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Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics

  • Epidemiology
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Abstract

There has been conflicting evidence on the impact of bilateral breast cancer (BBC) on the survival and management of patients. The objectives of this study were to address the incidence of BBC and to investigate its characteristics and outcome compared to unilateral cancer. Data were acquired from the prospectively maintained NUIG breast cancer database between 1988 and 2008. BBC were then categorized as synchronous (within 12 months) or metachronous (after 12 months of first tumour). SPSS was used for data analysis. The incidence of BBC in our population was 4.4% (112 of 2,524). Of those 2.1% were synchronous while 2.3% were metachronous. Compared to unilateral cases, bilateral cancer patients were younger (P = 0.021) and had smaller size (P = 0.001) and earlier stage (P < 0.001) tumours at diagnosis. We identified the HER2/neu positivity as a risk factor for developing contralateral breast tumour and ER negativity as a risk factor for developing metachronous tumours. While there was no significant difference in survival for patients with bilateral compared to unilateral tumour (P > 0.05), the synchronous tumour was associated with poorer survival (P = 0.010) in comparison to metachronous tumour. This large single-institutional experience does not support the increasing practice of prophylactic mastectomy but does justify regular follow-up with mammography for early detection of contralateral tumour.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Donovan AJ (1990) Bilateral breast cancer. Surg Clin N Am 70:1141–1149

    CAS  PubMed  Google Scholar 

  3. Michowitz M, Noy S, Lazebnik N, Aladjem D (1985) Bilateral breast cancer. J Surg Oncol 30:109–112

    Article  CAS  PubMed  Google Scholar 

  4. Gogas J, Markopoulos C, Skandalakis P, Gogas H (1993) Bilateral breast cancer. Am Surg 59:733–735

    CAS  PubMed  Google Scholar 

  5. Chen Y, Thompson W, Semenciw R, Mao Y (1999) Epidemiology of contralateral breast cancer. Cancer Epidemiol, Biomark Prev 8:855–861

    CAS  Google Scholar 

  6. Chaudary MA, Millis RR, Hoskins EO, Halder M, Bulbrook RD, Cuzick J, Hayward JL (1984) Bilateral primary breast cancer: a prospective study of disease incidence. Br J Surg 71:711–714

    Article  CAS  PubMed  Google Scholar 

  7. Heron DE, Komarnicky 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

    Article  CAS  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Hartman M, Czene K, Reilly M, Bergh J, Lagiou P, Trichopoulos D, Adami H-O, Hall P (2005) Genetic implications of bilateral breast cancer: a population based cohort study. Lancet Oncol 6:377–382

    Article  PubMed  Google Scholar 

  11. Lee MM, Heimann R, Powers C, Weichselbaum RR, Chen LM (1999) Efficacy of breast conservation therapy in early stage bilateral breast cancer. Breast J 5:36–41

    Article  PubMed  Google Scholar 

  12. Jobsen JJ, Jvd Palen, Ong F, Meerwaldt JH (2003) Synchronous, bilateral breast cancer: prognostic value and incidence. Breast 12:83–88

    Article  CAS  PubMed  Google Scholar 

  13. Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, Virnig BA (2009) Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol 27:1362–1367

    Article  PubMed  Google Scholar 

  14. Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Mayers JL, Arnold PG, Petty PM, Sellers TA, Johnson JL, McDonnell SK, Frost MH, Jenkins RB (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84

    Article  CAS  PubMed  Google Scholar 

  15. Quan G, Pommier SJ, Pommier RF (2008) Incidence and outcomes of contralateral breast cancers. Am J Surg 195:645–650

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Boetes C, Veltman J (2005) Screening women at increased risk with MRI. Cancer Imaging 23:S10–S15

    Article  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. Adami HO, Bergstrom R, Hansen J (1985) Age at first primary as a determinant of the incidence of bilateral breast cancer: cumulative and relative risks in a population-based case-control study. Cancer 55:643–647

