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Long-term risk of second malignancies in women after breast conservation therapy for ductal carcinoma in situ or early-stage breast cancer

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Abstract

Purpose

Women with ductal carcinoma in situ (DCIS) or early-stage breast cancer have an excellent prognosis, but their risk of developing second malignant neoplasms (SMNs) is not well established. We analyzed SMNs in a large cohort with long follow-up after breast conservation therapy.

Methods

The study population comprised 755 women with DCIS (n = 135) or stage I-II breast carcinoma (n = 620). Subjects were aged 25-89 (median 55) years when they underwent breast-conserving surgery followed by radiotherapy to the entire breast (60-68Gray) between 1992 and 2001. Additional treatment included hormonal therapy and/or chemotherapy based on clinical characteristics. SMNs were grouped by site. The rate of SMNs over time was determined using the Kaplan–Meier method. To compare the probability of developing SMNs overall and for specific organs or sites, probability estimates were obtained for a 55-year-old female from the Surveillance, Epidemiology, and End Results Program (SEER).

Results

Median follow-up from radiotherapy was 13.8 years. The 15-year age-adjusted probability of developing any SMN was 12.0%, close to the SEER rate of 12.1% for a non-breast malignancy. Systemic therapy and higher-dose radiotherapy (> 63 Gray) were not associated with significantly increased risks of SMNs. Compared to SEER, significantly increased risk was noted for gynecologic cancers and melanoma.

Conclusions

Most SMNs were unrelated to treatment, and the 15-year incidence was similar to that of cancer in the SEER control group—findings that should be reassuring to patients. Further risk reduction is expected from prophylactic gynecologic surgery. Continued investigations into genetic links with melanoma are warranted.

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Funding

This work is supported in part by the University of Pennsylvania Abramson Cancer Center Core Grant (P30CA016520) to Wei-Ting Hwang.

Author information

Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Carolyn J. Kushner

  2. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Wei-Ting Hwang & Shiyu Wang

  3. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Lawrence J. Solin & Neha Vapiwala

  4. Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA

    Lawrence J. Solin

Authors
  1. Carolyn J. Kushner
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  2. Wei-Ting Hwang
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  3. Shiyu Wang
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  4. Lawrence J. Solin
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  5. Neha Vapiwala
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Corresponding author

Correspondence to Neha Vapiwala.

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The authors declare that they have no conflict of interest.

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Data availability statement:

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Kushner, C.J., Hwang, WT., Wang, S. et al. Long-term risk of second malignancies in women after breast conservation therapy for ductal carcinoma in situ or early-stage breast cancer. Breast Cancer Res Treat 170, 45–53 (2018). https://doi.org/10.1007/s10549-018-4729-7

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  • DOI: https://doi.org/10.1007/s10549-018-4729-7

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