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Pathologic findings from the national surgical adjuvant breast project (protocol no. 4): XI. Bilateral breast cancer

1984; Wiley; Volume: 54; Issue: 12 Linguagem: Inglês

10.1002/1097-0142(19841215)54

1097-0142

Edwin R. Fisher, Bernard Fisher, Richard Sass, Lawrence Wickerham,

Cancer and Skin Lesions

CancerVolume 54, Issue 12 p. 3002-3011 ArticleFree Access Pathologic findings from the national surgical adjuvant breast project (protocol no. 4): XI. Bilateral breast cancer Edwin R. Fisher MD, Corresponding Author Edwin R. Fisher MD Department of Pathology, Shadyside Hospital, and the University of Pittsburgh, School of Medicine, Pittsburgh, PennsylvaniaInstitute of Pathology, Shadyside Hospital, Pittsburgh PA 15232===Search for more papers by this authorBernard Fisher MD, Bernard Fisher MD Department of Surgery, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this authorRichard Sass PhD, Richard Sass PhD Department of Project Statistician, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this authorLawrence Wickerham MD, Lawrence Wickerham MD Department of Surgery, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this author Edwin R. Fisher MD, Corresponding Author Edwin R. Fisher MD Department of Pathology, Shadyside Hospital, and the University of Pittsburgh, School of Medicine, Pittsburgh, PennsylvaniaInstitute of Pathology, Shadyside Hospital, Pittsburgh PA 15232===Search for more papers by this authorBernard Fisher MD, Bernard Fisher MD Department of Surgery, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this authorRichard Sass PhD, Richard Sass PhD Department of Project Statistician, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this authorLawrence Wickerham MD, Lawrence Wickerham MD Department of Surgery, University of Pittsburgh, School of Medicine, Pittsuburgh, PennsylvaniaSearch for more papers by this author First published: 15 December 1984 https://doi.org/10.1002/1097-0142(19841215)54:12 3.0.CO;2-VCitations: 127AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Sixty-six confirmed instances of clinically metachronous second breast cancers were encountered over a 10-year period in 1578 women with invasive breast cancer enrolled in Protocol 4 of the National Surgical Adjuvant Breast Project (NSABP). Seven of the second cancers were in situ, yielding an incidence of 3.7% invasive and 0.5% noninvasive cancers. Except for a peak of 1.75% in the second postoperative year, the annual incidence based on patients at risk was constant and less than 1%. Ninety-three percent of the second cancers occurred within 7 years and 80% within 5 years following mastectomy for the initial primary. All of the second cancers were regarded as being primarily of mammary origin exhibitng either: (1) an in situ component; (2) dissimilar but well-recognized patterns of primary breast cancers; or (3) the appearance of scar cancer, a recently described morphologic feature characteristically observed in some primary breast cancers. A search for factors that might be predictive of bilaterality was performed. Thirty-eight pathologic and eight clinical factors were assessed, including family history. Although the latter was 1.5 to 2 times more frequent in patients with bilateral disease, this estimate was not statistically significant. On the other hand, a statistically significant association with bilateral disease was found when the initial tumor measured more than 2.0 cm, was associated with invasive cancer or proliferative fibrocystic disease, nipple involvement, absent nodal sinus histiocytosis, lobular carcinoma in situ in the vicinity of the dominant mass, or was of the lobular invasive or tubular types. However, the degree of risk of these discriminants was no greater than 2 to 3:1. Despite the clinical scrutiny imposed by the NSABP protocol second tumors measured only 1 cm less than the first, measuring on average 2.4 cm, which reflects the difficulty attendant on the clinical detection of so-called early breast cancers. Yet, no significant difference in pathologic nodal status was noted between the first and second cancers or that of patients with unilateral