Allen Isaac, Hassan Hend, Joko-Fru Walburga Yvonne, Huntley Catherine, Loong Lucy, Rahman Tameera, Torr Bethany, Bacon Andrew, Knott Craig, Jose Sophie, Vernon Sally, Lüchtenborg Margreet, Pethick Joanna, Lavelle Katrina, McRonald Fiona, Eccles Diana, Morris Eva J A, Hardy Steven, Turnbull Clare, Tischkowitz Marc, Pharoah Paul, Antoniou Antonis C
National Disease Registration Service, National Health Service England, London, United Kingdom.
Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Lancet Reg Health Eur. 2024 Apr 24;40:100903. doi: 10.1016/j.lanepe.2024.100903. eCollection 2024 May.
Second primary cancers (SPCs) after breast cancer (BC) present an increasing public health burden, with little existing research on socio-demographic, tumour, and treatment effects. We addressed this in the largest BC survivor cohort to date, using a novel linkage of National Disease Registration Service datasets.
The cohort included 581,403 female and 3562 male BC survivors diagnosed between 1995 and 2019. We estimated standardized incidence ratios (SIRs) for combined and site-specific SPCs using incidences for England, overall and by age at BC and socioeconomic status. We estimated incidences and Kaplan-Meier cumulative risks stratified by age at BC, and assessed risk variation by socio-demographic, tumour, and treatment characteristics using Cox regression.
Both genders were at elevated contralateral breast (SIR: 2.02 (95% CI: 1.99-2.06) females; 55.4 (35.5-82.4) males) and non-breast (1.10 (1.09-1.11) females, 1.10 (1.00-1.20) males) SPC risks. Non-breast SPC risks were higher for females younger at BC diagnosis (SIR: 1.34 (1.31-1.38) <50 y, 1.07 (1.06-1.09) ≥50 y) and more socioeconomically deprived (SIR: 1.00 (0.98-1.02) least deprived quintile, 1.34 (1.30-1.37) most).
Enhanced SPC surveillance may benefit BC survivors, although specific recommendations require more detailed multifactorial risk and cost-benefit analyses. The associations between deprivation and SPC risks could provide clinical management insights.
CRUK Catalyst Award CanGene-CanVar (C61296/A27223). Cancer Research UK grant: PPRPGM-Nov 20∖100,002. This work was supported by core funding from the NIHR Cambridge Biomedical Research Centre (NIHR203312)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
乳腺癌（BC）后的第二原发性癌症（SPC）给公共卫生带来的负担日益加重，而关于社会人口统计学、肿瘤及治疗影响的现有研究较少。我们利用国家疾病登记服务数据集的新型关联，在迄今为止最大的乳腺癌幸存者队列中解决了这一问题。
该队列包括1995年至2019年间确诊的581,403名女性和3562名男性乳腺癌幸存者。我们使用英格兰的发病率，总体上以及按乳腺癌确诊时的年龄和社会经济地位，估计了合并及特定部位SPC的标准化发病比（SIR）。我们估计了按乳腺癌确诊时年龄分层的发病率和Kaplan-Meier累积风险，并使用Cox回归评估了社会人口统计学、肿瘤及治疗特征的风险差异。
两性患对侧乳腺癌（SIR：女性为2.02（95%CI：1.99 - 2.06）；男性为55.4（35.5 - 82.4））和非乳腺癌（女性为1.10（1.09 - 1.11），男性为1.10（1.00 - 1.20））的SPC风险均升高。乳腺癌确诊时年龄较小的女性（SIR：<50岁为1.34（1.31 - 1.38），≥50岁为1.07（1.06 - 1.09））和社会经济剥夺程度较高的女性（SIR：最不贫困五分位数为1.00（0.98 - 1.02），最贫困为1.34（1.30 - 1.37））的非乳腺癌SPC风险更高。
加强SPC监测可能使乳腺癌幸存者受益，尽管具体建议需要更详细的多因素风险和成本效益分析。剥夺与SPC风险之间的关联可为临床管理提供见解。
英国癌症研究基金会催化剂奖CanGene-CanVar（C61296/A27223）。英国癌症研究基金会资助：PPRPGM - 11月20日∖100,002。这项工作得到了英国国家卫生研究院剑桥生物医学研究中心的核心资金支持（NIHR203312）。所表达的观点是作者的观点，不一定是英国国家卫生研究院或卫生与社会保健部的观点。
