Retrospective Analysis of Clinicopathological Features and Familial Cancer History of Synchronous Bilateral Breast Cancer.

Kai-Ling Huang,Wen-Ling Kuo,Yu-Ling Liu,Ya-Ying Hsu

doi:10.3390/healthcare9091203

Kai-Ling Huang, Wen-Ling Kuo + Show 2 more

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https://doi.org/10.3390/healthcare9091203

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Journal: Healthcare	Publication Date: Sep 13, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Chang Gung Memorial Hospital, Chang Gung University

Abstract

Bilateral breast cancer is a strong predictor of BRCA 1/2 mutation and hence one criterion indicated for hereditary genetic testing. The purpose of this study is to assess the characteristics of synchronous bilateral breast cancer (SBBC) and its association with personal and familial cancer traits. Patients diagnosed with SBBC in our institute between 1992 and 2018 were retrospectively reviewed, and the information of clinicopathological features, personal and family cancer history were analyzed. Of the 307 SBBCs enrolled, the growing case number generally aligned with the regional breast cancer incidence after the era of population-based mammography screening. SBBC patients had similar cancer stages but worse survival outcomes than those in the standard scenario. A total of 42.0% had mixed pathological diagnoses, and 22.8% had discordant immunohistochemistry (IHC) subtypes from both sides, which contributed to treatment challenges. The correlation of SBBC with hereditary breast and ovarian cancer (HBOC) syndrome was strongly implied, as 20.7% of our SBBC patients with known familial cancer histories had HOBC-related familial cancers (breast, ovarian, or prostate cancers). These findings highlight the need for genetic counseling and germline mutation testing in patients with SBBC. Early PARP inhibitor treatment should also be considered in high-risk cases for outcome improvement.

Highlights

Bilateral breast cancer is one of the risk-enrichment criteria for BRCA1/2 mutation in the Pen II risk model [1], BRCAPRO [2], and NCCN guidelines [3] to select appropriate patients indicated for germline mutation testing
Synchronous bilateral breast cancer (SBBC) refers to the simultaneous development of breast cancers in both breasts, while metachronous or asynchronous breast cancer refers to bilateral breast cancer occurring at different times
We defined SBBC as simultaneous diagnosis of bilateral breast cancer and breast cancer from each side diagnosed within 6 months apart, and those meeting the criteria were selected for further analysis

Summary

Introduction

Bilateral breast cancer is one of the risk-enrichment criteria for BRCA1/2 mutation in the Pen II risk model [1], BRCAPRO [2], and NCCN guidelines [3] to select appropriate patients indicated for germline mutation testing. Bilateral breast cancer accounts for 1–3% of all breast cancers and is a strong predictor for BRCA mutation carriers [3]. In a Korean cohort, 16.3% of patients with bilateral breast cancer had germline BRCA mutations [6]. SBBC patients in a Chinese cohort had higher BRCA 1/2 mutations when there was a presence of family history and bilateral estrogen receptor (ER)-negative disease [7]. In a Polish cohort, BRCA1/2 mutations were present in as many as 29.6% of bilateral breast cancers. In the post-genomic era, the ability to confirm and control the genetic impact of personal cancer predisposition has been considerably enhanced, non-genetic causes of bilateral breast cancer or personal breast cancer predisposition remain challenging to determine

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