Bilateral synchronous breast cancer developed as metachronous malignancy after therapy of other primaries

Objectives: Cancer morbidity rates have been increasing steadily. A longer lifespan and easier access to modern diagnostic and therapeutic methods are the main reasons for the growing number of cancer survivors. Additionally, some types of oncological treatment, such as radiotherapy or immunosuppression, may also increase the risk of secondary tumors. These factors have resulted in an increased incidence of primary multiple cancers. Multiple primary cancers are generally under­stood as either synchronous, in which the cancers occur at the same time, or metachronous, in which the cancers follow in sequence (for instance, more than 2 months apart).The results published in other studies show that between 2% and 15.8% of all cancer patients have more primary multiple cancers. Within this group with multiple primary cancers, some have bilateral breast cancer, and our study focuses on patients from this group. Material and methods: Our study describes 10 patients who were treated for bilateral synchronous breast cancer at the Cracow Branch of the Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology during the years 1992–2014 and who developed another primary tumor after their treatment bilateral synchronous breast cancer. Results: In our discussion we present detailed data on the incidence of metachronous cancers in the 10 patients, including breast cancer, following the treatment of their other primary tumors. Conclusion: The 10 cases of our study, and clinical experiences and publications in general show how important it is for patients to continue medical follow-up after treatment of primary tumors, not only to detect recurrences as early as pos­sible, but also to diagnose any other malignancies occurring in other sites, including secondary, treatment-related tumors

The characteristics of breast cancer patients with metachronous primary malignancies

    Introduction. The risk of developing subsequent primary cancers varies from 1% to 18% and it depends on the type of first cancer and treatment methods applied. Considering the time of occurrence, multiple primary cancers generally fall into two categories: synchronous and metachronous. In breast cancer patients, 10.5% developed multiple primary cancers, from which 23.8% had synchronous, 79% had metachronous and the remaining 2.8% had both synchronous and metachronous malignancies. In patients with breast cancer, elevated risk is observed especially in the development of contralateral breast cancer, endometrial cancer, esophageal cancer, ovarian cancer and thyroid cancer. Aim. This paper presented the characteristics of breast cancer patients with metachronous primary malignancies in relation to the type of metachronous primaries (breast versus non-breast) and to analyse the impact of the type of metachronous cancers on survival rate. Material and methods. Among patients treated for breast cancer between 1963 and 2010, 354 patients (2.1%) developed metachronous primary malignancies and these made up 13.8% of all patients with multiple primary cancers. The mean age at diagnosis of the first breast cancer was 53 ± 11.5 years; positive family cancer history was noted in 127 patients (35.9%). Metachronous malignancies are defined as primaries following the diagnosis of breast cancer in a time interval greater than or equal to than 6 months. In our group, the mean time interval between the diagnosis of breast cancer and the appearance of metachronous malignancies was 100.9 ± 74.9 months (range: 6–543 months, median: 83 months). For comparison of the two groups (patients with second breast vs non-breast cancer) we used the Pearson’s Chi-square test for independence (for categorized variables) and variance analysis with Student’s t-test (for continuous variables). The survival rate was evaluated with the Kaplan-Meier method, and the log rank test was applied to assess the influ­ence of some factors on the evaluated results. The significance level at α = 0.05 was adopted for all statistical analyses. Results. The probability of occurrence of new cancer averaged from 38.1% to 67.8% for 5 and 10 years after diagnosis of first breast cancer, respectively. In our group, 380 cases of metachronous carcinomas were noted in 354 analysed patients. The most frequent metachronous malignancy was breast cancer (194 cases — 54.8%), which occurred as second (192 cases) or third (2 cases) cancer. Patients with contralateral breast cancer in comparison to other types of metachronous malignancies were significantly (p < 0.05): younger (under 50 years: 56.2% vs 34.4%), premenopausal (69.6% vs 48.8%), had a lobular type of first breast cancer (6.7% vs 1.3%), and rarely received tamoxifen (25.3% vs 48.2%). The type of me­tachronous cancers significantly influenced survival rate: 10-year overall survival rates were 80.1% vs 67.8%, (p = 0.0271). Conclusions. The risk of occurrence of second malignancies in breast cancer survivors makes early detection of metachronous malignancies obligatory because it is an important factor which influences the quality of life in breast cancer survivors

The characteristics of breast cancer patients with metachronous primary malignancies

