Breast Cancer May Return in Opposite Breast
Younger women with non-BRCA hereditary breast cancer are up to six times more likely to develop a new cancer in the other breast in the next 20 years, when compared with the general population, according to a study reported in the medical journal Cancer.
"We did not expect this high rate of new tumors in the contralateral [opposite] breast," says study co-author Dr. Henrik Gronberg, a professor of cancer epidemiology and biostatistics at Karolinska Institute in Stockholm.
Breast cancer is the most common cancer among women, except for nonmelanoma skin cancers, according to the American Cancer Society.
The chance of developing invasive breast cancer at some time in a woman's life is about 1 in 8 (13 percent of women). It is estimated that in 2006, about 212,920 new cases of invasive breast cancer will be diagnosed among women in the United States. At this time there are slightly over 2 million breast cancer survivors in the US.
Carcinoma in situ (CIS) accounts for about 61,980 new cases each year. CIS is noninvasive and is the earliest form of breast cancer. Breast cancer also occurs in men. An estimated 1,720 cases of invasive breast cancer was diagnosed in men in 2005.
In the new report, Dr. Gronberg’s team reviewed data from 120 families and 204 women with breast cancer and a family history of breast cancer, but not of the type caused by mutations in the BRCA1 or BRCA2 genes, also known to boost breast cancer risk.
Overall, the probability of these women getting cancer in the other breast was 5.5 percent at five years and up to 27.3 percent at 20 years - about six times the expected risk at 20 years.
In comparison, the general population's risk of getting a primary breast cancer was figured at 1.9 percent at five years and 4.9 percent at 20 years, the researchers report.
When they analyzed risk by age group, the scientists found that the 15-year likelihood of developing cancer in the other breast was much higher for women under age 50 than for those over age 50.
Forty percent of those under age 50 had a probability of developing cancer in the other breast at 15 years after the original cancer diagnosis, compared to 10 percent in those over age 50.
The risk is similar to the estimated risk among BRCA1 and BRCA2 mutation carriers, says Dr. Gronberg. In previous research, other investigators had found that breast-cancer survivors are 25 percent more likely to develop cancer in another part of their body than those without a cancer history.
And it is well known that women with mutations in BRCA1 and BRCA2 genes have a higher risk of breast cancer. In 2004, researchers reported that BRCA1 and 2 gene-mutation carriers are also more likely to get breast cancer in the opposite breast.
Dr. Gronberg’s study found that more than 37 percent of the 87 women studied who were known to carry a BRCA gene mutation and who had a lumpectomy for breast cancer developed a new cancer in the untreated breast within 10 years of the original diagnosis. That report also appeared in Cancer.
The study findings suggest that several courses of action are wise, explains Dr. Gronberg.
"Young women, those under age 50, with hereditary breast cancer, regardless of BRCA1/2 mutation status, should consider a prophylactic operation in the opposite breast within two-to-three years after the treatment of the first cancer," he says. "This will reduce the risk of being diagnosed with a new breast cancer in the opposite breast."
For women over age 50, he notes, "the need for prophylactic surgery is much less, and the use of adjuvant hormonal therapy is most appropriate among these women."
Genetic counseling is also important for women with hereditary breast cancer, says Dr. Gronberg.
The study results probably will not surprise those in the genetic-counseling field, says Scott Weissman, a certified genetics counselor and co-chairman of the familial cancer risk counseling special interest group for the National Society of Genetic Counselors.
Genetic counseling can help women decide what options to pursue, he says.
"We try to identify the mutation in a gene causing a breast cancer in the family," he explains. "If we are able to identify one, we can counsel these women about their chances of getting a cancer in the opposite breast."
"You can very much put numbers on it," says Weissman. Women can be told their chances of getting another cancer in specific percent terms, over a specific time period, he notes.
"Genetics counseling can help guide you on how to manage the risk," he says. That might mean more frequent screening for breast cancer or adding a breast MRI to regular mammograms.
Always consult your physician for more information.
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Each individual may experience breast cancer symptoms differently.
Early breast cancer usually does not cause pain and may cause no symptoms at all.
And, some breast cancers never cause symptoms or other indications of a problem.
As the cancer grows, however, it can cause changes that women and men should watch for, such as:
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a lump or thickening (a mass, swelling, skin irritation, or distortion) in or near the breast or in the underarm area
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a change in the size or shape of the breast
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a change in the color or feel of the skin of the breast, areola, or nipple (dimpled, puckered, or scaly)
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nipple discharge, erosion, inversion, or tenderness
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A woman (or man) should consult a physician when any of these changes are noticed.
A woman or man may need surgery to remove as much of the cancer as possible - the primary treatment for breast cancer.
Today, women have many surgical options and choices. The type of surgery performed depends upon:
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the size and location of the breast lump or tumor
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the type and stage of the breast cancer (if the cancer has spread within the breast or has spread outside of the breast to the lymph nodes, or to other parts of the body)
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the size of the breast
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the woman's preference
There are several types of breast surgery. Your physician can explain the benefits and risks of each type, in addition to answering any questions or concerns you may prior to surgery.
Always consult your physician for more information.
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