Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer

Breast Cancer Res Treat. 2010 Dec;124(3):863-73. doi: 10.1007/s10549-010-1106-6. Epub 2010 Aug 11.


To examine whether there are any characteristics of women or their initial tumors that might be useful for tailoring surveillance recommendations to optimize outcomes. We followed 17,286 women for up to 5 years after an initial diagnosis of ductal carcinoma in situ (DCIS) or early stage (I/II) invasive breast cancer diagnosed between 1996 and 2006. We calculated rates per 1,000 women years of recurrences and second breast primaries relative to demographics, risk factors, and characteristics of initial diagnosis: stage, treatment, mode of initial diagnosis. Nearly 4% had a second breast cancer event (314 recurrences and 344 second breast primaries). Women who used adjuvant hormonal therapy or were ≥ 80 years had the lowest rates of second events. Factors associated with higher recurrence and second primary rates included: initial DCIS or stage IIB, estrogen/progesterone receptor-negative, younger women (<50 years). Women with a family history or greater breast density had higher second primary rates, and women who received breast conserving surgery without radiation had higher recurrence rates. Roughly one-third of recurrences (37.6%) and second primaries (36.3%) were not screen-detected. Initial mode of diagnosis was a predictor of second events after adjusting for age, stage, primary treatment, and breast density. A recent negative mammogram should not falsely reassure physicians or women with new breast symptoms or changes because one-third of second cancers were interval cancers. This study does not provide any evidence in support of changing surveillance intervals for different subgroups.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Fine-Needle
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / pathology
  • Carcinoma, Intraductal, Noninfiltrating / diagnosis*
  • Carcinoma, Intraductal, Noninfiltrating / diagnostic imaging
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Mammography
  • Mass Screening* / methods
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neoplasms, Second Primary / diagnosis*
  • Neoplasms, Second Primary / diagnostic imaging
  • Neoplasms, Second Primary / pathology
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States
  • Young Adult