Abstract
This study was undertaken to determine the differences in the clinicopathology and survival between synchronous bilateral breast cancer (sBBC) and metachronous bilateral breast cancer (mBBC). Additionally, we analyzed the risk factors for single tumors to develop as sBBC or mBBC. Of the 190 bilateral breast cancer (BBC) cases, 84 cases were sBBC and 106 were mBBC. We defined sBBC as two tumors that developed within 12 months, while mBBC was defined as two tumors that developed over more than 12 months. The peak age of onset of the first mBBC tumors was significantly younger than that of sBBC tumors (p = 0.001). There was a higher concordance rate of ER/ER positivity and PR/PR positivity in the first and second tumors of sBBC than mBBC. The two sBBC breast cancers had relatively similar hormone conditions because of the low rate of ER and PR transformation from positive to negative or vice versa. We determined that patients who presented with extracapsular extension (p = 0.008) and ER positivity (p = 0.001) tend to have synchronous cancers, while patients with 3+ HER2 were more likely to develop metachronous tumors. The prognosis for mBBC was better than that for sBBC when the survival time of mBBC was measured from the initial observation of the first tumors.
References
Chaudary MA, Millis RR, Hoskins EO, Halder M, Bulbrook RD, Cuzick J, et al. Bilateral primary breast cancer: a prospective study of disease incidence. Br J Surg. 1984;71:711–4.
Huo D, Melkonian S, Rathouz PJ, Khramtsov A, Olopade OI. Concordance in histological and biological parameters between first and second primary breast cancers. Cancer. 2011;117:907–15.
Wedam SB, Yang SX. Neoadjuvant bevacizumab and chemotherapy in breast cancer. Transl Cancer Res. 2012;1:57–8.
Dong X, Alpaugh KR, Cristofanilli M. Circulating tumor cells (CTCs) in breast cancer: a diagnostic tool for prognosis and molecular analysis. Chin J Cancer Res. 2012;24:388–98.
Tamura K. Medical oncology in Asia. Chin Clin Oncol. 2012;1:2.
Ozaki S, Tozaki M, Fukuma E, Kawano N, Suzuki T, Yamashiro N, et al. Bilateral breast MR imaging: is it superior to conventional methods for the detection of contralateral breast cancer? Breast Cancer. 2008;15:169–74.
Hemminki K, Vaittinen P. Familial risks in second primary breast cancer based on a family cancer database. Eur J Cancer. 1999;35:455–8.
Li CI, Malone KE, Porter PL, Daling JR. Epidemiologic and molecular risk factors for contralateral breast cancer among young women. Br J Cancer. 2003;89:513–8.
Verkooijen HM, Chatelain V, Fioretta G, Vlastos G, Rapiti E, Sappino AP, et al. Survival after bilateral breast cancer: results from a population-based study. Breast Cancer Res Treat. 2006;105:347–57.
Kheirelseid EA, Jumustafa H, Miller N, Curran C, Sweeney K, Malone C, et al. Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics. Breast Cancer Res Treat. 2010;126:131–40.
Bhullar JS, Unawane A, Subhas G, Poonawala H, Dubay L, Ferguson L, et al. Receptor changes in metachronous breast tumors—our experience of 10 years. Am J Surg. 2012;203:405–9.
Bailey MJ, Royce C, Sloane JP, Ford HT, Powles TJ, Gazet JC. Bilateral carcinoma of the breast. Br J Surg. 1980;67:514–26.
Zhang BN, Cao XC, Chen JY, Chen J, Fu L, Hu XC, et al. Guidelines on the diagnosis and treatment of breast cancer. Gland Surg. 2012;1:39–61.
Quan G, Pommier SJ, Pommier RF. Incidence and outcomes of contralateral breast cancers. Am J Surg. 2008;195:645–50.
Wolff AC, Hammond ME, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, et al. American Society of Clinical Oncology; College of American Pathologists. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007;25:118–45.
Kollias J, Pinder SE, Denley HE, Ellis IO, Wencyk P, Bell JA, et al. Phenotypic similarities in bilateral breast cancer. Breast Cancer Res Treat. 2004;85:255–61.
Hartman M, Czene K, Reilly M, Adolfsson J, Bergh J, Adami HO, et al. Incidence and prognosis of synchronous and metachronous bilateral breast cancer. J Clin Oncol. 2007;25:4210–6.
