Method of Detection of New Contralateral Primary Breast Cancer in Younger Versus Older Women

doi:10.3816/CBC.2007.n.030

Clinical Breast Cancer

Volume 7, Issue 9, August 2007, Pages 705-709

https://doi.org/10.3816/CBC.2007.n.030 Get rights and content

Abstract

Background

Surveillance for contralateral primary breast cancer after a diagnosis of unilateral breast cancer typically consists of yearly mammography and physical examinations at 3–6 month intervals. Mammography is known to be less sensitive in younger, dense breasts. It is unknown at this time how well mammography performs in young patients to detect a new contralateral primary breast cancer.

Patients and Methods

Patients with contralateral breast cancer diagnosed between 1980 and 2004 were identified from the British Columbia Cancer Agency's Breast Cancer Outcomes Unit database in Vancouver. Characteristics of the tumor at baseline and the contralateral tumor were recorded as well as the method of detection of the contralateral breast cancer. A subset of patients was identified based on the age at which they were diagnosed with their initial primary cancer: < 40 years (group A) and 55–59 years (group B). χ² and independent-sample t tests were used for between-group comparisons.

Results

Older patients were significantly more likely to have their second primary tumor detected by routine follow-up mammography compared with the younger cohort (P < 0.001). Older patients were also more likely to have estrogen receptor–positive, lower grade second primary tumors, and there was a trend toward smaller tumors. Tumors detected by mammography were more likely to be lower grade, estrogen receptor positive, and smaller.

Conclusion

Older patients were more likely to have a contralateral breast cancer detected by conventional mammography, whereas younger patients tended to have cancer detected by physical examinations or by self-diagnosis. Better imaging techniques are required to detect new contralateral primary breast cancer in younger patients.

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Cited by (14)

Breast Cancer: Stages I-II
2015, Clinical Radiation Oncology
Ultrasound screening of contralateral breast after surgery for breast cancer
2015, European Journal of Radiology
Citation Excerpt :
Surveillance for metachronous contralateral breast cancer after a diagnosis of unilateral breast cancer typically consists of yearly mammography and physical examinations at 3–6 month intervals [3]. However, mammography is known to be less sensitive in younger, dense breasts and showed poor sensitivity for the surveillance of contralateral breast cancer in early-onset breast cancer patients, so better imaging modalities are required to detect new contralateral breast cancer in patients with increased risk and dense breasts [4–8]. Meantime, the detection of isolated loco-regional or contralateral breast cancer recurrences in asymptomatic patients has beneficial impact on survival of breast cancer patients when compared to late symptomatic detection [9].
To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts.
During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed.
Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by mammography plus US was 8.3 per 1000 patients. Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15).
US can be helpful to detect mammographically occult breast cancer in the contralateral breast with high positive biopsy rate and low category 3 rate in patients with a previous history of breast cancer and dense breasts.
Effectiveness of routine follow-up in the detection of contralateral breast cancer in young women with early breast cancer
2013, European Journal of Surgical Oncology
Citation Excerpt :
However, we found no differences in tumour size or nodal status between the two groups. Previous studies, including women of all ages, did show significant differences in tumour stage and survival rates between CBCs detected during routine follow-up or in between follow-up visits.5,7,9,14–16 Another hypothesis underlying our study was that a gradual decrease in the number of follow-up visits over time would result in a delay in the diagnosis of CBC.
The purpose of the study was to determine the effectiveness of routine follow-up to detect contralateral breast cancer (CBC) in young women.
We used the data of the population-based Eindhoven Cancer Registry, which covers the southern part of the Netherlands. Between 1988 and 2005, 1451 women aged ≤40 years were treated for early-stage breast cancer with breast-conserving treatment or mastectomy.
Of the 94 patients who developed CBC 17 had an in situ carcinoma. Fifty-seven CBCs (61%) were diagnosed more than 5 years after the primary tumour. Forty-two CBCs (45%) were detected during routine follow-up visits, while 52 (55%) presented between two visits. Of the CBC diagnosed between two visits, only 27 (60%) were visible on mammography. Of the invasive CBCs more than 25% was larger than 2 cm in diameter and in 34% positive axillary lymph nodes were found.
These figures indicate that routine follow-up does not guarantee early detection of CBC in young women with breast cancer.
Breast Cancer: Stages I and II
2012, Clinical Radiation Oncology: Third Edition
The value of routine physical examination in the follow up of women with a history of early breast cancer
2011, European Journal of Cancer
Citation Excerpt :
Age has been reported to have an important influence on the sensitivity of mammography and the value of physical examination. Tumour characteristics are different across ages that might influence the performance of routine physical examination.17,19,22 In addition, it is possible that physicians might pay more attention when they examine younger patients due to the debatable performance of mammography.
Routine physical examination is recommended in follow up guidelines for women with a history of breast cancer. The objective of this paper is to assess the contribution of routine physical examination in addition to mammography in the early diagnosis of breast cancer recurrences.
The medical follow-up documents of 669 patients were reviewed. 127 contra-lateral breast cancers (CBCs) and 58 loco-regional recurrences (LRRs) in 163 patients were included. The additional contribution of routine physical examination over mammography was evaluated with the proportions of CBCs or LRRs detected by physical examination alone. χ² tests were used to compare the difference of contribution of physical examination among subgroups.
Seven (6%) out of 127 CBCs and 13 (22%) out of 58 LRRs were detected by routine physical examination alone. Six LRRs (17%; 6/35) were in patients after breast conserving surgery and seven LRRs (30%; 7/23) in patients after mastectomy. There was a trend that the contribution of physical examination is higher in women under 60 years of age in the detection of CBCs (9%; 5/57) and LRRs (28%, 8/29) than in women over 60 years of age (CBCs:3%; 2/70 and LRRs:17%, 5/29; χ² = 3.090, P = 0.079).
Twenty-two percent of loco regional breast cancer recurrences would have been detected later without physical examination. Routine physical examination may be most valuable for women with a history of breast cancer younger than 60 years at follow-up visit.
Breast Cancer: Stages I and II
2011, Clinical Radiation Oncology, Third Edition

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Original ContributionMethod of Detection of New Contralateral Primary Breast Cancer in Younger Versus Older Women

Abstract

Background

Patients and Methods

Results

Conclusion

Breast

Ann Oncol

Eur J Cancer

American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting

J Clin Oncol

Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update)

CMAJ

Epidemiologic and molecular risk factors for contralateral breast cancer among young women

Br J Cancer

British Columbia Cancer Agency. Cancer Management Guidelines

Preventive health care, 2001 update: screening mammography among women aged 40-49 years at average risk of breast cancer

CMAJ

Randomised controlled trial of mammographic screening in women from age 40: predicted mortality based on surrogate outcome measures

BJC

Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)

Lancet

Breast magnetic resonance image screening and ductal lavage in women at high genetic risk for breast carcinoma

Cancer

Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer

J Clin Oncol

Ten years of breast screening in the Screening Mammography Program of British Columbia, 1988-97

J Med Screen

Original Contribution
Method of Detection of New Contralateral Primary Breast Cancer in Younger Versus Older Women