  Introduction. The risk of developing subsequent primary cancers varies from 1% to 18% and it depends on the type of first cancer and treatment methods applied. Considering the time of occurrence, multiple primary cancers gene­rally fall into two categories: synchronous and metachronous. In breast cancer patients, 10.5% developed multiple primary cancers, from which 23.8% had synchronous, 79% had metachronous and the remaining 2.8% had both synchronous and metachronous malignancies. In patients with breast cancer, elevated risk is observed especially in the development of contralateral breast cancer, endometrial, esophageal cancer, ovarian cancer and thyroid cancer. Aim. This paper presented the characteristics of breast cancer patients with metachronous primary malignancies in relation to the type of metachronous primaries (breast versus non-breast) and to analyse the impact of the type of metachronous cancers on survival rate. Material and methods. Among patients treated for breast cancer between 1963 and 2010, 354 patients (2.1%) deve­loped metachronous primary malignancies and these made up 13.8% of all patients with multiple primary cancers. The mean age at diagnosis of the first breast cancer was 53 ± 11.5 years; positive family cancer history was noted in 127 patients (35.9%). Metachronous malignancies are defined as primaries following the diagnosis of breast cancer in a time interval greater than or equal to than 6 months. In our group, the mean time interval between the diagnosis of breast cancer and the appearance of metachronous malignancies was 100.9 ± 74.9 months (range: 6–543 months, median: 83 months). For comparison of the two groups (patients with second breast vs non-breast cancer) we used the Pearson’s Chi-square test for independence (for categorized variables) and variance analysis with Student’s t-test (for continuous variables). The survival rate was evaluated with the Kaplan-Meier method, and the log rank test was applied to assess the influ­ence of some factors on the evaluated results. The significance level at α = 0.05 was adopted for all statistical analyses. Results. The probability of occurrence of new cancer averaged from 38.1% to 67.8% for 5 and 10 years after diagnosis of first breast cancer, respectively. In our group, 380 cases of metachronous carcinomas were noted in 354 analysed patients. The most frequent metachronous malignancy was breast cancer (194 cases — 54.8%), which occurred as second (192 cases) or third (2 cases) cancer. Patients with contralateral breast cancer in comparison to other types of metachronous malignancies were significantly (p < 0.05): younger (under 50 years: 56.2% vs 34.4%), premenopausal (69.6% vs 48.8%), had a lobular type of first breast cancer (6.7% vs 1.3%), and rarely received tamoxifen (25.3% vs 48.2%). The type of metachronous cancers significantly influenced survival rate: 10-year overall survival rates were 80.1% vs 67.8%, (p = 0.0271). Conclusions. The risk of occurrence of second malignancies in breast cancer survivors makes early detection of metachronous malignancies obligatory because it is an important factor which influences the quality of life in breast cancer survivors

The characteristics of bilateral breast cancer patients

Introduction. Bilateral breast cancer (BBC) consists of 2–12% all cases of breast carcinoma. In relation to time between the first and second cancer diagnosis, the synchronous (s-BBC) or metachronous (m-BBC) bilateral breast cancer is defined. Material and methods. The clinicopathologic characteristics of 303 patients treated between 1963 and 2014 for bilateral breast cancer was presented. Synchronous BBC was diagnosed in 70 patients (23.1%) and remaining 233 patients (76.9%) developed metachronous BBC. Patients with m-BBC in comparison to s-BBC were younger (mean age: 51.4 vs 60.6 years), the positive family cancer history was rare (36.7% vs 48.5%), and more frequently these patients were before menopause (65.7% vs 44.3%). While the lobular type of breast cancer which consisted of 6.6% cases in first breast and 8.9% cases of second carcinomas, more frequently was presented in s-BBC (8.6%) in comparison to m-BBC (6%). Results. The mean time of follow up was 174 months. The 5- and 10-year overall survival rates were 89.3% and 76.1%, respectively. The presence of s-BBC connected with worse prognosis; the 5- and 10-year overall survival were 93.1% and 82% for m-BBC and 76.4% and 52.1% for s-BBC (p = 0.00244, log-rank test).Introduction. Bilateral breast cancer (BBC) consists of 2–12% all cases of breast carcinoma. In relation to time between the first and second cancer diagnosis, the synchronous (s-BBC) or metachronous (m-BBC) bilateral breast cancer is defined. Material and methods. The clinicopathologic characteristics of 303 patients treated between 1963 and 2014 for bilateral breast cancer was presented. Synchronous BBC was diagnosed in 70 patients (23.1%) and remaining 233 patients (76.9%) developed metachronous BBC. Patients with m-BBC in comparison to s-BBC were younger (mean age: 51.4 vs 60.6 years), the positive family cancer history was rare (36.7% vs 48.5%), and more frequently these patients were before menopause (65.7% vs 44.3%). While the lobular type of breast cancer which consisted of 6.6% cases in first breast and 8.9% cases of second carcinomas, more frequently was presented in s-BBC (8.6%) in comparison to m-BBC (6%). Results. The mean time of follow up was 174 months. The 5- and 10-year overall survival rates were 89.3% and 76.1%, respectively. The presence of s-BBC connected with worse prognosis; the 5- and 10-year overall survival were 93.1% and 82% for m-BBC and 76.4% and 52.1% for s-BBC (p = 0.00244, log-rank test)

