Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment

Rubino, Carole; Vathaire, Florent de; Shamsaldin, Akhtar; Labbé, Martine; Lê, Monique G.

doi:10.1038/sj.bjc.6601138

Cited by 78 publications

(69 citation statements)

References 24 publications

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“…A number of previous studies have demonstrated a link between hormonal treatment for invasive breast cancer and the development of uterine or endometrial cancer (Khandekar et al, 1978;Hardell, 1988;Fornander et al, 1989;Atlante et al, 1990;Gusberg, 1990;Mathew et al, 1990;Andersson et al, 1991;Fisher et al, 1994;Rubino et al, 2003). However, it is generally accepted that for women with invasive breast cancer, the benefits of hormonal treatment, such as tamoxifen, outweigh the associated risks (Gail et al, 1999).…”

Section: Discussionmentioning

confidence: 97%

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

2008

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Approximately 1 in every 600 women attending breast-screening programmes in the United Kingdom is diagnosed with breast carcinoma in situ (BCIS). However, there is little information on the occurrence of subsequent cancers (other than second breast cancers) in these women. We investigated the occurrence of invasive cancers in 12 836 women diagnosed with BCIS in southeast England between 1971 and 2003, using data from the Thames Cancer Registry. A greater than expected number of subsequent cancers was found for two sites: breast (standardised incidence ratio (SIR) 1.96; 95% confidence interval (CI) 1.79 -2.14) and corpus uteri (SIR 1.42; 95% CI 1.11 -1.78). For subsequent ipsilateral breast cancer in those treated with breast conservation, the excess was independent of the time since diagnosis of BCIS, whereas for subsequent contralateral breast cancer, there was a steady decline in excess over time. For subsequent uterine cancer, the excess became statistically significant only at 45 years after BCIS diagnosis, consistent with a treatment effect. This was further supported by Cox regression anaysis: the risk of subsequent uterine cancer was significantly increased in women receiving hormonal therapy compared with those not receiving it, with a hazard ratio of 2.97 (95% CI 1.84 -4.80). (2008) Currently, approximately 1 in every 600 women attending breastscreening programmes in the United Kingdom is diagnosed with breast carcinoma in situ (BCIS). This amounted to almost 3000 cases in 2004 (NHS Cancer Screening Programmes, 2006. The most common form of treatment is lumpectomy, with or without radiotherapy, although women with a more diffuse pattern of BCIS may undergo mastectomy. A number of previous studies have focused on the risk of second breast cancer following a diagnosis of BCIS (Habel et al, 1997;Wärnberg et al, 2000;Claus et al, 2003;Levi et al, 2005;Rawal et al, 2005), with estimates of relative risk generally of the order of two-to fivefold. Few studies have looked at the occurrence of subsequent invasive cancers at other sites (Ward et al, 1992;Franceschi et al, 1998;Soerjomataram et al, 2006), and these were based on relatively small numbers of cases. British Journal of CancerIn the current population-based study, we have investigated the occurrence of subsequent invasive cancers in a very large series of unselected women with BCIS in southeast England. We have also examined the relationship between treatment for BCIS and the development of subsequent cancers. MATERIALS AND METHODSAll recorded cases of BCIS (ICD10 code D05) diagnosed in women between 1971 and 2003 were extracted from the Thames Cancer Registry (TCR) database. The TCR is a population-based registry covering London and a large part of southeast England. Patients with any other cancers diagnosed prior to, or at the same time as, BCIS were excluded in order to avoid confounding the sequelae of BCIS with those of other cancers, particularly breast cancer. The occurrence of subsequent cancers was analysed by calculating the standardised inc...

