Feasibility of Breast Conservation Therapy in Metachronous or Synchronous Bilateral Breast Cancer

Heaton, Keith M.; Peoples, George E.; Singletary, S. Eva; Feig, Barry W.; Ross, Merrick I.; Ames, Frederick C.; Buchholz, Thomas A.; Strom, Eric A.; McNeese, Marsha D.; Hunt, Kelly K.

doi:10.1007/s10434-999-0102-8

Cited by 31 publications

(18 citation statements)

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“…28 -32 However, a few other studies have reported a higher median age, 6,27,33,34 whereas a younger age at diagnosis is rarely observed. 35 In most series, the median age of patients with synchronous cancers is not significantly younger than the age of patients with bilateral metachronous and unilateral breast carcinomas, as confirmed in the current series. We did not find a trend toward a young age in the SBIBC group compared with the UIBC cohort (median age, 53 years).…”

Section: Discussionsupporting

confidence: 82%

“…34 This aggressive approach was adopted based on the suggestion that patients with SBIBC have a worse prognosis than patients with UIBC, according to the concept that patients with tumors with worse prognostic factors need more extensive surgical treatment. 25,35 Conversely, at our institution, the majority of patients underwent bilateral breast conservation treatment (57%) and only as few as 22% of the patients underwent bilateral mastectomy. Although significantly higher than in the UIBC cohort (P Ͻ 0.001), the proportion of patients with SBIBC who received mastectomy in our series was much lower than in the majority of published SBIBC series.…”

Section: Discussionmentioning

confidence: 90%

“…However, these latter studies covered a long time period during which the use of breast-conserving surgery increased and became the treatment of choice for early-stage breast carcinoma. Heaton et al 35 have shown that bilateral breast carcinoma is amenable to bilateral breast conservative treatment without affecting overall and disease-free survival, while enhancing patient cosmesis. For patients who received mastectomy on one side and quadrantectomy on the contralateral side, to realize the best breast symmetry, the conservative surgery was sometimes performed with the help of a plastic surgeon during a reduction mammaplasty.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Intra

Rotmensz

Viale

et al. 2004

Cancer

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BACKGROUNDSynchronous bilateral invasive breast carcinoma (SBIBC) ranged in incidence from 0.3% to as high as 12%.METHODSBetween April 1997 and February 2003, 143 consecutive patients with SBIBC were treated at the European Institute of Oncology (Milan, Italy). Their information was collected prospectively in a database. The bilateral tumors were divded into left and right tumors. Tumor size, histology, grade, lymph node status, estrogen (ER) and progesterone receptor (PgR) status, HER‐2 expression, peritumoral vascular invasion (PVI), Ki‐67 expression, extensive in situ component (EIC), and multifocality between the two groups were analyzed. During the same time period, 6218 patients with unilateral invasive breast carcinoma (UIBC) were analyzed in the same manner for comparison with the patients with SBIBC.RESULTSThere were no significant differences between left and right tumors, and the observed histopathologic agreement within the same patient was significantly superior than statistically expected for all characteristics except size, lymph node status, and multifocality. When compared with patients with UIBC, patients with SBIBC were more likely to present with smaller tumors and showed a higher frequency of invasive lobular carcinoma, lower histologic grade, higher rate of ER and PgR positivity, and lower PVI and Ki‐67 expression.CONCLUSIONSThe high concordance of histopathologic characteristics between SBIBC within the same patient could reflect a particular hormonal environment that influenced either the initiation and development of these lesions simultaneously and independently from the single or multi‐clonal origin, either a less aggressive biological behavior compared with UIBC. In particular, the strong agreement of the observed EIC in SBIBC within the same patient seemed to definitively exclude the metastatic origin of these tumors. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Intra

Rotmensz

Viale

et al. 2004

Cancer

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“…Due to the rarity of SCBC, estimations of the prognostic significance of SCBC have varied in different studies, with some suggesting a poorer prognosis than unilateral or metachronous breast cancer [34][35][36] while others have described no negative effect on survival [7,[37][38][39]. These differences may be attributed to variations in sample size, age, follow-up, and treatment regimens.…”

Section: Discussionmentioning

confidence: 96%

Synchronous and metachronous bilateral breast cancer: a long-term single-institution experience

et al. 2010

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Bilateral breast cancer (bBC) is the most common 2nd tumor in primary BC patients. However, its natural history is poorly understood as is the effect of previous adjuvant therapies. Between 1980 and 2005, we identified 3757 BC patients treated in our Institution, with 120 (3.2%) cases of bBC, 91 (2.4%) were metachronous BC (mBC), 29 (0.8%) synchronous BC (sBC). sBC defined as found before 3 months of the initial diagnosis. We performed a descriptive and an overall survival (OS) analysis. mBC appeared in young patients with a strong family history of BC. Most were diagnosed mammographically. The risk did not disappear after 15 years of follow-up. In most estrogen receptor (ER)-positive cases, the 2nd tumor was also ER-positive (concordance rate of 91%). No differences were seen according to the previous use of tamoxifen. In ER-negative cases, 43% of mBC were ER-positive. Synchronous BC (sBC) appeared in an elderly population with a strong family history. About 76% were ER-positive. ER status concordance was seen in 62%. There were no statistically significant differences in OS between patients with sBC or those with the 2nd mBC. A shorter time to appearance of the 2nd tumor predicted a worse OS. ER negativity and grade 3 tumors were negative prognostic factors. The risk of mBC does not abate with the pass of time. Contralateral mammographies should form part of follow-up. ER status concordance is high, especially in ER-positive cases. No differences were seen according to previous use of tamoxifen. Shorter disease-free intervals were linked with worse OS.

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“…Women with cancer in one breast have an increased risk for contralateral breast cancer; the incidence of metachronous contralateral breast carcinoma is 0.5% to 1% per year. 3 Therefore, patients with breast cancer undergoing concurrent or delayed breast reduction for symmetry would be expected to have a higher incidence of occult carcinoma than would patients having bilateral reduction for macromastia.…”

mentioning

confidence: 99%

Management of Breast Carcinoma Identified Intraoperatively During Reduction Mammaplasty

Butler

Hunt

Singletary

2003

Annals of Plastic Surgery

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Before reduction mammaplasty, patients should be assessed for breast cancer risk and evaluated with physical examination and mammography. Patients determined to be at increased risk should be informed of the possibility of occult breast carcinoma and the potential treatment options. Intraoperative discovery of an occult carcinoma may allow for breast conservation therapy under certain circumstances if an appropriate biopsy sample is taken from the tumor and if clear margins are obtained.

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Feasibility of Breast Conservation Therapy in Metachronous or Synchronous Bilateral Breast Cancer

Cited by 31 publications

References 47 publications

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution

Synchronous and metachronous bilateral breast cancer: a long-term single-institution experience

Management of Breast Carcinoma Identified Intraoperatively During Reduction Mammaplasty

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