Inferior survival for young patients with contralateral compared to unilateral breast cancer: a nationwide population-based study in the Netherlands
To compare overall survival between women with unilateral breast cancer (UBC) and contralateral breast cancer (CBC). Women with UBC (N = 182,562; 95 %) and CBC (N = 8,912; 5 %) recorded in the Netherlands Cancer Registry between 1989 and 2008 were included and followed until 2010. We incorporated CBC as a time-dependent covariate to compute the overall mortality rate ratio between women with CBC and UBC. Prognostic factors for overall death were examined according to age at first breast cancer. Women with CBC exhibited a 30 % increase in overall mortality (Hazard Ratio (HR), 95 % Confidence Interval: 1.3, 1.3–1.4) compared with UBC, decreasing with rising age at diagnosis of first breast cancer (<50 years: 2.3, 2.2–2.5 vs. ≥70 years: 1.1, 1.0–1.1). Women older than 50 years at CBC diagnosis and diagnosed 2–5 years after their first breast cancer exhibited a 20 % higher death risk (1.2, 1.0–1.3) compared to those diagnosed within the first 2 years. In women younger than 50 years, the HR was significantly lower if the CBC was diagnosed >5 years after the first breast cancer (0.7, 0.5–0.9). The prognosis for women with CBC significantly improved over time (2004–2008: 0.6, 0.5-0.7 vs. 1989–1993). Women with CBC had a lower survival compared to women with UBC, especially those younger than 50 years at first breast cancer diagnosis. A tailored follow-up strategy beyond current recommendations is needed for these patients who, because of their age and absence of known familial risk, are currently not invited for population-based screening.
KeywordsBreast neoplasms Mortality Prognosis Retrospective cohort studies Second primary
The authors thank the registration clerks and data managers at the Comprehensive Cancer Centres for their collection of data for the Netherlands Cancer Registry as well as the scientific staff of the Netherlands Cancer Registry. This study is part of a project funded by the Dutch Cancer Society (KWF): The increasing burden of second primary cancers in the Netherlands: trend in incidence, survival and causes-of-death since 1970 (EMCR 2008-4132). Anna Font-Gonzalez was funded through an Academy Assistantship from the KNAW (Royal Netherlands Academy of Arts and Sciences).
Conflict of interest
The authors declare that they have no conflict of interest.
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