Breast cancer mortality in synchronous bilateral breast cancer patients.
Journal
British journal of cancer
ISSN: 1532-1827
Titre abrégé: Br J Cancer
Pays: England
ID NLM: 0370635
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
02
10
2018
accepted:
24
01
2019
revised:
24
01
2019
pubmed:
26
2
2019
medline:
18
12
2019
entrez:
27
2
2019
Statut:
ppublish
Résumé
Evidence suggests that patients with synchronous bilateral breast cancer (SBBC), diagnosed within 4 months, have an inferior prognosis compared to unilateral breast cancer (UBC) patients. Using data from nationwide Danish clinical databases, this cohort study investigated whether the inferior prognosis could be explained by SBBC patients having a more aggressive disease, or whether the prognosis could be explained by the fact that they have two simultaneous cancers. Patients were diagnosed from 1999-2015. The main outcome was excess mortality, subtracting background population mortality from observed mortality. Differences between SBBC and UBC patients were evaluated by rate ratios (RR) and estimated by Poisson regression. In total, 1214 SBBC and 59 177 UBC patients were included. SBBC patients had a significantly higher excess mortality than UBC patients after adjustment for age and period (RR = 1.73; 95% CI:1.44-2.08; p < 0.01) and after adjusting for characteristics of the worst tumour as traditionally done (RR = 1.31; 95% CI:1.08-1.57; p = 0.01). However, adjusting for characteristics of both tumours, using a more advanced competing risks model, no difference was observed (RR = 1.01; 95% CI:0.83-1.22; p = 0.93). Our study does not support that the inferior prognosis in SBBC patients is due to having more aggressive tumours per se, but rather the combined effect of having two simultaneous cancers.
Sections du résumé
BACKGROUND
Evidence suggests that patients with synchronous bilateral breast cancer (SBBC), diagnosed within 4 months, have an inferior prognosis compared to unilateral breast cancer (UBC) patients. Using data from nationwide Danish clinical databases, this cohort study investigated whether the inferior prognosis could be explained by SBBC patients having a more aggressive disease, or whether the prognosis could be explained by the fact that they have two simultaneous cancers.
METHODS
Patients were diagnosed from 1999-2015. The main outcome was excess mortality, subtracting background population mortality from observed mortality. Differences between SBBC and UBC patients were evaluated by rate ratios (RR) and estimated by Poisson regression.
RESULTS
In total, 1214 SBBC and 59 177 UBC patients were included. SBBC patients had a significantly higher excess mortality than UBC patients after adjustment for age and period (RR = 1.73; 95% CI:1.44-2.08; p < 0.01) and after adjusting for characteristics of the worst tumour as traditionally done (RR = 1.31; 95% CI:1.08-1.57; p = 0.01). However, adjusting for characteristics of both tumours, using a more advanced competing risks model, no difference was observed (RR = 1.01; 95% CI:0.83-1.22; p = 0.93).
CONCLUSIONS
Our study does not support that the inferior prognosis in SBBC patients is due to having more aggressive tumours per se, but rather the combined effect of having two simultaneous cancers.
Identifiants
pubmed: 30804429
doi: 10.1038/s41416-019-0403-z
pii: 10.1038/s41416-019-0403-z
pmc: PMC6461871
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
761-767Références
Holm, M., Tjonneland, A., Balslev, E. & Kroman, N. Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies. Breast Cancer Res. Treat. 146, 461–475 (2014).
doi: 10.1007/s10549-014-3045-0
Imyanitov, E. N. & Hanson, K. P. Molecular pathogenesis of bilateral breast cancer. Cancer Lett. 191, 1–7 (2003).
doi: 10.1016/S0304-3835(02)00523-2
Renz, D. M. et al. The contralateral synchronous breast carcinoma: a comparison of histology, localization, and magnetic resonance imaging characteristics with the primary index cancer. Breast Cancer Res. Treat. 120, 449–459 (2010).
doi: 10.1007/s10549-009-0718-1
Roder, D. et al. Survival from synchronous bilateral breast cancer: the experience of surgeons participating in the breast audit of the Society of Breast Surgeons of Australia and New Zealand. Asian Pac. J. Cancer Prev. 13, 1413–1418 (2012).
doi: 10.7314/APJCP.2012.13.4.1413
Verkooijen, H. M. et al. Survival after bilateral breast cancer: results from a population-based study. Breast Cancer Res. Treat. 105, 347–357 (2007).
