Sackey Helena, Hui Miao, Czene Kamila, Verkooijen Helena, Edgren Gustaf, Frisell Jan, Hartman Mikael
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden.
Breast Cancer Res. 2016 Oct 18;18(1):105. doi: 10.1186/s13058-016-0764-7.
The clinical behavior of in situ breast cancer is incompletely understood and several factors have been associated with invasive recurrence. The purpose of this study was to evaluate long-term risk of subsequent breast cancer and mortality among women diagnosed with in situ breast cancer, in relation to family history METHODS: Using the population-based Swedish Multi-Generation and Cancer Registers we identified 8111 women diagnosed with in situ breast cancer between 1980 and 2004. We used standardized incidence ratios (SIRs) to measure the relative risk of subsequent invasive or contralateral in situ breast cancer and standardized mortality ratios (SMRs) for relative risks of death.
Among women diagnosed with in situ breast cancer, the cumulative 10-year and 20-year risk for subsequent contralateral or ipsilateral invasive cancer was approximately 10 % and 18 %, respectively. The risk of subsequent invasive breast cancer was increased more than 4-fold (SIR 4.6 (95 % CI 4.2 - 4.9)) among women with in situ breast cancer as compared to women in the general population and the risk of contralateral in situ breast cancer was increased almost 16-fold (SIR 16.0 (95 % CI 13.2-19.1)). Having a family history of breast cancer increased the risk of contralateral invasive breast cancer by almost 50 % (incidence rate ratio 1.5 (95 % CI 1.0-2.0)). Women under forty years old at diagnosis, without family history, had a 7-fold increased risk, and those with a family history had a 14-fold increased risk for subsequent invasive breast cancer with SIRs of 7.2 (95 % CI 4.8-10.5) and 14.3 (95 % CI 7.4-25.0), respectively. The overall risk of death in women with in situ breast cancer was significantly increased by 30 % compared to the general population but was highly dependent on the occurrence of a second invasive cancer event (SMR 1.3 (95 % CI 1.2-1.4)).
Among women with in situ breast cancer, a positive family history increases the risk of contralateral invasive breast cancer by almost 50 %. The risk of subsequent invasive breast cancer and mortality is substantially higher in younger women, which should be taken into account when planning their treatment and follow up.
原位乳腺癌的临床行为尚未完全明确，且有多种因素与浸润性复发相关。本研究旨在评估诊断为原位乳腺癌的女性后续发生乳腺癌及死亡的长期风险，并探讨其与家族史的关系。
利用基于人群的瑞典多代癌症登记系统，我们确定了1980年至2004年间诊断为原位乳腺癌的8111名女性。我们使用标准化发病比（SIR）来衡量后续浸润性或对侧原位乳腺癌的相对风险，使用标准化死亡比（SMR）来衡量死亡的相对风险。
在诊断为原位乳腺癌的女性中，后续对侧或同侧浸润性癌的累积10年和20年风险分别约为10%和18%。与一般人群中的女性相比，原位乳腺癌女性后续发生浸润性乳腺癌的风险增加了4倍多（SIR 4.6（95%CI 4.2 - 4.9）），对侧原位乳腺癌的风险增加了近16倍（SIR 16.0（95%CI 13.2 - 19.1））。有乳腺癌家族史使对侧浸润性乳腺癌的风险增加了近50%（发病率比1.5（95%CI 1.0 - 2.0））。诊断时年龄在40岁以下且无家族史的女性，后续发生浸润性乳腺癌的风险增加了7倍，有家族史的女性风险增加了14倍，SIR分别为7.2（95%CI 4.8 - 10.5）和14.3（95%CI 7.4 - 25.0）。与一般人群相比，原位乳腺癌女性的总体死亡风险显著增加了30%，但高度依赖于第二次浸润性癌事件的发生（SMR 1.3（95%CI 1.2 - 1.4））。
在原位乳腺癌女性中，阳性家族史使对侧浸润性乳腺癌的风险增加了近50%。年轻女性后续发生浸润性乳腺癌和死亡的风险显著更高，在制定其治疗和随访计划时应予以考虑。
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