Synchronous malignancies in patients with breast cancer

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively)

Synchronous malignancies in patients with breast cancer

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively)

Charakterystyka chorych na obustronnego raka piersi

Wstęp. Obustronny rak piersi (ORP) stanowi 2–12% wszystkich przypadków raka piersi. W zależności od odstępu czasu, jaki upływa pomiędzy rozpoznaniem raka w jednej i w drugiej piersi, wyróżnia się synchronicznego i metachronicznego ORP (s-ORP i m-ORP). Materiał i metody. Przedstawiono charakterystykę grupy 303 chorych na ORP leczonych w latach 1963–2014. Synchroniczny ORP stwierdzono u 70 chorych (23,1%), natomiast u pozostałych 233 chorych (76,9%) wystąpił metachroniczny ORP. Stwierdzono, że w grupie m-ORP — w porównaniu z s-ORP — pacjentki były młodsze (średni wiek: 51,4 vs 60,6 roku), rzadziej występowało u nich rodzinne zachorowanie na nowotwory (36,7% vs 48,5%), częściej były przed menopauzą (65,7% vs 44,3%). Natomiast zrazikowy typ raka piersi, który stanowił 6,6% nowotworów pierwszej i 8,9% nowotworów drugiej piersi, częściej występował w s-ORP (8,6%) w porównaniu z m-ORP (6%) w pierwszym raku piersi. Wyniki. Średni okres obserwacji wynosił 174 miesiące. Odsetek 5- i 10-letniego przeżycia całkowitego w całej grupie wyniósł odpowiednio 89,3% i 76,1%. Stwierdzono, że s-ORP istotnie wpływał na pogorszenie rokowania. 5- i 10-letni odsetek przeżycia całkowitego wyniósł 93,1% i 82% dla m-ORP oraz 76,4% i 52,1% dla s-BBC (p = 0,00244, test log-rank)

Differences in the prognosis of HPV16-positive patients with squamous cell carcinoma of head and neck according to viral load and expression of P16

Purpose To evaluate the impact of HPV16 load (VL-the number of virus genome copies per cell) and P16 expression on prognosis of patients with squamous cell carcinomas (SCCs) of head and neck (HN). Materials and methods HPV16 presence was assessed in the group of 109 patients with HNSCCs by quantitative polymerase chain reaction (qPCR). VL (assessed by qPCR) and P16 expression (evaluated by immunohistochemistry) were analysed only in the subgroup of HPV16-positive tumours. These features were correlated with 5-year overall survival (OS) and disease-free survival (DFS). Results HPV16 infection was found in 36 tumours (33.0%). Virus-positive patients had better OS and DFS than those without infection (P = 0.041 and 0.005). Among HPV16-positive HNSCCs, 18 (50.0%) had higher VL (median value > 6764.3 copies/cell) and 25 (73.5%) P16 over expression. The significant differences in OS and DFS (P = 0.008 and 0.004) were noticed according to VL, wherein 100% DFS was found for patients with higher VL. According to P16 expression, significant difference was found only for OS (P = 0.020). In multivariate analysis, VL (P = 0.045; HR = 2.795; CI 0.121-1.060) and the level of smoking (P = 0.023, HR = 2.253; CI 1.124-4.514) were independent factors affecting DFS of HPV16-positive patients. Conclusion On the basis of viral load, it is possible to differentiate prognosis of patients with HPV16-positive HNSCCs. In this subgroup, viral load has stronger prognostic potential than P16 expression