Race, ethnicity and risk of second primary contralateral breast cancer in the United States

Watt, Gordon P.; John, Esther M.; Bandera, Elisa V.; Malone, Kathleen E.; Lynch, Charles F.; Palmer, Julie R.; Knight, Julia A.; Troester, Melissa A.; Bernstein, Jonine L.

doi:10.1002/ijc.33501

Cited by 17 publications

(14 citation statements)

References 39 publications

(83 reference statements)

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“…Future research should explore population representative datasets to study racial/ethnic differences in CPM use and associated predictors. A recent study of nearly 460,000 women showed that, compared to NH White women, NH Black and Hispanic women have an increased risk of contralateral breast cancer that is not explained by available clinical or socioeconomic factors that did not include germline mutation data [ 27 ]. Future studies should explore racial/ethnic differences in predisposition to contralateral breast cancer and the consequent need for CPM use.…”

Section: Discussionmentioning

confidence: 99%

Contralateral Prophylactic Mastectomy among Women with Pathogenic Variants in BRCA1/2: Overall Survival, Racial, and Ethnic Differences

et al. 2022

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Background. Patients with unilateral breast cancer carrying pathogenic variants in BRCA1/2 have the option to undergo contralateral prophylactic mastectomy (CPM). However, differences in CPM use and survival outcomes following CPM are poorly understood in this high-risk population, in part due to a lack of data from contemporary clinical cohorts. The objective of this study was to evaluate post-CPM overall survival (OS) and related racial/ethnic differences in a contemporary clinical cohort. Methods. We retrospectively reviewed the medical records of women with a personal history of unilateral breast cancer carrying pathogenic variants in BRCA1/2 who were diagnosed between 1996 and 2012. Genetic test results, self-reported demographic characteristics, and clinical factors were abstracted from electronic medical records. Results. Of 144 BRCA-positive patients, the majority were White (79.2%, n = 114). Overall, 56.1% (n = 81) of all BRCA1/2 carriers chose to undergo CPM, with no racial/ethnic difference in CPM election ( p = 0.78). Of 81 patients who underwent CPM, there is strong evidence of a difference in survival between the racial/ethnic groups, with White patients having the highest OS compared to non-White patients ( p = 0.001). Of the 63 patients who did not undergo CPM, there is no racial/ethnic difference in overall survival ( p = 0.61). In multivariable cox regression, adjusted for demographic and clinical characteristics, OS was significantly lower among non-Whites than in Whites (HR = 0.39, p = 0.04). Conclusions. Evaluation of a contemporary clinical cohort of BRCA-positive women with unilateral breast cancer showed no racial/ethnic difference in CPM use, but there was a significant difference in post-CPM overall survival.

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Section: Discussionmentioning

confidence: 99%

Contralateral Prophylactic Mastectomy among Women with Pathogenic Variants in BRCA1/2: Overall Survival, Racial, and Ethnic Differences

et al. 2022

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“…The 5-, 10-, and 15-year risks of CBC for each gene were estimated from cumulative incidence curves. A multivariate proportional hazard regression analysis accounting for competing risk of death 15 was performed to compare the CBC risk between PV carriers in each of the five genes and non-PV carriers when adjusting for study, age of diagnosis, 16-18 race/ethnicity, 19,20 menopausal status, 21 histology 22,23 and estrogen receptor (ER) status 24 of the first breast cancer, and use of endocrine therapy. Further analyses stratified by ER status, menopausal status, race/ethnicity, and age of diagnosis of first breast cancer were performed, adjusting for all relevant covariates in the original model.…”

Section: Methodsmentioning

confidence: 99%

Contralateral Breast Cancer Risk Among Carriers of Germline Pathogenic Variants inATM,BRCA1,BRCA2,CHEK2, andPALB2

Yadav

Boddicker

et al. 2023

JCO

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PURPOSE To estimate the risk of contralateral breast cancer (CBC) among women with germline pathogenic variants (PVs) in ATM, BRCA1, BRCA2, CHEK2, and PALB2. METHODS The study population included 15,104 prospectively followed women within the CARRIERS study treated with ipsilateral surgery for invasive breast cancer. The risk of CBC was estimated for PV carriers in each gene compared with women without PVs in a multivariate proportional hazard regression analysis accounting for the competing risk of death and adjusting for patient and tumor characteristics. The primary analyses focused on the overall cohort and on women from the general population. Secondary analyses examined associations by race/ethnicity, age at primary breast cancer diagnosis, menopausal status, and tumor estrogen receptor (ER) status. RESULTS Germline BRCA1, BRCA2, and CHEK2 PV carriers with breast cancer were at significantly elevated risk (hazard ratio > 1.9) of CBC, whereas only the PALB2 PV carriers with ER-negative breast cancer had elevated risks (hazard ratio, 2.9). By contrast, ATM PV carriers did not have significantly increased CBC risks. African American PV carriers had similarly elevated risks of CBC as non-Hispanic White PV carriers. Among premenopausal women, the 10-year cumulative incidence of CBC was estimated to be 33% for BRCA1, 27% for BRCA2, and 13% for CHEK2 PV carriers with breast cancer and 35% for PALB2 PV carriers with ER-negative breast cancer. The 10-year cumulative incidence of CBC among postmenopausal PV carriers was 12% for BRCA1, 9% for BRCA2, and 4% for CHEK2. CONCLUSION Women diagnosed with breast cancer and known to carry germline PVs in BRCA1, BRCA2, CHEK2, or PALB2 are at substantially increased risk of CBC and may benefit from enhanced surveillance and risk reduction strategies.

