Risk Of Second Primary Cancers Among Long
- 1Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- 2Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- 3Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Cancer Institute, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
Purpose: The current study explored the risk of developing second primary cancers among long-term early-stage breast cancer survivors and identified risk factors to build an externally validated clinical prediction model.
Methods: The cumulative incidence of SPCs was calculated by Gray method among survivors of early-stage initial primary breast cancer . Comparisons of treatment-related risk by selected organ sites were performed. A nomogram was established to estimate the individual risk of developing SPCs based on the multivariate Fine and Gray risk model. Decision curve analysis was used to evaluate clinical usefulness of the model.
We found that the cumulative incidence of developing SPCs increased over time and did not plateau. Risk factors for developing SPCs identified by our study were not consistent with those of previous studies. The prediction model can help identify individuals at higher risk of SPCs.
Support For Living With Secondary Breast Cancer In The Liver
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatevers on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
Validation Of The Prediction Model
We assessed the calibration for risks of developing SPCs by comparing the observed risks based on the Gray method with the mean predicted risks predicted risks from the prediction model. Likewise, an external validation was performed in the validation cohort. The C-index was also used to quantify the discrimination ability of the prediction model.
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Establishment And Validation Of The Competing Risks Nomogram
The established nomogram based on the multivariable Fine and Gray model shows the relative importance of each independent variable: age was the vital predictors of developing SPCs, followed by the IPBC stage, radiotherapy, race, HR status, histology, and chemotherapy . The validated C-index of this prediction model in the development cohort was 0.59 . The C-index in the validation cohort was 0.58 . Calibration plots for internal and external validation of the prediction nomogram were shown in Supplemental Figure 2. Point assignment and risk score in the nomogram was summarized in Supplemental Table 2.
Figure 5. Competing risks nomogram for predicting the 10-, 15-, and 20-year risk of developing second primary cancers. The competing risks nomogram provides a method to calculate 10-, 15-, and 10-year probability of cumulative incidence of developing second primary cancers on the basis of a patient’s combination of covariates. To use, locate the patient’s age at initial diagnosis, draw a line straight up to the points axis to establish the score associated with that age. Repeat for the other five covariates . Add the score of each covariate together and locate the total score on the total points axis. Draw a line straight down to the 10-, 15-, and 20-year SPCs cumulative incidence axis to obtain the individual probability.
Secondary Cancers After Breast Cancer Treatment
After youâve undergone treatment such as chemotherapy or surgery to remove breast cancer, thereâs always a risk of the same type of cancer cells coming back. But for some people, aftereffects of cancer treatment may also put you at risk of developing a new, unrelated cancer. This is called a second cancer.
One recent study found that women with breast cancer have an 18% increased likelihood of developing a second cancer compared to the general public. Experts say the risk factors can range from genetics to long-term effects of breast cancer treatment.
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Thermal Ablation Or Cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.
The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
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What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
References
Development Of Second Primary Cancer In Korean Breast Cancer Survivors
Department of Surgery, Seran General Hospital, Seoul, Korea.
1Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea.
2Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
3Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
4Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Corresponding Author: Jihyoun Lee. Department of Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: +82-2-709-9241, Fax: +82-2-710-3140,
The Korean Surgical Society
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Should I Have Regular Routine Scans Or Blood Tests To Check For Distant Breast Cancer Recurrence
No. Routine scans to check for the presence of distant disease recurrence are not recommended in the absence of symptoms
Given the ominous nature of stage 4 disease, the obvious question is, why dont we scan for spread regularly after a first diagnosis, so that we can detect it early if it does return? The reason we dont scan or test for metastasis is that there really is no early stage 4 disease, and thus no real opportunity to intervene earlier and increase the chance of cure. Its also important to know that with recurrence, one does not progress from one stage to the next: a woman who was originally diagnosed with stage 1 breast cancer does not recur as stage 2, because once cells have taken up residence elsewhere, she is immediately considered to have stage 4 disease. And with stage 4 disease, either you respond well to treatment and the disease regresses, or you dont and it doesnt. Studies have shown that getting frequent scans after a first cancer diagnosis does not lead to improved survival, which is why we dont scan for stage 4even if we wish we could.
Current guidelines and evidence therefore recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on.
If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.
Comparisons Of Treatment And Hr Status Related Risk By Organ Sites
Furthermore, the effects of initial cancer-treatment and HR status on the SPCs risk in selected organ sites were estimated based on the multivariable Fine and Gray risk model. We found that, after adjusting for age, race, histology, IPBC stage, HR, and chemotherapy, patients with radiotherapy had an elevated risk of any SPCs and with increased risks of lung cancer , breast cancer , and acute myeloid leukemia . The results were shown in a forest plot . Patients with chemotherapy had a decreased risk of any SPCs and with decreased risks of lung and breast cancers, and with elevated risks of other leukemias , after adjusting for age, race, histology, IPBC stage, HR, and radiotherapy. The results were shown in a forest plot . After adjusting for initial age of IPBC diagnosis, race, histology, IPBC stage, radiotherapy, and chemotherapy, HR-positive status patients had a declined risk of any SPCs and with decreased risks of second breast and ovarian cancers , with elevated risks of urinary tract cancer . The results were shown in a forest plot . The risk of developing SPCs by selected organ sites was summary in Table 3.
Table 3. Factors associated with development of second primary cancer risks by organ sites within the entire cohort.
