Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 15;129(8):1173-1182.
doi: 10.1002/cncr.34679. Epub 2023 Feb 15.

Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status

Kathryn P Lowry  1 , Laura Ichikawa  2 , Rebecca A Hubbard  3 , Diana S M Buist  2 , Erin J A Bowles  2 , Louise M Henderson  4 , Karla Kerlikowske  5 , Jennifer M Specht  6 , Brian L Sprague  7   8 , Karen J Wernli  2 , Janie M Lee  1
Affiliations

Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status

Kathryn P Lowry et al. Cancer. .

Abstract

Background: In women with previously treated breast cancer, occurrence and timing of second breast cancers have implications for surveillance. The authors examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium.

Methods: Women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer were identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected at primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. The authors examined cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis.

Results: At 10 years, the cumulative second breast cancer incidence was 11.8% (95% confidence interval [CI], 10.7%-13.1%) for women with ER-negative disease and 7.5% (95% CI, 7.0%-8.0%) for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up (16.0 per 1000 person-years [PY]; 95% CI, 14.2-17.9 per 1000 PY; vs. 7.8 per 1000 PY; 95% CI, 7.3-8.4 per 1000 PY, respectively). After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer (12.1 per 1000 PY; 95% CI, 9.9-14.7; vs. 9.3 per 1000 PY; 95% CI, 8.4-10.3 per 1000 PY, respectively).

Conclusions: ER-negative primary breast cancers are associated with a higher risk of second breast cancers than ER-positive cancers during the first 5 years after diagnosis. Further study is needed to examine the potential benefit of more intensive surveillance targeting these women in the early postdiagnosis period.

Keywords: breast cancer; estrogen receptor; recurrence; surveillance; survivorship.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST STATEMENT

The remaining authors made no disclosures.

Figures

FIGURE 1
FIGURE 1
Cumulative risk of second breast cancers by estrogen receptor status of the primary breast cancer by time since breast cancer diagnosis. Estimated risks are depicted by solid lines, with shaded regions indicating 95% confidence intervals.
FIGURE 2
FIGURE 2
Annual rates of second breast cancers by estrogen receptor status of primary cancer, per 1000 person-years. Estimated rates are depicted by solid lines, with shaded regions indicating 95% confidence intervals (CI).
FIGURE 3
FIGURE 3
Annual rates of second ipsilateral and contralateral breast cancers by estrogen receptor status of the primary breast cancer, per 1000 person-years. Estimated rates are depicted by solid lines, with shaded regions indicating 95% confidence intervals (CI).
FIGURE 4
FIGURE 4
Cumulative risk of second breast cancer by primary cancer estrogen receptor status and stage. Advanced stage, American Joint Committee on Cancer (AJCC) stage IIB–III; early stage, AJCC stage I–IIA; ER, estrogen receptor.
See this image and copyright information in PMC

References

    1. Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611–635. PubMed PMID: 26644543. doi:1200/JCO.2015.64.3809 - PubMed
    1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Breast Cancer, Version 5.2020. NCCN; 2020. Accessed July 21, 2020. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
    1. Lewin AA, Moy L, et al. ACR Appropriateness Criteria® stage I breast cancer: initial workup and surveillance for local recurrence and distant metastases in asymptomatic women. J Am Coll Radiol. 2019;16(11S):S428–S439. Epub 2019/11/07PubMed PMID:31685110. doi:1016/j.jacr.2019.05.024 - PubMed
    1. Buist DSM, Ichikawa L, Wernli KJ, et al. Facility variability in examination indication among women with prior breast cancer: implications and the need for standardization. J Am Coll Radiol. 2020;17(6):755–764. Epub 2020/02/01PubMed PMID: 32004483; PubMed Central PMCID: PMCPMC7275918. doi:1016/j.jacr.2019. 12.020 - PMC - PubMed
    1. Henderson LM, Ichikawa L, Buist DSM, et al. Patterns of breast imaging use among women with a personal history of breast cancer. J Gen Intern Med. 2019;34(10):2098–2106. Epub 2019/08/15PubMed PMID: 31410813; PubMed Central PMCID: PMCPMC 6816668. doi:1007/s11606-019-05181-6 - PMC - PubMed

Publication types

Substances