    Article  CAS  PubMed  Google Scholar 

  20. Brenner H, Engelsmann B, Stegmaier C, Ziegler H (1993) Clinical epidemiology of bilateral breast cancer. Cancer 72:3629–3635

    Article  CAS  PubMed  Google Scholar 

  21. Rauschecker HF, Sauerbrei W, Gatzemeier W, Sauer R, Schauer A, Schmoor C, Schumacher M (1998) Eight-year results of a prospective non-randomized study on therapy of small breast cancer. The German Breast Cancer Study Group (GBSG). Eur J Cancer 34:315–323

    Article  CAS  PubMed  Google Scholar 

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

    CAS  Google Scholar 

  23. Samant RS, Olivotto IA, Jakson ISH, Mates D (2001) Diagnosis of metachronous contralateral breast cancer. Breast J 7:405–410

    Article  CAS  PubMed  Google Scholar 

  24. Gajalakshmi CK, Shanta V, Hakama M (1999) Survival from contralateral breast cancer. Breast Cancer Res Treat 58:115–122

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  26. Lesser ML, Rosen PP, Kinne DW (1982) Multicentricity and bilaterality in invasive breast carcinoma. Surgery 91:234–240

    CAS  PubMed  Google Scholar 

  27. de la Rochefordiere A, Asselain B, Scholl S, Campana F, Ucla L, Vilcoq JR, Durand JC, Pouillart P, Fourquet A (1994) Simultaneous bilateral breast carcinoma: a retrospective review of 149 cases. Int J Radiat Oncol Biol Phys 30:35–41

    Article  Google Scholar 

  28. Coradini D, Oriana S, Mariani L, Miceli R, Bresciani G, Marubini E, Di Fronzo G (1998) Is steroid receptor profile in contralateral breast cancer a marker of independence of the corresponding primary tumour? Eur J Cancer 34:825–830

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  30. Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Peterse H, Tilanus-Linthorst MM, Muller SH, Meijer S, Oosterwijk JC, Beex LV, Tollenaar RA, de Koning HJ, Rutgers EJ, Klijn JG (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437

    Article  CAS  PubMed  Google Scholar 

  31. Viehweg P, Rotter K, Laniado M, Lampe D, Buchmann J, Kölbl H, Heywang-Köbrunner S (2004) MR imaging of the contralateral breast in patients after breast-conserving therapy. Eur Radiol 14:402–408

    Article  PubMed  Google Scholar 

  32. Lehman CD, Blume JD, Thickman D, Bluemke DA, Pisano E, Kuhl C, Julian TB, Hylton N, Weatherall P, O’loughlin M, Schnitt SJ, Gatsonis C, Schnall MD (2005) Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 92:9–15

    Article  PubMed  Google Scholar 

  33. Moore SG, Shenoy PJ, Fanucchi L, Tumeh JW, Flowers CR (2009) Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Serv Res 9:9

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bertelsen L, Bernstein L, Olsen JH, Mellemkjaer L, Haile RW, Lynch CF, Malone KE, Anton-Culver H, Christensen J, Langholz B, Thomas DC, Begg CB, Capanu M, Ejlertsen B, Stovall M, Boice JD Jr, Re S, Women’s Environment CaRESCG, Bernstein JL (2008) Effect of systemic adjuvant treatment on risk for contralateral breast cancer in the Women’s Environment, Cancer and Radiation Epidemiology Study. J Natl Cancer Inst 100:32–40

    Article  CAS  PubMed  Google Scholar 

  35. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, Bevers TB, Fehrenbacher L, Pajon ER Jr, Wade JL III, Robidoux A, Margolese RG, James J, Lippman SM, Runowicz CD, Ganz PA, Reis SE, McCaskill-Stevens W, Ford LG, Jordan VC, Wolmark N (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2727–2741