doi: 10.1007/s10549-006-9455-x
Schwentner, L., Wolters, R., Wischnewsky, M., Kreienberg, R. & Wockel, A. Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: a multi-centre cohort study of 5292 patients. Breast 21, 171–177 (2012).
doi: 10.1016/j.breast.2011.09.007
Shi, Y. X. et al. Comparison of clinicopathological characteristics and prognoses between bilateral and unilateral breast cancer. J. Cancer Res. Clin. Oncol. 138, 705–714 (2012).
doi: 10.1007/s00432-011-1141-7
Beckmann, K. R. et al. Clinical characteristics and outcomes of bilateral breast cancer in an Australian cohort. Breast 20, 158–164 (2011).
doi: 10.1016/j.breast.2010.10.004
Irvine, T., Allen, D. S., Gillett, C., Hamed, H. & Fentiman, I. S. Prognosis of synchronous bilateral breast cancer. Br. J. Surg. 96, 376–380 (2009).
doi: 10.1002/bjs.6553
Hartman, M. et al. Incidence and prognosis of synchronous and metachronous bilateral breast cancer. J. Clin. Oncol. 25, 4210–4216 (2007).
doi: 10.1200/JCO.2006.10.5056
Polednak, A. P. Bilateral synchronous breast cancer: a population-based study of characteristics, method of detection, and survival. Surgery 133, 383–389 (2003).
doi: 10.1067/msy.2003.110
Schmid, S. M. et al. Prognosis of early-stage synchronous bilateral invasive breast cancer. Eur. J. Surg. Oncol. 37, 623–628 (2011).
doi: 10.1016/j.ejso.2011.05.006
Jobsen, J. J., van der Palen, J., Ong, F., Riemersma, S. & Struikmans, H. Bilateral breast cancer, synchronous and metachronous; differences and outcome. Breast Cancer Res. Treat. 153, 277–283 (2015).
doi: 10.1007/s10549-015-3538-5
Jobsen, J. J., van der Palen, J., Ong, F. & Meerwaldt, J. H. Synchronous, bilateral breast cancer: prognostic value and incidence. Breast 12, 83–88 (2003).
doi: 10.1016/S0960-9776(02)00278-3
Nichol, A. M. et al. A case-match study comparing unilateral with synchronous bilateral breast cancer outcomes. J. Clin. Oncol. 29, 4763–4768 (2011).
doi: 10.1200/JCO.2011.35.0165
Ejlertsen, B. et al. Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration. Acta Oncol. 57, 3–12 (2018).
doi: 10.1080/0284186X.2017.1408962
Moller, S. et al. The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise. Acta Oncol. 47, 506–524 (2008).
doi: 10.1080/02841860802059259
Christiansen, P., Ejlertsen, B., Jensen, M. B. & Mouridsen, H. Danish Breast Cancer Cooperative Group. Clin. Epidemiol. 8, 445–449 (2016).
doi: 10.2147/CLEP.S99457
Bjerregaard, B. & Larsen, O. B. The Danish pathology register. Scand. J. Public Health 39(7 Suppl.), 72–74 (2011).
doi: 10.1177/1403494810393563
Schmidt, M., Pedersen, L. & Sorensen, H. T. The Danish Civil Registration System as a tool in epidemiology. Eur. J. Epidemiol. 29, 541–549 (2014).
doi: 10.1007/s10654-014-9930-3
Rasmussen, C. B. et al. Incidence of metachronous contralateral breast cancer in Denmark 1978-2009. Int J. Epidemiol. 43, 1855–1864 (2014).
doi: 10.1093/ije/dyu202
Jensen, M. B. et al. The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007-2016. Acta Oncol. 57, 13–18 (2018).
doi: 10.1080/0284186X.2017.1404638
McCaul K. Bilateral breast cancer incidence and survival, PhD thesis. https://digital.library.adelaide.edu.au/dspace/bitstream/2440/37870/10/02whole.pdf . (2006).
Baretta Z., Olopade O. I., Huo D. Heterogeneity in hormone-receptor status and survival outcomes among women with synchronous and metachronous bilateral breast cancers. Breast. 24, 131–136 (2014).
Hartman, M. et al. Genetic implications of bilateral breast cancer: a population based cohort study. Lancet Oncol. 6, 377–382 (2005).
doi: 10.1016/S1470-2045(05)70174-1
Kwast, A. B. et al. Increased risks of third primary cancers of non-breast origin among women with bilateral breast cancer. Br. J. Cancer 107, 549–555 (2012).
doi: 10.1038/bjc.2012.270