Journal of the National Cancer Institute Advance Access originally published online on July 9, 2009
JNCI Journal of the National Cancer Institute 2009 101(15):1058-1065; doi:10.1093/jnci/djp181
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author 2009. Published by Oxford University Press.
ARTICLES |
Second Primary Breast Cancer Occurrence According to Hormone Receptor Status
Affiliations of authors: Department of Medicine (AWK, JMF), Department of Health Research and Policy (AWK, EMJ, PLH-R, CAC), and Department of Genetics (JMF), Stanford University School of Medicine, Stanford, CA; Northern California Cancer Center, Fremont, CA (LAM, EMJ, PLH-R, CAC)
Correspondence to: Christina A. Clarke, PhD, MPH, Northern California Cancer Center, 2201 Walnut Ave, Ste 300, Fremont, CA 94538-2334 (e-mail: tina{at}nccc.org).
Background: Contralateral second primary breast cancers occur in 4% of female breast cancer survivors. Little is known about differences in risk for second primary breast cancers related to the estrogen and progesterone receptor (hormone receptor [HR]) status of the first tumor.
Methods: We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for contralateral primary breast cancers among 4927 women diagnosed with a first breast cancer between January 1, 1992, and December 31, 2004, using the National Cancer Institute’s Surveillance, Epidemiology, and End Results database.
Results: For women whose first breast tumors were HR positive, risk of contralateral primary breast cancer was elevated, compared with the general population, adjusted for age, race, and calendar year (SIR = 2.22, 95% CI = 2.15 to 2.29, absolute risk [AR] = 13 cases per 10 000 person-years [PY]), and was not related to the HR status of the second tumor. For women whose first breast tumors were HR negative, the risk of a contralateral primary tumor was statistically significantly higher than that for women whose first tumors were HR positive (SIR = 3.57, 95% CI = 3.38 to 3.78, AR = 18 per 10 000 PY), and it was associated with a much greater likelihood of an HR-negative second tumor (SIR for HR-positive second tumors = 1.94, 95% CI = 1.77 to 2.13, AR = 20 per 10 000 PY; SIR for HR-negative second tumors = 9.81, 95% CI = 9.00 to 10.7, AR = 24 per 10 000 PY). Women who were initially diagnosed with HR-negative tumors when younger than 30 years had greatly elevated risk of HR-negative contralateral tumors, compared with the general population (SIR = 169, 95% CI = 106 to 256, AR = 77 per 10 000 PY). Incidence rates for any contralateral primary cancer following an HR-negative or HR-positive tumor were higher in non-Hispanic blacks, Hispanics, and Asians or Pacific Islanders than in non-Hispanic whites.
Conclusions: Risk for contralateral second primary breast cancers varies substantially by HR status of the first tumor, age, and race and/or ethnicity. Women with HR-negative first tumors have nearly a 10-fold elevated risk of developing HR-negative second tumors, compared with the general population. These findings warrant intensive surveillance for second breast cancers in women with HR-negative tumors.
| CONTEXT AND CAVEATS Prior knowledge Little has been known about whether a woman's risk of developing a second primary breast tumor is related to the hormone receptor (HR) status of the first tumor. Study design Data from the Surveillance Epidemiology, and End Results (SEER) registry were analyzed for 4927 women who were first diagnosed with breast cancer between 1992 and 2004 and subsequently developed contralateral second primary breast cancers. Incident cases, standardized incidence ratios, and absolute risks were determined as a function of HR status and either time to second tumor, calendar year, or the patient's age or race. Contribution Women who had survived HR-positive breast cancers had more than a twofold increased risk of a second primary tumor, and women who had survived HR-negative breast cancers had nearly a fourfold increased risk, compared with the age-, race-, and year-adjusted general population. Those with HR-negative first tumors were much more likely to develop HR-negative second tumors, and this was especially true for women first diagnosed before age 30, who had 169 times the normal risk of a second HR-negative tumor. Implications Women who have had breast cancer should be more intensively screened for the appearance of second tumors, particularly if the first tumors were HR negative and/or if the women were first diagnosed at less than 30 years of age. Limitations The available data did not allow analysis by additional tumor markers nor by family history, inherited mutations, or treatment details including tamoxifen use. From the Editors
|
Manuscript received November 24, 2008; revised May 6, 2009; accepted May 22, 2009.
Related Article in JNCI
CiteULike 
Connotea 
Del.icio.us What's this?
J Natl Cancer Inst 2009 101: 1033.