    Article  CAS  PubMed  Google Scholar 

  36. Early Breast Cancer Trialists’ Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351:1451–1467

    Article  Google Scholar 

  37. Bedrosian I, Hu CY, Chang GJ (2010) Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst 102(6):401–409

    Article  PubMed  PubMed Central  Google Scholar 

  38. Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ (2000) Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg 180:439–445

    Article  CAS  PubMed  Google Scholar 

  39. Zion SM, Slezak JM, Sellers TA, Woods JE, Arnold PG, Petty PM, Donohue JH, Frost MH, Schaid DJ, Hartmann LC (2003) Reoperations after prophylactic mastectomy with or without implant reconstruction. Cancer 98:2152–2160

    Article  PubMed  Google Scholar 

  40. Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods JE, Petty PM, Donohue JH, Grant CS, Sloan JA, Sellers TA, Hartmann LC (2005) Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol 23:7849–7856

    Article  PubMed  Google Scholar 

  41. Gollamudi SV, Gelman RS, Peiro G, Schneider LJ, Schnitt SJ, Recht A, Silver BJ, Harris JR, Connolly JL (1997) Breast-conserving therapy for stage I–II synchronous bilateral breast carcinoma. Cancer 79:1362–1369

    Article  CAS  PubMed  Google Scholar 

  42. Yamauchi C, Mitsumori M, Nagata Y, Kokubo M, Inamoto T, Mise K, Kodama H, Hiraoka M (2005) Bilateral breast-conserving therapy for bilateral breast cancer: results and consideration of radiation technique. Breast Cancer 12:135–139

    Article  PubMed  Google Scholar 

  43. Bernstein JL, Thompson WD, Risch N, Holford TR (1992) Risk factors predicting the incidence of second primary breast cancer among women diagnosed with a first primary breast cancer. Am J Epidemiol 136:925–936

    CAS  PubMed  Google Scholar 

  44. Gajalakshmi CK, Shanta V, Hakama M (1998) Risk factors for contralateral breast cancer in Chennai (Madras), India. Int J Epidemiol 27:743–750

    Article  CAS  PubMed  Google Scholar 

  45. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  46. Boice JD Jr, Harvey EB, Blettner M, Stovall M, Flannery JT (1992) Cancer in the contralateral breast after radiotherapy for breast cancer. N Engl J Med 326:781–785

    Article  PubMed  Google Scholar 

  47. Storm HH, Andersson M, Boice JD Jr, Blettner M, Stovall M, Mouridsen HT, Dombernowsky P, Rose C, Jacobsen A, Pedersen M (1992) Adjuvant radiotherapy and risk of contralateral breast cancer. J Natl Cancer Inst 84:1245–1250

    Article  CAS  PubMed  Google Scholar 

  48. Gao X, Fisher SG, Emami B (2003) Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys 56:1038–1045

    Article  PubMed  Google Scholar 

  49. Takahashi H, Watanabe K, Takahashi M, Taguchi K, Sasaki F, Todo S (2005) The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer. Breast Cancer 12:196–202

    Article  PubMed  Google Scholar 

  50. Verkooijen HM, Chatelain V, Fioretta G, Vlastos G, Rapiti E, Sappino AP, Bouchardy C, Chappuis PO (2007) Survival after bilateral breast cancer: results from a population-based study. Breast Cancer Res Treat 105:347–357

    Article  PubMed  Google Scholar 

  51. Mhuircheartaigh JN, Curran C, Hennessy E, Kerin MJ (2008) Prospective matched-pair comparison of outcome after treatment for lobular and ductal breast carcinoma. Br J Surg 95:827–833

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the National Breast Cancer Research Institute (NBCRI) for their financial support of this study.

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Correspondence to Michael J. Kerin.

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Kheirelseid, E.A.H., Jumustafa, H., Miller, N. et al. Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics. Breast Cancer Res Treat 126, 131–140 (2011). https://doi.org/10.1007/s10549-010-1057-y

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  • DOI: https://doi.org/10.1007/s10549-010-1057-y

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