Comparison of primary and secondary breast cancers in adolescents and young adults

Abstract

BACKGROUND: Breast cancer is one of the most common cancers in adolescent and young adult (AYA) patients (ages 15-39) and may develop de novo or in patients previously treated for cancer. This study compares the demographic, tumor, treatment characteristics, and overall survival (OS) of primary versus secondary (SMN) breast cancer in female AYAs. METHODS: All cases of invasive female AYA breast cancer in the 1998-2010 American College of Surgeons National Cancer Database were divided into 2 cohorts according to primary or secondary occurrence. Comparisons using appropriate statistical methods were performed. RESULTS: Of 106,771 patients, 6241 (5.8%) had experienced a prior, histologically distinct malignancy. Breast SMNs were more likely ER-/PR-(OR, 1.24; 95% CI, 1.15-1.34), <1 cm (OR, 1.86; 95% CI, 1.73-1.99) tumors and present at a lower T, N (OR, 1.43; 95% CI, 1.34-1.52), and summary stage but with more distant metastases (OR, 1.42; 95% CI, 1.21-1.67) compared with primary cancers. Adjusted by stage, SMN patients underwent more total mastectomies and received less chemotherapy, radiation, and hormonal therapy. However, SMN patients received definitive surgical treatment almost twice as fast compared with primary cancers (36.12 vs 67.26 days, P <.001). Patients with SMNs had a significantly decreased 3-year OS (79% vs 88.5%, P <.001), with SMN status an independent risk factor for increased mortality (HR, 1.58; 95% CI, 1.41-1.77). CONCLUSIONS: Nonprimary breast cancer in AYAs has different tumor characteristics, presents at a lower stage, and receives less adjuvant therapy than primary cancers. SMN status is an independent risk factor for decreased OS, with an almost 10% decrease at 3 years. Whether the outcome disparity results from previous cancer treatment or differences in biology, environment, or access to care needs further investigation. Cancer 2015;121:1295-302.

Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort

“…No differences between the two groups were observed with regard to stage and grade distribution, in accordance with two small studies among HL survivors [13,29]. In contrast to our findings, two large registry-based studies in AYA cancer survivors did report that AYA cancer/HL survivors with breast SMNs were significantly more likely to have estrogen-and progestogennegative breast cancer compared to breast-FMN patients [16,17]. The percentage of triple negative breast cancer in our study was lower than that reported in a retrospective case series of breast cancer patients with a past history of chest radiotherapy (7.7% vs. 29.2%) [30].…”

“…Several studies have addressed differences in prognostic, clinical, and/or histopathological characteristics of specific types of solid SMNs after childhood, adolescent, and young adult cancers and comparable first malignant neoplasms (FMNs) in the general population [10][11][12][13][14][15][16][17][18][19]. Since the majority of these type of studies focused on breast-SMN, most were conducted in Hodgkin lymphoma or other adolescent and young adult (AYA) cancer survivors.…”

“…Since the majority of these type of studies focused on breast-SMN, most were conducted in Hodgkin lymphoma or other adolescent and young adult (AYA) cancer survivors. Only few studies have specifically focused on young cancer survivors [12,14,17] and few have compared cause-specific survival between patients with specific types of SMNs following cancer at a young age and comparable FMN patients [14,16].…”

Impact of latency time on survival for adolescents and young adults with a second primary malignancy

“…A handful of publications have compared survival with PMs and SPMs of the same type in AYAs . All showed an increased risk of death if a tumor occurred as an SPM versus a primary cancer, although few evaluated whether death was due to the PM or SPM.…”

“…A handful of publications have compared survival with PMs and SPMs of the same type in AYAs. [31][32][33][34] All showed an increased risk of death if a tumor occurred as an SPM versus a primary cancer, although few evaluated whether death was due to the PM or SPM. A few studies of older adult populations of either prostate or renal cell carcinoma survivors compared survival for patients who did and did not develop an SPM.…”