Risk of Second Primary Thyroid Cancer in Women with Breast Cancer.

Monika Cieszyńska,Róża Derkacz,Jacek Gronwald,Dominika Mocarz,Cezary Cybulski,Wojciech Marciniak,Wojciech Kluźniak,Piotr Baszuk,Steven A Narod,Tomasz Huzarski,Marcin Lener,Dominika Wokołorczyk,Tadeusz Dębniak,Karolina Woronko,Anna Jakubowska,Jan Lubiński,Marta Bryśkiewicz,Michał Falco

doi:10.3390/cancers14040957

Abstract

The goal of this study was to estimate the risk of thyroid cancer following breast cancer and to identify therapeutic and genetic risk factors for the development of thyroid cancer after breast cancer. We followed 10,832 breast cancer patients for a mean of 14 years for new cases of thyroid cancer. All women were genotyped for three Polish founder mutations in BRCA1 (C61G, 4153delA, 5382insC) and four mutations in CHEK2 (1100delC, IVS2 + 1G/A, del5395, I157T). Information was collected on chemotherapy, radiotherapy, hormonal therapies, and oophorectomy. Of the 10,832 women, 53 (0.49%) developed a second primary thyroid cancer. Based on Polish population statistics, the expected number was 12.4 (SIR = 4.3). The ten-year risk of developing thyroid cancer was higher in women who carried a CHEK2 mutation (1.5%) than in women who carried no mutation (0.9%). The age-adjusted hazard ratio for developing thyroid cancer was 1.89 (0.46-7.79; p = 0.38) for those with a CHEK2 protein-truncating mutation and 2.75 (1.29-5.85; p = 0.009) for those with a CHEK2 missense mutation.

Highlights

The number of survivors of breast cancer is increasing worldwide due to wide-scale screening programs and effective therapies [1]
A diagnosis of breast cancer increases the risk of psychosocial distress, cardiovascular disease, and second primary cancers, including those of the contralateral breast, endometrium, ovary, colon, lung, and thyroid [2]
Women with breast cancer are offered a range of therapies, including radiotherapy, chemotherapy, hormonal therapies, and oophorectomy

Summary

Introduction

The number of survivors of breast cancer is increasing worldwide due to wide-scale screening programs and effective therapies [1]. The risk of thyroid cancer increases approximately two-fold in breast cancer survivors [3,4]. Breast cancer is the most common secondary malignancy among thyroid cancer patients [5]. Women with breast cancer are offered a range of therapies, including radiotherapy, chemotherapy, hormonal therapies (tamoxifen and aromatase inhibitors), and oophorectomy. It is not clear if any of these treatments impact the risk of thyroid cancer. It is important to consider the risk of secondary primary cancers in the follow-up of breast cancer survivors and to identify those at the highest risk

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Discussion

Conclusion