disease. Furthermore, there was no difference in survival rate between patients who developed a second cancer and those with unilateral disease. These data, when considered with those of previous reports, indicate that: (1) the incidence as well as annual accrual per patients at risk of bilateral cancers is low; (2) most second cancers, although clinically metachronous, are probably biologically synchronous; (3) a second cancer does not influence the expected survival of patients who develop such an event; (4) the incidence of contralateral metastases from breast cancer is extremely rare and their distinction from a second primary depends principally if not exclusively on histologic assessment rather than on the somewhat empirical considerations often used in the past; (5) the influence of predictive characteristics for the development of bilateral disease that have been enumerated are relatively weak; and (6) it is justifiable to follow the contralateral breast of patients with breast cancer by careful physical and mammographic examinations rather than contralateral biopsies or mastectomies. References 1 Prior R, Waterhouse JAH. The incidence of bilateral breast cancer: II. A proposed model for the analysis of coincidental tumours. Br J Cancer 1981; 43: 615–622. 2 Webber BL, Heise H, Neifeld JP, Cost J. Risk of subsequent breast carcinoma in a population of patients with in situ breast carcinoma. Cancer 1981; 47: 2928–2932. 3 Kessler HJ, Grier WRN, Seidman I, McIlveen SJ. Bilateral primary breast cancer. JAMA 1976; 236: 278–280. 4 McCredie JA, Inch WR, Alderson M. Consecutive primary carcinomas of the breast. Cancer 1975; 35: 1472–1477. 5 Del Turco MR, Ciatto S, Prigli G, Borrelli D, Carcangiu ML, Santucci M. Bilateral cancer of the breast. Tumori 1982; 68: 155–160. 6 Al-Jurf AS, Jochimsen PR, Urdanetta LF, Scott D. Factors influencing survival in bilateral breast cancer. J Surg Oncol 1981; 16: 343–348. 7 Khafagy MM, Schottenfield D, Robbins GF. Prognosis of the second breast cancer: The role of previous exposure to the first primary. Cancer 1975; 596–599. 8 Bloom ND, Daluvoy RV, Ceccarelli F. Degenshein GA. Bilateral mammary carcinoma: Immunologic implications. NY State J Med 1980; 80: 908–910. 9 Fukami A, Kasumi F, Hori M et al. Bilateral primary breast cancer treated at the Cancer Institute Hospital, Tokyo. Prog Clin Biol Res 1977; 16: 525–535. 10 Buls JG, Bennett RC, Chan DPS. Bilateral carcinoma of the breast. Aust NZ J Surg 1976; 46: 336–340. 11 Egan RL. Bilateral breast carcinomas: Role of mammography. Cancer 1976; 38: 931–938. 12 Robbins GF, Berg JW. Bilateral primary breast cancers: A clinicopathological study. Cancer 1964; 17: 1501–1527. 13 Mueller CB, Ames F. Bilateral carcinoma of the breast: Frequency and mortality. Can J Surg 1978; 21: 459–465. 14 Slack N, Bross KDJ, Nemoto T, Fisher B. Experiences with bilateral primary carcinoma of the breast. Surg Gynecol Obstet 1973; 136: 433–440. 15 Bailey MJ, Royce C, Sloane JP, Ford HT, Powles TJ, Gazet JC. Bilateral carcinoma of the breast. Br J Surg 1980; 67: 514–516. 16 Leis HP. Managing the remaining breast. Cancer 1980; 46: 1026–1030. 17 Leis HP. Bilateral breast cancer. Surg Clin N Am 1978; 58: 833–841. 18 Harris RE, Lynch HT, Guirgis HA. Familial breast cancer: Risk to the contralateral breast. J Natl Cancer Inst 1978; 60: 955–960. 19 Haagensen CD. Primary carcinoma of the second breast. In: Diseases of the Breast. Philadelphia: W. B. Saunders Co., 1971; 449–458. 20 Kruse CA, Wagner DE. An evaluation of bilateral breast carcinoma: Simultaneous and sequential lesions. West J Med 1976; 124: 187–190. 21 King RE, Terz JJ, Lawrence W Jr. Experience with opposite breast biopsy in patients with operable breast cancer. Cancer 1976; 37: 43–45. 22 Urban JA. Bilateral breast cancer: Biopsy of contralateral breast. Prog Clin Biol Res 1977; 12: 517–523. 23 Urban JA, Papachristou D, Taylor J. Bilateral breast cancer. Cancer 1977; 40: 1968–1973. 24 Gutter Z. Cancer of the remaining breast: Radiologic contribution to diagnosis. Can Med Assoc J 1976; 114: 27–30. 25 Martin JK, van Heerden JA, Gaffey TA. Synchronous and metachronous carcinoma of the breast. Surgery 1982; 91: 12–16. 