Bilateral breast carcinomas: Role of mammography.

From 1963 to 1973, at Emory Clinic, out of a total of 1112 patients with breast carcinoma studied with mammography, 83 had carcinoma in both breasts. The carcinoma in the second breast was primary in 67 patients and metastatic in 16 patients; in 18 patients there were simultaneous bilateral primary carcinomas. Mammography proved highly effective in detecting the second carcinoma and was reliable in differentiating a second primary from metastatic carcinoma. Forty-one of the second primary carcinomas were not associated with a palpable mass; 31 of these were having mammography as a routine check-up. The second nonsimultaneous carcinoma was considerably smaller than the first and fewer axillary lymph node metastasis. The second primary occurred within 6 years of the first in 86% of the cases with the remaining 14% scattered evenly up to 23 years. At 4 years after the diagnosis of the second primary, 25 of 27 deaths had occurred and only 1 patient was alive with cancer. Breast cancer patients need close follow-up for at least 6 years after the first primary carcinoma; and 4 years past the second primary signals a more optimistic prognosis.