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“…The changes in average dose to the contralateral breast in the general population of all breast cancer patients remains unclear and will require dosimetric analysis of large populations recruited from diverse treatment centers and continued follow-up in the next decades. Such studies could also address changes in cardiac dose (45) as well as disparities in radiationassociated outcomes (8,46). There were no observed differences in dose received to the contralateral breast by tumor size, estrogen receptor status, receipt of chemotherapy or hormonal therapy, or patient age at time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…These second breast cancers account for 40% of all new malignancies for survivors of breast cancer (2)(3)(4). The risk of CBC is associated with characteristics of the patient and first breast tumor (5)(6)(7)(8), treatment received for the first breast cancer (9,10), and radiation dose received to the untreated contralateral breast during radiation therapy (9)(10)(11)(12)(13)(14). The dose received to the contralateral breast is associated with a proportional increase in risk of CBC, primarily for young women treated at ,40 years of age (14,15).…”

Section: Introductionmentioning

confidence: 99%

Trends in Radiation Dose to the Contralateral Breast During Breast Cancer Radiation Therapy

Watt,

Smith,

Howell

et al. 2023

Radiation Research

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Over 4 million survivors of breast cancer live in the United States, 35% of whom were treated before 2009. Approximately half of patients with breast cancer receive radiation therapy, which exposes the untreated contralateral breast to radiation and increases the risk of a subsequent contralateral breast cancer (CBC). Radiation oncology has strived to reduce unwanted radiation dose, but it is unknown whether a corresponding decline in actual dose received to the untreated contralateral breast has occurred. The purpose of this study was to evaluate trends in unwanted contralateral breast radiation dose to inform risk assessment of second primary cancer in the contralateral breast for long-term survivors of breast cancer. Individually estimated radiation absorbed doses to the four quadrants and areola central area of the contralateral breast were estimated for 2,132 women treated with radiation therapy for local/regional breast cancers at age <55 years diagnosed between 1985 and 2008. The two inner quadrant doses and two outer quadrant doses were averaged. Trends in dose to each of the three areas of the contralateral breast were evaluated in multivariable models. The population impact of reducing contralateral breast dose on the incidence of radiation-associated CBC was assessed by estimating population attributable risk fraction (PAR) in a multivariable model. The median dose to the inner quadrants of the contralateral breast was 1.70 Gy; to the areola, 1.20 Gy; and to the outer quadrants, 0.72 Gy. Ninety-two percent of patients received ≥1 Gy to the inner quadrants. For each calendar year of diagnosis, dose declined significantly for each location, most rapidly for the inner quadrants (0.04 Gy/year). Declines in dose were similar across subgroups defined by age at diagnosis and body mass index. The PAR for CBC due to radiation exposure >1 Gy for women <40 years of age was 17%. Radiation dose-reduction measures have reduced dose to the contralateral breast during breast radiation therapy. Reducing the dose to the contralateral breast to <1 Gy could prevent an estimated 17% of subsequent radiation-associated CBCs for women treated under 40 years of age. These dose estimates inform CBC surveillance for the growing number of breast cancer survivors who received radiation therapy as young women in recent decades. Continued reductions in dose to the contralateral breast could further reduce the incidence of radiation-associated CBC.

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Race, ethnicity and risk of second primary contralateral breast cancer in the United States

Cited by 17 publications

References 39 publications

Contralateral Prophylactic Mastectomy among Women with Pathogenic Variants in BRCA1/2: Overall Survival, Racial, and Ethnic Differences

Contralateral Prophylactic Mastectomy among Women with Pathogenic Variants in BRCA1/2: Overall Survival, Racial, and Ethnic Differences

Contralateral Breast Cancer Risk Among Carriers of Germline Pathogenic Variants inATM,BRCA1,BRCA2,CHEK2, andPALB2

Trends in Radiation Dose to the Contralateral Breast During Breast Cancer Radiation Therapy

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