Bilateral breast cancer

The magnitude of the clinical problem of bilateral occurrence of breast cancer is controversial. In order to evaluate clinical and pathologic factors associated with increased risk for metachronous, contralateral breast cancer, we reviewed the records of 187 patients undergoing operative treatment for primary breast cancer by the same surgeon at a single institution. Variables analyzed included age, race, history of tuberculosis or cancer at other sites, family history of breast cancer or cancer at other sites, prior use of estrogens, tobacco, and alcohol, marital status, parity, age at first pregnancy, tumor size and location, histologic diagnosis, degree of cellular differentiation and involvement of axillary lymph nodes. The incidence of metachronous, contralateral breast cancer was 11.8 per cent. The only factor with a statistically significant association with bilateral cancer was histologic diagnosis characterized by multicentricity. Life table survival analysis revealed that the five-year survival following treatment for metachronous, contralateral cancer was 59 per cent. We conclude that bilateral breast cancer is a significant clinical problem, that histology characterized by multicentricity is associated with a higher incidence of bilateral breast cancer, and that favorable survival justifies an aggressive approach.     

双侧原发性乳腺癌

目的：探讨双侧原发性乳腺癌临床特点及诊治。方法：回顾性分析1985年11月－2000年1月行乳腺癌根治性手术655例中双侧原发性乳腺癌（bilateral primary breast cancer,BPBC）10例的临床资料。结果：BPBC较单侧乳腺癌发病年龄明显提前。BPBC绝经前较绝经后发病率高。BPBC好发部位多集中于腺体丰富区域和导管集中部位，即乳房外上象限及乳晕区域最常见。同时性癌及异时性癌的首发癌以Ⅱ、Ⅲ期较多。首发癌及时正确的治疗是影响BPBC预后的重要因素。BPBC病灶大小、腋淋巴转移数目及水平均影响预后。同时性BPBC发病较少，预后较差；异时性BPBC多见，预后较好。结论：BPBC较单侧癌预后差，对单侧癌术前要常规做联合诊断检查，术后严密随访，要特别注意检查对侧乳腺。对高危病人有可疑病变要及时切除活检，以利于早期发现及时治疗。无腋淋巴转移也是发生BPBC的危险因素。     

Bilateral breast cancer.

The true incidence of bilateral breast cancer, both simultaneous and subsequent, is higher than older statistics indicate, and the frequency can be expected to increase as more efficient methods of detection and treatment become commonplace. Furthermore, there is a subgroup of patients who have an especially high risk for having a second primary cancer in the other breast; if such a cancer develops it deleteriously influences the survival of the patient. A rational approach to the management of the other breast is presented using contralateral biopsy as an added modality for detection and reserving prophylatic matectomy of the other breast for those patients who ar at high risk for developing cancer in it.     

Bilateral breast cancer associated with diffuse scleroderma

There is a strong evidence to suggest the association between breast cancer and diffuse scleroderma, though it is an infrequent occurrence. We describe the clinical and radiological findings in a patient who, over a period of 2 years, was diagnosed initially of diffuse scleroderma, next with right breast cancer and finally with left breast cancer. A review of the literature evidencing the relation between these two pathologies is provided. We suggest that special vigilance for tumoral pathology of the breast should be performed in patients with systemic scleroderma.     

Bilateral adrenalectomy in treatment of disseminated breast cancer.

Forty-three patients underwent bilateral adrenalectomy for advanced breast cancer at the Hospital of the University of Pennsylvania from 1960 to 1974. Fourteen patients (32 per cent) experienced an objective remission. There was no difference in the initial free interval between the responders and nonresponders. Premenopausal patients who improved after surgical castration or androgen therapy and postmenopausal patients who responded to estrogen therapy and its subsequent withdrawal had a greater response to adrenalectomy. Twenty-three of the forty-three patients who underwent bilateral adrenalectomy had evidence of metastatic involvement in at least one of the excised adrenal glands. Results show that patients who responded to previous therapy had a longer survival after adrenalectomy.     

