Abstract
The overall risk of developing a second primary cancer is increasing. The purpose of this study was to analyze the survival of patients with breast cancer diagnosed after a prior cancer and identify risk factors of breast cancer death in this population. Using the SEER database, we identified 1,310 woman diagnosed with breast cancer between 2010 and 2015 after a prior cancer as the primary cohort. Clinicopathological characteristics were compared using the Student t-test and chi-square test. Fine and Gray’s regression was used to evaluate the effect of treatments on breast cancer death. After propensity score matching (PSM), 9,845 pairs of patients with breast cancer as the prior or second cancer diagnosed between 2010 and 2011 were included as a second cohort. PSM-adjusted Kaplan-Meier and Cox hazards models were used to evaluate the impact of prior cancer on survival. The results showed that survivors of gynecologic cancers (e.g., ovarian cancer) had a higher risk of developing breast cancer than survivors of gastrointestinal and urinary tract cancers. More patients died of breast cancer than of prior urinary cancer (53.3% vs. 40%, P < 0.05) and melanoma (66.7% vs. 33.3%, P < 0.05). The ratio of breast cancer deaths to prior cancer deaths was significantly higher in patients with diagnoses interval ≥ 3 years than in those with the interval < 3 years (2.67 vs. 0.69, P < 0.001). Breast cancer-specific survival and overall survival rates were significantly lower in women with breast cancer as the second primary cancer than in those with breast cancer as the prior cancer, especially among hormone receptor-positive women. However, breast cancer treatment decreased the risk of breast cancer -specific death (hazard ratio = 0.695, 95% confidence interval: 0.586–0.725, P < 0.001). Breast cancer patients with prior cancers must be carefully considered for clinical trials.
Highlights
Due to the advances in the detection of early-stage cancers and cancer treatment, the population of cancer survivors has increased by approximately 4 folds in the United States in the past 30 years [1,2,3]
920 (70.2%) patients had their prior cancers diagnosed at Tumor Node Metastasis (TNM) stage I-II, and 1094 (83.5%) had their breast cancers diagnosed at TNM stage I-II
The clinicopathological characteristics and survival of patients with this disease remain largely unknown. In this population-based study, we found that gynecologic cancers, gastrointestinal cancer, urinary tract cancers, hematological cancers, lung cancer, and melanoma were the most common types of prior cancer
Summary
Due to the advances in the detection of early-stage cancers and cancer treatment, the population of cancer survivors has increased by approximately 4 folds in the United States in the past 30 years [1,2,3]. Almost twothirds of cancer survivors live more than 5 years after the initial diagnosis, which increases the risk of developing a second primary malignancy (SPM) [4,5,6,7,8]. The prognosis of patients with stage IV lung cancer as a SPM was not affected by a prior cancer [22]. Garg et al [24] reported that early diagnosis and the absence of recurrence in patients with prior breast cancer who had abdominal carcinomatosis were significantly associated with the development of ovarian/peritoneal cancer as a SPM. Prior breast cancer and tamoxifen exposure did not affect the prognosis of women with uterine papillary serous carcinoma as a SPM [25]. The risk of breast cancer as a SPM in patients with a prior cancer and the cancer-specific survival for these patients are not known
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