Women successfully treated for early-stage breast cancer have a higher-than-average risk of a new breast cancer developing in the same or opposite breast. These women also are at risk of the original cancer coming back (recurrence). The study reviewed here found that survival rates are much better when any second breast cancer is detected early.
Researchers looked at the medical records of 1,044 women in Florence, Italy who were diagnosed and successfully treated for early-stage breast cancer. All the women were diagnosed with another breast cancer, at least 6 months after the first diagnosis, between 1980 and 2005. The timing is important because many of the women received breast cancer treatment more than 20 years ago, when diagnosis, treatment, and prevention techniques for new and recurrent breast cancer weren't as good as they are today.
The women were followed for an average of 14 years after their first breast cancer diagnosis. During this time, about half the women had a recurrence of the original breast cancer and the other half had a new, second breast cancer in the opposite breast diagnosed.
After breast cancer was diagnosed a second time, the women's chances of survival were 27% to 47% higher if the second breast cancer was small and had no symptoms when diagnosed, compared to second breast cancers that caused symptoms such as a lump, a skin change, or nipple discharge. Mammograms were much better than clinical breast exams at finding the second breast cancer. Still, clinical exams were the only way the second breast cancers were found in about 14% of the women.
If you've been diagnosed with early-stage breast cancer, your treatment plan may include radiation therapy, chemotherapy, and hormonal therapy to lower the risk of the cancer coming back. Still, breast cancer recurrence does happen. Even if the original breast cancer doesn't come back, your risk of developing a new, second breast cancer in the same or opposite breast is much higher than average. Sticking to an aggressive screening plan is the best way to make sure that any breast cancer is diagnosed early, when it's most treatable.
There are a number of things you can do to take charge and make sure your risk of the cancer coming back or being diagnosed with a new, different breast cancer is as low as it can be:
Plan your treatment with any future risk in mind. If you've been diagnosed with early-stage breast cancer, ask your doctor about treatment options that are best for your current diagnosis and also address your future risk. Surgery, radiation therapy, chemotherapy, targeted therapies, and hormonal therapies are used to treat breast cancer AND to lower the risk of the breast cancer coming back.
Stick with your treatment plan. Your doctor may have prescribed hormonal therapy or another treatment to lower your risk of the breast cancer coming back. Follow that treatment plan just as your doctor has prescribed. Don't change your plan or stop taking any medicine without talking to your doctor about any concerns you have.
Create a screening plan and stick to it. The best time to develop a screening plan for a possible recurrence or a new, second breast cancer is while you're being treated. Together, you and your doctor can create a screening plan that's best for your unique situation. Your plan may include frequent exams by your doctor, breast self-exams, mammograms, or other imaging techniques, such as MRI. After your treatment is done, you may tempted to skip some follow-up screening tests. Don't -- you need to take good care of you and your future.
Lower your risk by taking charge of those things you can. You may be able to make changes in your diet and lifestyle to reduce your risk of breast cancer. Visit the Breastcancer.org Lower Your Risk section to learn more.
FLORENCE, Italy, March 17 (MedPage Today) -- Early detection of a second breast cancer -- whether contralateral or relapse -- saves lives, according to a retrospective study.
Women who survived a primary breast cancer were 27% to 47% more likely to survive a subsequent breast cancer if it was detected in the early, asymptomatic stage than if it was already symptomatic (P<0.0001), according to a report online in the Annals of Oncology.
These findings adjusted for length- and lead-time bias provided some of the first reliable evidence to support a survival advantage of surveillance in this population said Nehmat Houssami, M.B.B.S., Ph.D., of the Istituto Scientifico della Regione Toscana, here, and the University of Sydney in Australia, and colleagues.
The American Society of Clinical Oncology recommends regular breast examination for all breast cancer survivors and yearly mammography for those who have undergone breast-conserving surgery.
But despite their elevated risk of subsequent breast cancer, the intuitive benefit has not been consistently borne out in studies of the prognosis of mammography-detected second cancers, Dr. Houssami's group said.
So, they retrospectively reviewed outcomes at a single center in Florence for all 1,044 women diagnosed from 1980 through 2005 with a second invasive or in situ breast cancer at least six months after a prior primary breast cancer.
During the median 13.7 years of follow-up after primary breast cancer diagnosis, 455 women had ipsilateral breast cancer recurrence and 589 developed a cancer in the contralateral breast.
These second tumors were more likely to be asymptomatic at diagnosis than to present with symptoms such as a lump, nipple discharge, skin change, or axillary mass (67% versus 33%, P<0.0001).
Asymptomatic tumors were smaller (P<0.001), more likely to be early stage in situ or T1a-b (P<0.0001), and less often node positive (P=0.0001).
Disease-specific survival -- measured from first cancer diagnosis to avoid lead-time bias from the extra time that diagnosis is advanced by early detection -- significantly favored asymptomatic cases (hazard ratio 0.53, P<0.0001).
In a sensitivity analysis to control for length-time bias from slower growing, less aggressive cancers being more likely to be detected at the asymptomatic stage, the hazard ratios compared with detection in symptomatic cases ranged from:
Mammography was more sensitive than clinical breast examination overall (86.1% versus 56.7%), for ipsilateral recurrence (80.5% versus 59.5%), and for contralateral second cancers (90.5% versus 54.5%, all P<0.0001).
However, the researchers noted that clinical examination was the only positive finding for 13.8% of women overall.
Despite attempts to control for lead- and length-time bias, they acknowledged the limitations of the nonrandomized, retrospective design and the lack of control for differences in treatment.
Because breast cancer survivors are at increased risk of a second breast cancer, the best, randomized controlled design may not be feasible, they said.
The study was supported by a grant from the National Health and Medical Research Council.
The researchers provided no information on conflicts of interest.
Primary source: Annals of Oncology Source reference: Houssami N, et al "Early detection of second breast cancers improves prognosis in breast cancer survivors" Ann Oncol 2009; DOI:10.1093/annonc/mdp037.
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