双侧原发性乳腺癌10例

对l0例双侧原发性乳腺癌患者的临床表现、病理类型及手术方式等资料进行回顾性分析。其中3例为同时性癌，7例为异时性癌。l2侧为单纯性癌，4例患者的双侧(8侧)癌类型相同。所有癌均行手术切除。随访9例，随访时间9年。3例死亡，存活6例。生存期为半年至8年，平均存活57个月。本组资料提示，双侧原发性乳腺癌的发生与发病年龄、部位、临床分期，病理类型有关，但未发现与家族遗传有关。     

Bilateral breast carcinoma

Out of 4,777 cases of female breast carcinoma operated at the Cancer Institute Hospital, Tokyo from 1946 to 1980, 170 cases, 3.56% had bilateral breast carcinoma. According to our criteria, 157 cases (92. 3%, 3.29%) were classified as primary and 103 cases (7.6%, 0.27%) were metastatic. Our criteria depend upon the histological proof whether intraductal cancer parts in the smaller or in the second cancer exist or not. Out of 157, 48 cases (1.01%) were simultaneous (within one year) and 109 cases (2.28%) were subsequent bilateral carcinoma cases. The clinical characteristics of primary bilateral breast carcinoma were earlier onset, earlier stage and better prognosis than those of unilateral cases. From the epidemiological point of view, bilateral cases showed high percentage in sterile case and familial disposition. In so called breast cancer family, bilateral cases were common and the tendency of earlier onset in succeeding generation was recognized. The annual incidence rate of bilateral breast carcinoma among amputated patients for unilateral carcinoma was calculated as 4%. So it is well said that the incidence of breast carcinoma among Japanese women is as low as one-sixth of that of Americans, but the rate of bilaterality is high and almost the same as Americans.     

Bilateral breast cancer. Risk reduction by contralateral biopsy.

Although survival from primary breast cancer has improved with earlier diagnosis and treatment, the management of the opposite breast is still in question. The risk factors for bilaterality are known, and preoperative mammography is occasionally helpful, but identification of early second breast cancer is very limited. Contralateral biopsy may provide a reasonable answer to the problem. During a 5-year period, 62 elective contralateral biopsies were performed in patients having mastectomies for primary breast cancer. This consisted of either a mirror image biopsy or, more commonly, a biopsy of the upper outer quadrant. Thirteen patients had simultaneous contralateral cancers, of whom two had clinically overt bilateral cancers and 11 (18%) had clinically occult malignancy. Seven of these 11 had both radiologically and clinically normal breasts. Thus, 11.3% had radiologically and clinically occult cancer demonstrated by biopsy. Surgical management consisted of total mastectomy with low axillary dissection for noninvasive cancers and modified radical mastectomy for invasive cancers. Pathologic findings of the dominant breast cancer and the contralateral lesion were: bilateral, noninvasive: three patients; invasive, noninvasive: (seven patients), and invasive, invasive: three patients. Although follow-up is short (median of 40 months), 82% of the patients who had clinically occult second-breast cancer remain free of disease. During a previous 8-year period, 37 of 500 primary breast cancer patients (7.4%) developed metachronous (33) or synchronous (4) second-breast primary cancers primarily diagnosed clinically or radiologically. Of these, 35 were invasive and two noninvasive cancers; 41% had nodal metastases. A selected "favorable group," 28 of these patients who were free of disease 3 years after their first cancer, was analyzed. The analysis showed that only 10 (36%) were surviving free of disease at 7 years; 25% were free of disease at 10 years. Although the incidence of clinically-recognized, second-primary breast cancer is relatively low, development of a second invasive cancer severely impairs patient survival. Contralateral biopsy would appear useful to identify patients with early invasive or preinvasive cancer in the second breast, which appears normal after clinical observation or mammography. It provides opportunity to reduce the risk of invasive cancer in that breast, as well as to provide important diagnostic and prognostic information.     

Bilateral reduction mammoplasty following breast cancer: A case-control study

PURPOSE:

Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed.

METHODS:

A matched case-control study with patients serving as their own control (treated breast cancer breasts were ‘cases’, healthy breasts were ‘controls’) was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions.

RESULTS:

Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%).

CONCLUSIONS:

Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.