Risk of metachronous contralateral breast cancer in patients with primary invasive lobular breast cancer: Results from a nationwide cohort

Delal Akdeniz, Iris Kramer, Carolien H. M. van Deurzen, Bernadette A. M. Heemskerk-Gerritsen, Michael Schaapveld, Pieter J. Westenend, Adri C. Voogd, Agnes Jager, Ewout W. Steyerberg, Stefan Sleijfer, Marjanka K. Schmidt, Maartje J. Hooning*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
45 Downloads (Pure)

Abstract

Lobular primary breast cancer (PBC) histology has been proposed as a risk factor for contralateral breast cancer (CBC), but results have been inconsistent. We investigated CBC risk and the impact of systemic therapy in lobular versus ductal PBC. Further, CBC characteristics following these histologic subtypes were explored. We selected 74,373 women diagnosed between 2003 and 2010 with stage I-III invasive PBC from the nationwide Netherlands Cancer Registry. We assessed absolute risk of CBC taking into account competing risks among those with lobular (n = 8903), lobular mixed with other types (n = 3512), versus ductal (n = 62,230) histology. Hazard ratios (HR) for CBC were estimated in a cause-specific Cox model, adjusting for age at PBC diagnosis, radiotherapy, chemotherapy and/or endocrine therapy. Multivariable HRs for CBC were 1.18 (95% CI: 1.04-1.33) for lobular and 1.37 (95% CI: 1.16-1.63) for lobular mixed versus ductal PBC. Ten-year cumulative CBC incidences in patients with lobular, lobular mixed versus ductal PBC were 3.2%, 3.6% versus 2.8% when treated with systemic therapy and 6.6%, 7.7% versus 5.6% in patients without systemic therapy, respectively. Metachronous CBCs were diagnosed in a less favourable stage in 19%, 26% and 23% and less favourable differentiation grade in 22%, 33% and 27% than the PBCs of patients with lobular, lobular mixed and ductal PBC, respectively. In conclusion, lobular and lobular mixed PBC histology are associated with modestly increased CBC risk. Personalised CBC risk assessment needs to consider PBC histology, including systemic treatment administration. The impact on prognosis of CBCs with unfavourable characteristics warrants further evaluation.

Original languageEnglish
Pages (from-to)3123-3133
Number of pages11
JournalCancer Medicine
Volume12
Issue number3
Early online date20 Sept 2022
DOIs
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
We thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry (NCR) as well as the IKNL staff for scientific advice. We would also like to thank all patients of whom we used the data and all clinicians involved in the care of these patients. We would like to thank Benjamin Y. Gravensteijn for his efforts in the statistical analysis in R.

Funding Information:
This work was supported by the Dutch Cancer Society/Alpe d'HuZes [A6C/6253].

Publisher Copyright:
© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Fingerprint

Dive into the research topics of 'Risk of metachronous contralateral breast cancer in patients with primary invasive lobular breast cancer: Results from a nationwide cohort'. Together they form a unique fingerprint.

Cite this