Inferior survival for young patients with contralateral compared to unilateral breast cancer: a nationwide population-based study in the Netherlands

Abstract

To compare overall survival between women with unilateral breast cancer (UBC) and contralateral breast cancer (CBC). Women with UBC (N = 182,562; 95 %) and CBC (N = 8,912; 5 %) recorded in the Netherlands Cancer Registry between 1989 and 2008 were included and followed until 2010. We incorporated CBC as a time-dependent covariate to compute the overall mortality rate ratio between women with CBC and UBC. Prognostic factors for overall death were examined according to age at first breast cancer. Women with CBC exhibited a 30 % increase in overall mortality (Hazard Ratio (HR), 95 % Confidence Interval: 1.3, 1.3-1.4) compared with UBC, decreasing with rising age at diagnosis of first breast cancer (<50 years: 2.3, 2.2-2.5 vs. ≥70 years: 1.1, 1.0-1.1). Women older than 50 years at CBC diagnosis and diagnosed 2-5 years after their first breast cancer exhibited a 20 % higher death risk (1.2, 1.0-1.3) compared to those diagnosed within the first 2 years. In women younger than 50 years, the HR was significantly lower if the CBC was diagnosed >5 years after the first breast cancer (0.7, 0.5-0.9). The prognosis for women with CBC significantly improved over time (2004-2008: 0.6, 0.5-0.7 vs. 1989-1993). Women with CBC had a lower survival compared to women with UBC, especially those younger than 50 years at first breast cancer diagnosis. A tailored follow-up strategy beyond current recommendations is needed for these patients who, because of their age and absence of known familial risk, are currently not invited for population-based screening.

Incidence of metachronous contralateral breast cancer in the Canton of Zurich: a population-based study of the cancer registry

“…As in some other studies older patients -older than 84 years of age in our case -were not included because of the insufficient follow-up of older patients (Font-Gonzalez et al 2013;Kollias et al 1999;Nichols et al 2011). Patients younger than 20 were also excluded because of the small number of cases (n=1175).…”

Clinicopathologic features and time interval analysis of contralateral breast cancers

“…17,18,27 Most studies have shown that development of a CBC leads to worse overall and disease specific survival. Some studies have suggested that CBCs that develop within a short time interval may actually represent a form of metastatic disease.…”

Utility of Regular Radiological Follow-up on Early Detection of Contralateral Malignancy and Long-term Outcomes in Metachronous Bilateral Breast Cancer Patients

“…15,16 Bilateral breast cancer is known to be associated with a higher risk of mortality than unilateral breast cancer, with poorer outcomes recorded in a subgroup of patients that exhibited younger-onset and shorter durations between the first and second cancer diagnosis. 11,[17][18][19] Several studies have reported mean durations between the occurrence of the primary breast cancer and CBC as being > 5 years, which means patients need to pay careful attention to their contralateral breast for a significant amount of time after receiving treatment for the primary breast cancer. 17,20 In these patients, an annual MMG and physical examination are recommended as routine practice.…”