26 Fisher ER, Gregorio RM, Redmond C, Vellios F, Sommers SC, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project ( Protocol No. 4): I. Observations concerning the multi-centricity of mammary cancer. Cancer 1975; 25: 247–254. 27 Erdreich LS, Asal N, Hoge AF. Morphologic types of breast cancer: Age, bilaterality and family history. South Med J 1980; 73: 28–32. 28 Rosen PP, Leiberman PH, Braun DW, Kosloff C, Adair F. Lobular carcinoma in situ of the breast: Detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol 1978; 2: 225–251. 29 Anderson LI, Muchardt O. Simultaneous bilateral cancer of the breast: Evaluation of the use of a contralateral biopsy. Acta Chir Scand 1980; 146: 407–409. 30 Benfield JR, Jacobsen J, Warner NE. In situ lobular carcinoma of the breast. Arch Surg 1965; 91: 130–135. 31 Berge T, Osteberg G. Bilateral carcinoma of the female breast. Acta Chir Scand 1974; 140: 27–32. 32 Donegan WL, Perez-Mesa CM. Lobular carcinoma: An indication for elective biopsy of the second breast. Ann Surg 1972; 176: 178–187. 33 Hutter RVP. Clinical and pathological correlation with mammographic findings in lobular carcinoma in situ. Cancer 1969; 23: 826–839. 34 Lewison EF, Finney GG. Lobular carcinoma in situ of the breast. Surg Gynecol Obstet 1968; 126: 1280–1286. 35 Newman W. In situ lobular carcinoma of the breast: Report of 26 women with 32 cancers. Ann Surg 1963; 157: 591–599. 36 Farrow JH. Bilateral mammary cancer. Cancer 1956; 9: 1182–1188. 37 McDivitt RW, Stewart FW, Berg JW. Tumors of the breast, ed. 2. Washington, DC: Armed Forces Institute of Pathology, 1967; series 2, Fascicle 2; 83. 38 Lagios MD, Rose MR, Margolin FR. Tubular carcinoma of the breast: Association with multicentricity, bilaterality, and family history of mammary carcinoma. Am J Clin Pathol 1980; 73: 25–30. 39 Anderson DE. Some characteristics of familial breast cancer. Cancer 1971; 28: 1500–1504. 40 Adami H, Hansen J, Jung B, Rimsten A. Characteristics of familial breast cancer in Sweden: Absence of relation to age and unilateral versus bilateral disease. Cancer 1981; 48: 1688–1695. 41 Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma. Cancer 1949; 3: 74–85. 42 Fisher B, Fisher ER. Experimental evidence in support of the dormant tumor cell. Science 1959; 130: 918–919. 43 Harrington SW. Survival rates of radical mastectomy for unilateral and bilateral carcinoma of the breast. Surgery 1946; 19: 154–166. 44 Toombs BD, Kalisher L. Metastatic disease to the breast: Clinical, pathologic and radiographic features. Am J Roentgenol 1977; 129: 673–676. 45 Hajdu SI, Urban JA. Cancers metastatic to the breast. Cancer 1972; 29: 1691–1696. 46 Kiang DT, Kennedy BJ, Snover DC. Biological and histological characteristics of simultaneous bilateral breast cancer. Lancet 1980; 2: 1105–1108. 47 Fisher ER, Palekar AS, Sass R, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project ( Protocol No. 4): IX. Scar cancers. Breast Cancer Res Treat 1983; 3: 39–59. 48 Mantel N. Evaluation of survival data and the new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50: 163–170. 49 Fisher ER, Gregorio RM, Fisher B. The pathology of invasive breast cancer: A syllabus derived from the findings of the National Surgical Adjuvant Breast Project ( Protocol No. 4). Cancer 1975; 36: 1–85. 50 Fisher ER, Gregorio RM, Redmond C, Dekker A, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project ( Protocol No. 4): II. The significance of the regional node histology other than sinus histiocytosis in invasive mammary cancer. Am J Clin Pathol 1976; 65: 21–30. 51 Fisher ER, Gregorio RM, Redmond C, Kim WS, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project ( Protocol No. 4): III. The significance of extranodal extension of axillary metastases. Am J Clin Pathol 1976; 65: 439–444. 52 Cutler SJ, Ederer F. Maximum utilization of the life-table method in analyzing survival. J Chronic Dis 1958; 8: 699–713. 53 Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery 1982; 234–240. 54 Hermann JB. Management of the contralateral breast after mastectomy for unilateral carcinoma. Surg Gynecol Obstet 1973; 136: 777–779. Citing Literature Volume54, Issue1215 December 1984Pages 3002-3011 ReferencesRelatedInformation