Increased risk of breast cancer-specific mortality among cancer survivors who developed breast cancer as a second malignancy.

Abstract

BACKGROUND:

Cancer survivors who develop breast cancer as a second malignancy (BCa-2) are common. Yet, little is known about the prognosis of BCa-2 compared to first primary breast cancer (BCa-1).

METHODS:

Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 883,881 patients with BCa-1 and 36,313 patients with BCa-2 during 1990-2015. Compared with patients with BCa-1, we calculated hazard ratios (HRs) of breast cancer-specific mortality among patients with BCa-2, using multivariable Cox regression.

RESULTS:

During the follow-up (median 5.5 years), 114,964 and 3829 breast cancer-specific deaths were identified among BCa-1 and BCa-2 patients, respectively. Patients with BCa-2 had more favorable tumor characteristics and received less intensive treatment e.g., surgery and chemo-/radio-therapy, compared to patients with BCa-1. When adjusting for demographic factors, patients with BCa-2 were at similar risk of breast cancer-specific mortality (HR 1.00, 95% CI 0.97-1.03) compared to patients with BCa-1. However, when additionally controlling for tumor characteristics and treatment modes, BCa-2 patients were at an increased risk of breast cancer-specific mortality (HR 1.11, 95% CI 1.08-1.15). The risk elevation was particularly greater when the first malignancy was lung, bladder, ovarian or blood malignancy (HRs 1.16-1.85), or when the first malignancy was treated with chemotherapy and radiotherapy (HR 1.44, 95% CI 1.28-1.63).

CONCLUSIONS:

Overall, patients with BCa-2 have worse breast cancer-specific survival, compared with their BCa-1 counterparts, although the risk elevation is mild. High-risk subgroups based on first malignancy's characteristics may be considered for active clinical management.

• Authors: Chengshi Wang, Kejia Hu, Lei Deng, Wei He, Fang Fang, Rulla M Tamimi, Donghao Lu
• Journal: BMC cancer (BMC Cancer) Vol. 21 Issue 1 Pg. 491 (May 03 2021) ISSN: 1471-2407 [Electronic] England
• PMID: 33941118 (Publication Type: Journal Article)

Topics

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Breast Neoplasms (epidemiology, mortality, pathology)
• Cohort Studies
• Female
• Hematologic Neoplasms (drug therapy, pathology, radiotherapy)
• Humans
• Lung Neoplasms (drug therapy, pathology, radiotherapy)
• Middle Aged
• Mortality (trends)
• Neoplasms, Second Primary (epidemiology, mortality, pathology)
• Ovarian Neoplasms (drug therapy, pathology, radiotherapy)
• Prognosis
• Proportional Hazards Models
• Risk
• SEER Program
• Time Factors
• Urinary Bladder Neoplasms (drug therapy, pathology, radiotherapy)
• Young Adult