Five-year risk of interval-invasive second breast cancer.
Five-year risk of interval-invasive second breast cancer.
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间隔浸润性第二乳腺癌的五年风险。
DOI：
10.1093/jnci/djv109
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Hubbard,RebeccaA
中科院分区：
文献类型：
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作者：
Lee,JanieM;Buist,DianaSM;Houssami,Nehmat;Dowling,EmilyC;Halpern,ElkanF;Gazelle,GScott;Lehman,ConstanceD;Henderson,LouiseM;Hubbard,RebeccaA
研究背景：原发性乳腺癌（PBC）治疗后早期发现第二乳腺癌可提高生存率，但乳腺X线摄影在既往乳腺癌患者中的准确性较低。这项研究的目的是检查妇女临床表现与第二乳腺癌后，阴性监测乳腺摄影（间歇期癌症），方法我们评估了一个前瞻性队列的15 114名妇女与47 717监测乳房X线片诊断为0- 20期乳腺癌，1996年至2008年，在乳腺癌监测联盟的设施中进行了II期单侧PBC。我们使用离散时间生存模型来估计间隔浸润性第二乳腺癌的几率与候选预测因子之间的关联，包括人口统计学、PBC和影像学特征。所有的统计检验都是双侧的。ResultsThe累积发病率的第二次乳腺癌五年后为54.4每1000名妇女，325监测检测和138间浸润性第二次乳腺癌。具有参考类别特征的女性发生间隔浸润性第二癌的5年风险为0.60%。对于最有利和最不有利的女性，五年风险范围为0.07%至6.11%。多变量建模确定II级PBC（比值比[OR] = 1.95，95%置信区间[CI] = 1.15 - 3.31），接受肿瘤切除术治疗，不接受放射治疗（OR = 3.27，95% CI = 1.91 - 5.62），间期PBC显示（OR = 2.01，95% CI 1.28 - 3.16），乳腺X线检查显示乳腺密度不均匀（OR = 1.54，95% CI = 1.01至2.36）作为间期的独立预测因子-结论PBC的诊断和治疗特点有助于在发病间隔期内发生第二次乳腺癌的风险。考虑这些因素可能有助于制定量身定制的治疗后成像监测计划。
BackgroundEarlier detection of second breast cancers after primary breast cancer (PBC) treatment improves survival, yet mammography is less accurate in women with prior breast cancer. The purpose of this study was to examine women presenting clinically with second breast cancers after negative surveillance mammography (interval cancers), and to estimate the five-year risk of interval-invasive second cancers for women with varying risk profiles.MethodsWe evaluated a prospective cohort of 15 114 women with 47 717 surveillance mammograms diagnosed with stage 0-II unilateral PBC from 1996 through 2008 at facilities in the Breast Cancer Surveillance Consortium. We used discrete time survival models to estimate the association between odds of an interval-invasive second breast cancer and candidate predictors, including demographic, PBC, and imaging characteristics. All statistical tests were two-sided.ResultsThe cumulative incidence of second breast cancers after five years was 54.4 per 1000 women, with 325 surveillance-detected and 138 interval-invasive second breast cancers. The five-year risk of interval-invasive second cancer for women with referent category characteristics was 0.60%. For women with the most and least favorable profiles, the five-year risk ranged from 0.07% to 6.11%. Multivariable modeling identified grade II PBC (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.15 to 3.31), treatment with lumpectomy without radiation (OR = 3.27, 95% CI = 1.91 to 5.62), interval PBC presentation (OR = 2.01, 95% CI 1.28 to 3.16), and heterogeneously dense breasts on mammography (OR = 1.54, 95% CI = 1.01 to 2.36) as independent predictors of interval-invasive second breast cancers.ConclusionsPBC diagnosis and treatment characteristics contribute to variation in subsequent-interval second breast cancer risk. Consideration of these factors may be useful in developing tailored post-treatment imaging surveillance plans.