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Things You Can Do To Lower Your Risk For Second Cancer
While most breast cancer survivors donât get a second cancer, theyâre still at a higher risk to develop one. Thereâs no way to prevent a second cancer after breast cancer treatment, but there are steps you can take to lower your risk.
These include:
- Early detection. Go for your recommended follow-up appointments and stick to your treatment plan during remission.
- Maintain a healthy weight.
- Stay active. Start slow, with gentle exercises like walking or stretching. You can work your way up as you build strength.
- Eat a healthy, well balanced diet with fruits, vegetables, and whole grains.
- Cut back or avoid red and processed meats, sugary drinks, and highly processed foods.
- Limit alcohol. If you do drink, try to limit it to one per day.
- Quit smoking and stay away from tobacco products.
Show Sources
American Cancer Society: âSecond Cancer after Breast Cancer,â âFollow-up Care After Breast Cancer Treatment,â âSecond Cancers Related to Treatment.â
CDC: âObesity and Cancer.â
Kaiser Permanente: âWeight linked to risk of second cancer after breast cancer.â
Frontiers in Oncology: âRisk of Second Primary Cancers Among Long-Term Survivors of Breast Cancer.â
Risk Factors For Second Cancers
Whether or not you will have a second cancer depends on many different things. This may include your age when treated, the treatment you received and your genetic make-up and family history. Even if you find you are at a higher risk, it does not mean that you will develop cancer again. Keep in mind that, although the risk is higher, the actual number of people who will get a second cancer is relatively small. Each cancer survivorâs experience is unique. This overview describes some of the risks for developing second cancers:
Keep Track of Your Family History
- If there is a history of cancer in your family, it is especially important to understand risk factors and have regular screenings. Your health care team can help you decide if genetic counseling or testing is recommended.
- If you do not know about your genetic background, start talking with relatives or friends who know your family’s medical history. In many cases, no one has written down the information and only an oral history is known. You can begin to develop these records for yourself. It may also be helpful to other members of your family.
Sometimes second cancers happen in survivors who were not affected by any of the risk factors mentioned above. Ask your health care provider to discuss your risk factors for a second cancer based on your cancer type, treatment received and your general medical history.
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What Are The Signs Of Distant Breast Cancer Recurrence
If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:
- Unexpected weight loss or change in appetite
- Severe or ongoing headaches
However, symptoms will vary depending on where the secondary cancer presents. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.
Studies have shown that doctors are sometimes reluctant to mention the symptoms of metastatic disease. In medical school it was suggested that we shouldnt tell people who had been treated for cancer what to look for if they were worried about recurrences because theyd start imagining that they had every symptom we told them about, but that doesnt reassure people at all it just means theyll be afraid of everything instead of a few specific things. When youve had cancer, youre acutely aware of your body, and any symptom thats newor that you never noticed beforecan take on terrifying significance as you worry that your cancer may be back. Inevitably this will mean a lot of fear over symptoms that turn out to be harmless.
As I explain to my patients, there are good reasons these days to remain optimistic, even after cancer comes back. Newer, better treatments are becoming available all the time. And for women who were treated a long time ago, the options for treatment may have changed and improved significantly since the first time they were treated
Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and supportive care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
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Do I Need To Have Screening For Other Types Of Cancer
Cancer survivors are at higher risk of developing a second cancer than someone who has never had cancer. For this reason, it is important to have any cancer screenings appropriate for your age and personal and family history. Talk with your provider about which tests are right for you and at what age you should begin having them. These can include screening for breast, cervical, prostate, colon, and lung cancers. In addition, during routine health or dental exams your healthcare provider may also look for cancers of the skin, mouth, and thyroid.
You can learn more about cancer screening tests on OncoLink.
It can be scary to learn about the late effects of cancer treatment. Understand that these complications are not common but knowing about them helps you stay healthy. You can learn more about caring for your health after cancer treatment by creating an OncoLife survivorship care plan.
If Cancer Has Spread To The Lungs
The first symptoms of this may be a cough that doesn’t get better or breathlessness. If cancer cells settle on the outside of the lungs, they can irritate the membranes which cover the lungs . This causes fluid to build up and press on the lungs which can make you breathless. This is called apleural effusion. The fluid can be drained away to make your breathing easier.
Breathlessness can be frightening, but there are effective ways of managing it. When treatment – usually chemotherapy – starts to work, your breathing will improve.
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What Is Secondary Breast Cancer In The Lung
Secondary breast cancer in the lung happens when breast cancer cells spread to the lung. It can also be known as lung metastases or secondaries in the lung.
Secondary breast cancer in the lung is not the same as cancer that started in the lung.
Usually secondary breast cancer occurs months or years after primary breast cancer. But sometimes its found at the same time as the primary breast cancer, or before the primary breast cancer has been diagnosed. In this situation, the breast cancer has already spread to the other parts of the body such as the lung. This is referred to as de novo metastatic breast cancer, meaning the breast cancer is metastatic from the start.
Newly Diagnosed Or Worried About A Symptom
In the days or weeks after a diagnosis of secondary breast cancer, you may feel distressed and find it hard to think clearly.
You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.
If you havent been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.
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Where Can Breast Cancer Spread
The most common places for breast cancer to spread to are the lymph nodes, bone, liver, lungs and brain. The symptoms you may experience will depend on where in the body the cancer has spread to. You might not have all of the symptoms mentioned here.
Remember other conditions can cause these symptoms. They don’t necessarily mean that you have cancer that has spread. But if you have symptoms that you are worried about, discuss them with your GP, cancer specialist, or breast care nurse so that you can be checked.