Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA.
Breast Cancer Res Treat. 2019 Nov;178(1):161-167. doi: 10.1007/s10549-019-05363-0. Epub 2019 Jul 19.
Increase in breast cancer survivorship, advancements in diagnostic imaging and standardization of contralateral breast screening before breast cancer surgery have resulted in increased detection of contralateral breast cancer (CBC). The aim of this study was to assess national trends of synchronous bilateral breast cancer (sBBC) and metachronous bilateral breast cancer (mBBC) incidence in newly diagnosed breast cancer patients.
The Surveillance, Epidemiology, and End Results (SEER) database (1973-2014) was used to identify 11,177 women diagnosed with CBC. CBC was classified as sBBC when primary breast cancer in both breasts is diagnosed in the same year, or as mBBC, when diagnosed more than one year from primary breast cancer. Temporal trends in sBBC incidence were then evaluated using the Cochran-Armitage test for trend.
Of the 11,177 women diagnosed with CBC, 4228 (38%) had sBBC and 6949 (62%) had mBBC. The incidence of sBBC increased significantly from 1.4% in 1975 to 2.9% in 2014 (p < 0.001). sBBC was more likely to be diagnosed as early stage in recent years (78% in 1975 vs. 90% in 2014 [p < 0.001]), and 69% of patients were treated with mastectomy in 2014.
The number of sBBC has increased, and contralateral tumors are more likely to be detected at an early stage with the first primary breast cancer. Despite the early stage findings, most were treated with mastectomy. Further studies are needed to define the best therapy for patients with contralateral disease and optimal surveillance and detection methods.
乳腺癌生存人数的增加、诊断成像技术的进步以及乳腺癌手术前对对侧乳房筛查的标准化，导致对侧乳腺癌（CBC）的检出率增加。本研究旨在评估新诊断乳腺癌患者中同时性双侧乳腺癌（sBBC）和异时性双侧乳腺癌（mBBC）的发病趋势。
利用监测、流行病学和最终结果（SEER）数据库（1973-2014 年），确定了 11177 例 CBC 患者。当双侧乳房的原发性乳腺癌在同一年被诊断时，将 CBC 归类为 sBBC；当原发性乳腺癌诊断超过一年时，将其归类为 mBBC。然后使用 Cochran-Armitage 趋势检验评估 sBBC 发病率的时间趋势。
在 11177 例诊断为 CBC 的女性中，4228 例（38%）为 sBBC，6949 例（62%）为 mBBC。sBBC 的发病率从 1975 年的 1.4%显著增加到 2014 年的 2.9%（p<0.001）。近年来，sBBC 更有可能被诊断为早期阶段（1975 年为 78%，2014 年为 90%[p<0.001]），2014 年 69%的患者接受了乳房切除术。
sBBC 的数量有所增加，并且随着第一个原发性乳腺癌的发生，对侧肿瘤更有可能被早期发现。尽管发现处于早期阶段，但大多数患者仍接受了乳房切除术。需要进一步研究以确定对侧疾病患者的最佳治疗方法以及最佳的监测和检测方法。
