Managing the remaining breast

Abstract

Bilateral breast cancer is discussed as to 1) the criteria for determining whether a cancer in the other breast is primary or metastatic; 2) the incidence of simultaneous and subsequent primary cancers in the second breast and the factors that could account for the reported frequency variance by different authors; 3) the influence that a second primary cancer in the contralateral breast makes on the survival of the patient; 4) the psychologic and physical importance of the remaining breast to the patient; and 5) the management of the other breast using preoperative x-rays and random biopsies as added modalities for detection and reserving prophylactic mastectomy of the remaining breast for those patients at high risk for developing cancer in it with a definition of these risk factors. Forty-two simultaneous primary cancers were found in the other breast in a series of 500 (8.4%) patients undergoing primary therapy for cancer in their first breast of which 19 (45.2%) were invasive, and 23 (54.8%) were non-invasive. Two (0.4%) were detected clinically, 16 (3.2%) by x-rays, and 24 (7.5%) by random biopsies in 321 patients. In a series of 846 patients with potentially curable breast cancer, the absolute ten-year survival rate was 63%. They were operated on before the routine use of preoperative x-rays and random biopsies. Eleven (1.3%) had either clinical or x-ray detected simultaneous cancers in the other breast. Of the remaining 835, 48 had prophylactic mastectomies in which 8 (16.6%) unsuspected cancers were found. In the remaining 787, 70 (8.9%) developed subsequent cancers making a total subsequent rate of 78 of 835 (9.3%).

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

“…1,2 The incidence of metachronous contralateral breast cancer (CC) has been estimated to occur at a constant annual rate of about 0.5% to 1% per year. [1][2][3][4][5][6][7][8][9] Although breast conservation therapy (BCT) is becoming an increasingly well-accepted method of managing patients with breast cancer, its role in treatment of synchronous bilateral breast cancers or metachronous CC in patients who have received previous BCT and radiotherapy for the initial cancer is not well documented.…”

Treatment of Bilateral Breast Cancer

“…[22][23][24] Nor is time alone a reliable means of differentiating between primary and metastatic tumors. 3,25 Also, a secondary primary malignancy may have been present when the initial breast cancer was treated (synchronous) but may have been unapparent because of a slower growth rate.…”

“…[3][4][5][6] When the initial diagnosis of the second cancer is established by clinical examination, the incidence is 0.2% to 2.0%. 7 The addition of mammography increases this to 2% to 5%, [8][9][10] and by performing a selective biopsy of the opposite breast, the yield can be increased to 16.7%.…”

Subcutaneous mastectomy ? surgical techniques and complications in 176 women

“…With a history of carcinoma of one breast, the risk of developing a contralateral primary carcinoma is increased [4,18,24,25,33]. Breast reconstruction after ME became an accepted treatment in the late seventies.…”