed H, Fentiman IS (2009) Prognosis of synchronous bilateral breast cancer. Br J Surg 96:376–380

    PubMed  Article  CAS  Google Scholar 

  31. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353:1119–1926

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wikke Setz-Pels.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Setz-Pels, W., Duijm, L.E.M., Groenewoud, J.H. et al. Patient and tumor characteristics of bilateral breast cancer at screening mammography in the Netherlands, a population-based study. Breast Cancer Res Treat 129, 955–961 (2011). https://doi.org/10.1007/s10549-011-1545-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1545-8

Keywords

  • Bilateral breast cancer
  • Screening mammography
  • Index cancer
  • Contralateral cancer
  • Sensitivity