Researchers identify risk factors for contralateral breast cancer
A preventive procedure to remove the unaffected breast in breast cancer patients with disease in one breast may only be necessary in patients who have high-risk features as assessed by examining the patient's medical history and pathology of the breast cancer, according to researchers at The University of Texas M. D. Anderson Cancer Center. Their findings, published in the March 1, 2009 issue of Cancer, may help physicians predict the likelihood of patients developing breast cancer in the opposite breast (contralateral breast cancer), stratify risk and counsel patients on their treatment options.
"Women often consider contralateral prophylactic mastectomy (CPM) not because of medical recommendation, but because they fear having their breast cancer return," said Kelly Hunt, M.D., professor in the Department of Surgical Oncology at M. D. Anderson and lead author on the study. "Currently it is very difficult to identify which patients are at enough risk to benefit from this aggressive and irreversible procedure. Our goal was to determine what characteristics defined these high-risk patients to better inform future decisions regarding CPM."
According to the researchers, approximately 2.7 percent of women diagnosed with breast cancer choose to have CPM. Recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States. Potential reasons breast cancer patients choose to undergo CPM include risk reduction, difficult surveillance and reconstructive issues such as symmetry and/or balance.
To begin to classify such risk factors, researchers reviewed the cases of 542 women with breast cancer only in one breast who received CPM to remove the second breast at M. D. Anderson from January 2000 to April 2007. Out of this group, 435 patients had no abnormal pathology identified in the opposite breast, 25 patients had contralateral breast cancer identified at surgery, and 82 patients had abnormal cells (atypical ductal hyperplasia, atypical lobular hyperplasia and lobular carcinoma in situ) that indicate a moderate to high-risk for breast cancer development in the contralateral breast found at the time of surgery.
Further analysis of the patients with contralateral breast cancer revealed that a five-year Gail risk of 1.67 percent or greater; an invasive lobular histology; and multiple tumors in the original breast were all strong predictors for contralateral breast cancer. Patient race, estrogen receptor status and progesterone receptor status were not associated with increased risk.
"We went from having very little information on the benefit of this procedure for individual patients to identifying three independent and significant risk factors," Hunt said. "Each provides valuable insight into how likely a woman is to develop the disease in her other breast and enables physicians to make an educated recommendation if a patient will potentially benefit from CPM."
The Gail model, typically used for patients without breast cancer, evaluates factors such age, age at menarche, number and findings of previous breast biopsies, age at first live birth and number of first-degree relatives with breast cancer, has been validated in several studies to calculate the risk of developing an invasive breast cancer over the next five years. The five-year risk of 1.67 percent is traditionally used as the cutoff point for the definition of "high risk."
"We've always known contralateral breast cancer risk is not the same for all women and it is unnecessary to perform preventive mastectomies routinely. As we begin to clarify the specific risk factors, the number of women undergoing CPM may decrease and those with a low to moderate-risk may be more open to less extreme options for risk reduction, such as hormonal therapy and newer agents for prevention of breast cancer."
Articles on the same topic
- PET/CT may improve prognosis for patients with inflammatory breast cancerMon, 2 Feb 2009, 10:35:56 EST
- New technology discovery at Mount Sinai Hospital holds promise for improved breast cancer treatmentSun, 1 Feb 2009, 15:09:23 EST
- Automated screening process may eventually reduce additional breast cancer surgeriesFri, 30 Jan 2009, 12:43:22 EST
- Breast cancer drug shows promise for treating, preventing progestin-dependent tumorsWed, 28 Jan 2009, 14:37:05 EST
- Many women who survived childhood cancer do not undergo recommended breast cancer screeningTue, 27 Jan 2009, 16:22:22 EST
- Study examines risk factors for cancer in unaffected breast of breast cancer patientsMon, 26 Jan 2009, 0:22:25 EST
- New technology holds promise for predicting breast cancer recoveryfrom CBC: Technology & ScienceMon, 2 Feb 2009, 12:58:00 EST
- New technology holds promise for predicting breast cancer recoveryfrom CBC: HealthMon, 2 Feb 2009, 12:56:09 EST
- New tool predicts women's outcome in breast cancerfrom Reuters:ScienceMon, 2 Feb 2009, 10:56:09 EST
- New tool predicts women's outcome in breast cancerfrom Reuters:ScienceSun, 1 Feb 2009, 18:14:06 EST
- New Promise For Improved Breast Cancer Treatmentfrom Science DailySun, 1 Feb 2009, 15:29:01 EST
- New technology discovery holds promise for improved breast cancer treatmentfrom PhysorgSun, 1 Feb 2009, 15:08:01 EST
- Automated screening process may eventually reduce additional breast cancer surgeriesfrom Science CentricSun, 1 Feb 2009, 13:49:15 EST
- Automated screening process may eventually reduce additional breast cancer surgeriesfrom PhysorgFri, 30 Jan 2009, 12:56:21 EST
- Breast cancer drug shows promise for treating, preventing progestin-dependent tumorsfrom PhysorgWed, 28 Jan 2009, 14:56:12 EST
- Many women who survived childhood cancer do not undergo recommended breast cancer screeningfrom Science CentricWed, 28 Jan 2009, 14:07:53 EST
- Childhood cancer survivors lag in mammogram screenings: studyfrom CBC: HealthTue, 27 Jan 2009, 18:07:31 EST
- Guiding preventive mastectomy decisions aim of researchersfrom CBC: HealthTue, 27 Jan 2009, 12:49:10 EST
- An individualized approach to breast cancer treatmentfrom PhysorgMon, 26 Jan 2009, 16:14:09 EST
- Risk Factors For Contralateral Breast Cancer Identifiedfrom Science DailyMon, 26 Jan 2009, 9:56:14 EST
- Researchers identify risk factors for contralateral breast cancerfrom Science CentricMon, 26 Jan 2009, 9:52:21 EST
- Study examines risk factors for cancer in unaffected breast of breast cancer patientsfrom Science CentricMon, 26 Jan 2009, 9:50:56 EST
- Researchers identify risk factors for contralateral breast cancerfrom PhysorgMon, 26 Jan 2009, 3:42:08 EST
- Reduced breast cancer risk: Physical activity after menopause pays offfrom Science CentricSat, 24 Jan 2009, 11:56:31 EST
- Breastfeeding May Prevent Breast Cancerfrom Science DailyThu, 22 Jan 2009, 9:15:37 EST
- Reduced Breast Cancer Risk: Physical Activity After Menopause Pays Offfrom Science DailyTue, 20 Jan 2009, 10:14:55 EST
Latest Science NewsletterGet the latest and most popular science news articles of the week in your Inbox! It's free!
Learn more about
Check out our next project, Biology.Net
From other science news sites
Popular science news articles
No popular news yet
- Kids' cartoon characters twice as likely to die as counterparts in films for adults
- Herd mentality: Are we programmed to make bad decisions?
- Origin of long-standing space mystery revealed
- NASA Goddard instrument makes first detection of organic matter on Mars
- Future batteries: Lithium-sulfur with a graphene wrapper