Characteristics and Survival of Breast Cancer Patients with Multiple Synchronous or Metachronous Primary Cancers

Abstract

PurposeNewly developed extra-mammary multiple primary cancers (MPCs) are an issue of concern when considering the management of breast cancer survivors. This study aimed to investigate the prevalence of MPCs and to evaluate the implications of MPCs on the survival of breast cancer patients.Materials and MethodsA total of 8204 patients who underwent surgery at Severance Hospital between 1990 and 2012 were retrospectively selected. Clinicopathologic features and survival over follow-up periods of ≤5 and >5 years were investigated using univariate and multivariate analyses.ResultsDuring a mean follow-up of 67.3 months, 962 MPCs in 858 patients (10.5%) were detected. Synchronous and metachronous MPCs were identified in 23.8% and 79.0% of patients, respectively. Thyroid cancer was the most prevalent, and the second most common was gynecologic cancer. At ≤5 years, patients with MPCs were older and demonstrated significantly worse survival despite a higher proportion of patients with lower-stage MPCs. Nevertheless, an increased risk of death in patients with MPCs did not reach statistical significance at >5 years. The causes of death in many of the patients with MPCs were not related to breast cancer. Stage-matched analysis revealed that the implications of MPCs on survival were more evident in the early stages of breast disease.ConclusionBreast cancer patients with MPCs showed worse survival, especially when early-stage disease was identified. Therefore, it is necessary to follow screening programs in breast cancer survivors and to establish guidelines for improving prognosis and quality of life.

The characteristics of breast cancer patients with metachronous primary malignancies

“…Published data indicate that the risk of developing subsequent primary cancers varies from 1% to 18%, and this depends on the type of first cancer and used treatment methods [3,[6][7][8][9][10][11].…”

“…Causal mechanisms of multiple primary cancer development include genetic predispositions, environmental exposures, lifestyle factors as well as late sequelae of cancer treatment (cytotoxic, radiation or hormonal therapies), its results and a combination of these mechanisms [1,3,4,5,8,9,12,13]. The risk of second primaries also depends on patient age and the amount of time elapsed since anticancer therapy [3,4,[14][15][16].…”

“…The definition of multiple primary cancers is based on the classic criteria of Warren and Gates which include 1) the site of origin -tumours arise in different organs than independent primaries, 2) morphology and histology of tumours -each tumour has to be histologically distinctive and the possibility of metastasis or recurrence must be excluded, and 3) the amount of time elapsed since the initial diagnosis [7,9,10]. Considering the time of occurrence, multiple primary cancers generally fall into two categories: 1) synchronous, if the cancers occur at the same time or within 2-6 months, and 2) metachronous, if the primaries follow in sequence in a interval time interval of more than 2-6 months [1,5,9,10].…”

“…Considering the time of occurrence, multiple primary cancers generally fall into two categories: 1) synchronous, if the cancers occur at the same time or within 2-6 months, and 2) metachronous, if the primaries follow in sequence in a interval time interval of more than 2-6 months [1,5,9,10]. It should be noted that the time interval distinguishing synchronous and metachronous malignancies has not been precisely defined in literature.…”

“…It should be noted that the time interval distinguishing synchronous and metachronous malignancies has not been precisely defined in literature. However, a time interval of 6 months between the occurrence of two primaries has been accepted by some authors [1,9]. Breast cancer is the most common cancer in women; in 2012 it was diagnosed in 1.7 million women in the world, and in 17 thousand women in Poland [17,18].…”