Chen Y, Thompson W, Semenciw R, Mao Y. Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomarkers Prev. 1999;8:855–61.
Carmichael AR, Bendall S, Lockerbie L, Prescott R, Bates T. The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumours. Eur J Surg Oncol. 2002;28:388–91.
Coradini D, Oriana S, Mariani L, Miceli R, Bresciani G, Marubini E, et al. Is steroid receptor profile in contralateral breast cancer a marker of independence of the corresponding primary tumour? Eur J Cancer. 1998;34:825–30.
Safal M, Lower EE, Hasselgren PO, Hungness ES, Gazder P, Aron B, et al. Bilateral synchronous breast cancer and HER-2/neu overexpression. Breast Cancer Res Treat. 2002;72:195–201.
Gong SJ, Rha SY, Jeung HC, Roh JK, Yang WI, Chung HC. Bilateral breast cancer: differential diagnosis using histological and biological parameters. Jpn J Clin Oncol. 2007;37:487–92.
Hähnel R, Twaddle E. The relationship between estrogen receptors in primary and secondary breast carcinomas and in sequential primary breast carcinomas. Breast Cancer Res Treat. 1985;5:155–63.
Holdaway IM, Mason BH, Bennett RC, Alexander AI, Hahnel R, Kiang DT. Estrogen receptors in bilateral breast cancer. Cancer. 1988;62:109–13.
Cui X, Schiff R, Arpino G, Osborne CK, Lee AV. Biology of progesterone receptor loss in breast cancer and its implications for endocrine therapy. J Clin Oncol. 2005;23:7721–35.
Swain SM, Wilson JW, Mamounas EP, Bryant J, Wickerham DL, Fisher B, et al. Estrogen receptor status of primary breast cancer is predictive of estrogen receptor status of contralateral breast cancer. J Natl Cancer Inst. 2004;96:516–23.
Arpino G, Weiss HL, Clark GM, Hilsenbeck SG, Osborne CK. Hormone receptor status of a contralateral breast cancer is independent of the receptor status of the first primary in patients not receiving adjuvant tamoxifen. J Clin Oncol. 2005;23:4687–94.
Fisher B, Anderson S, DeCillis A, Dimitrov N, Atkins JN, Fehrenbacher L, et al. Further evaluation of intensified and increased total dose of cyclophosphamide for the treatment of primary breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-25. J Clin Oncol. 1999;17:3374–88.
Sandberg ME, Hartman M, Klevebring D, Eloranta S, Ploner A, Hall P, et al. Prognostic implications of estrogen receptor pattern of both tumors in contralateral breast cancer. Breast Cancer Res Treat. 2012;134:793–800.
Fisher ER, Gregorio RM, Redmond C, Kim WS, Fisher B. Pathologic findings from the national surgical adjuvant breast project. (Protocol no. 4). III. The significance of extranodal extension of axillary metastases. Am J Clin Pathol. 1976;65:439–44.
Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet. 1998;351:1451–67.
Hooning MJ, Aleman BM, Hauptmann M, Baaijens MH, Klijn JG, Noyon R, et al. Roles of radiotherapy and chemotherapy in the development of contralateral breast cancer. J Clin Oncol. 2008;26:5561–8.
Lee MM, Heimann R, Powers C, Weichselbaum RR, Chen LM. Efficacy of breast conservation therapy in early stage bilateral breast cancer. Breast J. 1999;5:36–41.
Díaz R, Munárriz B, Santaballa A, Palomar L, Montalar J. Synchronous and metachronous bilateral breast cancer: a long-term single-institution experience. Med Oncol. 2012;29:16–24.
Shi YX, Xia Q, Peng RJ, Yuan ZY, Wang SS, An X, et al. Comparison of clinicopathological characteristics and prognoses between bilateral and unilateral breast cancer. J Cancer Res Clin Oncol. 2012;138:705–14.
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Liang, X., Li, D., Geng, W. et al. The prognosis of synchronous and metachronous bilateral breast cancer in Chinese patients. Tumor Biol. 34, 995–1004 (2013). https://doi.org/10.1007/s13277-012-0636-4
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DOI: https://doi.org/10.1007/s13277-012-0636-4