Breast carcinoma after cancer at another site: method of detection, tumor characteristics, and surgical treatment.

BACKGROUND: As the number of cancer survivors increases, so will the number of second primary cancers, including breast carcinoma after cancer at another site. Limited information is available regarding the clinical characteristics of breast carcinoma after a primary at another site. METHODS: TUMORS (The Upper Midwest Oncology Registry Services) was used to identify 937 women with breast carcinoma occurring as a second primary after a first primary at a known site other than the breast. They were compared with a sample of 1874 women with first primary breast carcinoma, frequency-matched by age to the second primary group, for method of detection, tumor characteristics, and type of surgery. RESULTS: Women with breast carcinoma after cancer at another site tended to have smaller tumors and less extensive disease than women with first primary breast carcinoma and were somewhat more likely than first primary cases to have had their breast carcinoma detected by mammogram or clinical breast exam rather than detecting it themselves. Differences in method of detection accounted for differences in tumor size and extent. Second primary breast carcinoma was less likely to be lobular or mixed ductolobular carcinoma compared with first primary breast carcinoma. Surgical treatment (mastectomy vs. breast-conserving surgery) did not differ for first and second primary breast carcinoma. CONCLUSIONS: Clinical characteristics of breast carcinoma after cancer at another site were by and large similar to those of first primary breast carcinoma. The more favorable prognostic characteristics among women with a history of cancer were accounted for by increased medical surveillance.

Survival of women ages 40-49 years with breast carcinoma according to method of detection.

BACKGROUND: The value of mammographic screening in reducing breast carcinoma mortality among women younger than 50 years continues to be controversial. Previous randomized clinical trials have not been definitive because of inadequate sample sizes, prolonged screening intervals, questionable randomization, and/or cross-contamination between intervention groups. This study uses a historical prospective cohort design to examine differences in prognostic factors at the time of breast carcinoma diagnosis and differences in overall survival among patients ages 40-49 years, according to the method of breast carcinoma detection. METHODS: Women (n = 971) ages 40-49 years diagnosed with invasive breast carcinoma between 1986 and 1992 were identified by TUMORS (The Upper Midwest Oncology Registry Services). Measures of tumor size, lymph node status, and overall survival were compared with breast carcinoma patients whose tumors were detected by breast self-exam (BSE), clinical breast exam (CBE), patient incidental finding (PI), or mammography. RESULTS: Mean tumor size among women in the mammography group was smaller than that among women in the BSE, CBE, and PI groups (P < 0.002). Tumors detected by mammography were significantly more likely to be localized than those detected by other methods (P < 0.0001). Patients whose tumors were detected by mammography had significantly better survival than patients in the other detection method groups, especially among those with smaller tumors (P < 0.0001). This difference persisted even after adjustment for lead time bias. CONCLUSIONS: Women ages 40-49 years whose invasive breast carcinoma is detected by mammography have significantly smaller tumors, more localized disease, and may have a lower risk of mortality than women whose tumors are detected by other methods.