Adami H O, Bergström R, Hansen J
Cancer. 1985 Feb 1;55(3):643-7. doi: 10.1002/1097-0142(19850201)55:3<643::aid-cncr2820550328>3.0.co;2-l.
This epidemiologic investigation comprised 1351 of 1423 women in a defined geographic area consecutively diagnosed as having a primary breast cancer. Simultaneous bilateral disease occurred in only 1 patient, whereas a history of previous cancer in the contralateral breast was reported by 65 patients. This prevalence was related to that of 23 previous cases in an age-matched control group of 1351 women from the same population. The relative risk of developing a second primary was 2.9 (95% confidence limit, 1.8-4.6) for the whole material and remained seemingly constant over several decades at a level predetermined by age at first diagnosis, namely 9.9 (95% confidence limit, 3.8-25.8) before the age of 50 and 1.9 (95% confidence limit, 1.1-3.2) after that age. The incidence ratio of bilateral to unilateral disease was used as an estimate of the lifetime risk of developing a second primary in this stable and well-defined population. This calculation revealed cumulative risk figures of 13.3% and 3.5% for women younger and older than 50 years, respectively, at first diagnosis. It was concluded that the occurrence of bilateral disease, which reflects a multicentric neoplastic transformation of the breast epithelium, is a characteristic of early-occurring (premenopausal) disease.
这项流行病学调查涵盖了某一特定地理区域内连续被诊断为原发性乳腺癌的1423名女性中的1351名。仅1例患者出现双侧同时发病，而65例患者报告有对侧乳腺既往癌症病史。这一患病率与来自同一人群的1351名年龄匹配的女性对照组中之前的23例病例的患病率相关。整个研究资料中发生第二原发性癌症的相对风险为2.9（95%置信区间，1.8 - 4.6），并且在几十年间似乎保持恒定，处于由首次诊断时的年龄预先确定的水平，即50岁之前为9.9（95%置信区间，3.8 - 25.8），50岁之后为1.9（95%置信区间，1.1 - 3.2）。在这个稳定且明确界定的人群中，双侧与单侧疾病的发病率比值被用作发生第二原发性癌症终生风险的估计值。该计算结果显示，首次诊断时年龄小于50岁和大于50岁的女性累积风险数字分别为13.3%和3.5%。得出的结论是，双侧疾病的发生反映了乳腺上皮的多中心肿瘤转化，是早期（绝经前）疾病的一个特征。