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Section: Discussionmentioning

confidence: 97%

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

2008

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“…Women with previous breast cancer are known to carry a two-fold increased risk of second cancer in comparison to the general population (Rubino et al, 2003;Soerjomataram et al, 2005a). Studies assessing the risk of second cancer following the diagnosis of BCIS (breast carcinoma in situ) are however scarce or only focused on the risk of second breast cancer (Habel et al, 1997;Warnberg et al, 2000;Claus et al, 2003;Levi et al, 2005;Rawal et al, 2005).…”

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confidence: 99%

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

et al. 2006

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Among 1276 primary breast carcinoma in situ (BCIS) patients diagnosed in 1972 -2002 in the Southern Netherlands, 11% developed a second cancer. Breast carcinoma in situ patients exhibited a two-fold increased risk of second cancer (standardised incidence ratios (SIR): 2.1, 95% confidence interval (CI): 1.7 -2.5). The risk was highest for a second breast cancer (SIR: 3.4, 95% CI: 2.6 -4.3; AER: 66 patients per 10 000 per year) followed by skin cancer (SIR: 1.7, 95% CI: 1.1 -2.6; AER: 17 patients per 10 000 per year). The increased risk of second breast cancer was similar for the ipsilateral (SIR: 1.9, 95% CI: 1.3 -2.7) and contralateral (SIR: 2.0, 95% CI: 1.4 -2.8) breast. Risk of second cancer was independent of age at diagnosis, type of initial therapy, histologic type of BCIS and period of diagnosis. Standardised incidence ratios of second cancer after BCIS (SIR: 2.3, 95% CI: 1.8 -2.8) resembled that after invasive breast cancer (SIR: 2.2, 95% CI: 2.1 -2.4). Surveillance should be directed towards second (ipsi-and contra-lateral) breast cancer.

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“…These findings have been attributed to shared lifestyle and genetic risk factors, carcinogenic effect of treatment (in particular radiotherapy), and most commonly to better medical surveillance of women with previous breast cancer. Most of those studies addressing melanoma risk after breast cancer concerned patients treated in the distant past and therefore with treatment regimens not including hormonal therapy (15,16), or lacked antiestrogen data or when available, did not evaluate if hormonal therapy influenced melanoma risk (17,19,(20)(21)(22)24). To our knowledge, only 2 prior studies evaluated melanoma cancer risk among breast cancer patients according to hormonal therapy (23,24).…”

Section: Discussionmentioning

confidence: 91%

“…Most of those studies addressing melanoma risk after breast cancer concerned patients treated in the distant past and therefore with treatment regimens not including hormonal therapy (15,16), or lacked antiestrogen data or when available, did not evaluate if hormonal therapy influenced melanoma risk (17,19,(20)(21)(22)24). To our knowledge, only 2 prior studies evaluated melanoma cancer risk among breast cancer patients according to hormonal therapy (23,24). The large study from the Netherlands of a population-based breast cancer cohort (23) showed an increased risk of secondary melanoma (SIR: 1.69, 95% CI: 1.44-1.97).…”

Section: Discussionmentioning

confidence: 99%

Antiestrogen Therapy for Breast Cancer Modifies the Risk of Subsequent Cutaneous Melanoma

Huber

Schaffar

Neyroud-Caspar

et al. 2012

Cancer Prevention Research

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Increased risk of secondary melanoma after breast cancer has been reported. Several lines of evidence suggest that elevated estrogen levels may be implicated in melanoma etiology. Accordingly, use of antiestrogens should be associated with decreased risk of melanoma. We compared melanoma incidence among a cohort of breast cancer patients with and without antiestrogen therapy, with data from the Geneva Cancer Registry. The cohort consisted of 7,360 women diagnosed with breast cancer between 1980 and 2005. About 54% of these patients received antiestrogens. All women were followed until December 2008. We compared cutaneous melanoma incidence rates among patients with and without antiestrogens with those expected in the general population by age and period standardized incidence ratios (SIR). A total of 34 women developed a melanoma during the follow-up period. Compared with the general population, the risk of melanoma was higher for patients who did not receive antiestrogens (SIR: 1.60, 95% CI: 1.08-2.12, P ¼ 0.02). On the contrary, the risk was close to 1 (SIR: 0.98, 95% CI: 0.40-1.56, P ¼ 0.57) for patients who received antiestrogen therapy. This study suggests that antiestrogen therapy modifies the risk of melanoma after breast cancer. Although our results are in agreement with the hypothesis that estrogens could play a role in melanoma occurrence, they need to be replicated in a larger study with data on potential confounders. Cancer Prev Res; 5(1); 82-88. Ó2012 AACR.

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Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment

Cited by 78 publications

References 24 publications

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

Antiestrogen Therapy for Breast Cancer Modifies the Risk of Subsequent Cutaneous Melanoma

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