Risk Factors for Second Primary Breast Cancer Among DCIS Survivors

DCIS 幸存者中第二原发乳腺癌的危险因素

• 批准号: 7885219
• 负责人: Christopher I Li
• 金额: $ 60.07万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-06-06 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7885219
• 关键词: Address; Adjuvant; Adjuvant Therapy; Age; Biopsy; Breast; Breast Cancer Detection; Breast Cancer Risk Factor; Breast-Conserving Surgery; Cancer Survivor; Caring; Categories; Characteristics; Clinical; Comedo; Contralateral; Control Groups; Data; Decision Making; Diagnosis; Disease; Duct (organ) structure; ERBB2 gene; Epidemiological Factors; Epidemiology; Estrogen Receptors; Exogenous Hormone Therapy; Family history of; Funding; General Population; Goals; In Situ; In Situ Lesion; Incidence; Invaded; Ipsilateral; Lesion; Literature; Local Therapy; Mammary gland; Mammographic Density; Mammography; Measures; Nested Case-Control Study; Noninfiltrating Intraductal Carcinoma; Operative Surgical Procedures; Patients; Population; Progesterone Receptors; Public Health; Race; Radiation; Radiation therapy; Recording of previous events; Recruitment Activity; Reporting; Research Infrastructure; Risk; Risk Factors; Sample Size; Screening procedure; Second Primary Cancers; Simple mastectomy; Survival Rate; Survivors; Time; Tissues; Translating; Tumor Markers; United States; Woman; Work; breast cancer diagnosis; breast lumpectomy; burden of illness; cancer cell; density; follow-up; high risk; hormone therapy; malignant breast neoplasm; public health relevance; reproductive; sound; trend; tumor

DESCRIPTION (provided by applicant): The proposed study is a competitive renewal of our currently funded project that is investigating how epidemiological factors, clinical and pathological characteristics, and tumor marker expression influence the risk of second primary invasive contralateral breast cancer among survivors of a first primary invasive breast cancer. Here we propose to expand this work by evaluating factors that are related to risk of second primary breast cancers among ductal carcinoma in situ (DCIS) survivors. Incidence rates of DCIS have increased 7.2- fold from 1980 to 2001 in the United States, largely as a result of widespread breast cancer screening. DCIS lesions are very responsive to available therapies, and five-year disease-specific survival rates are close to 100%. However, DCIS survivors have a 3.4 to 8.6-fold higher risk of developing a second breast cancer compared to the risk that women in the general population have of developing a first breast cancer. The recent rapid rise in DCIS incidence rates has translated into a large and growing population of DCIS survivors who are particularly susceptible to developing a second breast cancer. Not all DCIS patients will go on to develop a second breast cancer, so certain surgical and adjuvant therapy combinations for DCIS constitute over- treatment for those at low risk of a second breast cancer, while others constitute under-treatment for those at high risk. At present, however, there is a lack of meaningful prognosticators to indicate which DCIS survivors are at high or low risk of developing a second breast cancer. Such prognosticators could be important guides to help these patients and their clinicians choose the most appropriate course of therapy and subsequent follow-up care. We propose to investigate how epidemiological, clinical, and histopathological characteristics of DCIS impact the risk of second primary breast cancers among DCIS survivors. We will recruit 515 patients diagnosed with DCIS and a verified subsequent second primary in situ or invasive breast cancer, and a control group consisting of 1,030 patients diagnosed only with DCIS to address the following specific aims: 1) How do epidemiological risk factors for breast cancer, including reproductive characteristics, anthropometric measures, use of exogenous hormones, mammographic density, and family history of breast cancer, influence the risks of second primary breast cancer overall, contralateral second primary breast cancer, and ipsilateral second primary breast cancer among DCIS survivors?; and 2) How do the clinical and histopathological features of DCIS, including treatments, tumor grade, and histological subtype impact risks of second primary breast cancer overall, contralateral second primary breast cancer, and ipsilateral second primary breast cancer among DCIS survivors? The proposed study will provide important information to the rapidly growing population of DCIS survivors as its results may help modulate their risk of developing a second primary breast cancer and inform their decision-making regarding DCIS treatments and subsequent breast cancer screening. Public Health Relevance: In the United States about 20% of all breast cancers diagnosed are of a type called ductal carcinoma in situ (DCIS). DCIS patients have a very high survival rate but also have a high risk of developing a second breast cancer, and little is known about which DCIS survivors will and will not go on to develop second breast cancers. The primary goal of this study is to identify epidemiological, clinical, and histopathological characteristics that may be associated with risk of second breast cancers that can help DCIS survivors make decisions regarding their treatment and follow-up.

描述(申请人提供)：这项拟议的研究是我们目前资助的项目的竞争性更新，该项目正在调查流行病学因素、临床和病理特征以及肿瘤标记物的表达如何影响第一次原发浸润性乳腺癌幸存者患第二次原发浸润性对侧乳腺癌的风险。在这里，我们建议通过评估与导管原位癌(DCIS)幸存者的第二原发乳腺癌风险相关的因素来扩大这项工作。从1980年到2001年，DCIS在美国的发病率增加了7.2倍，这主要是由于广泛的乳腺癌筛查。DCIS病变对可用的治疗非常敏感，与疾病相关的五年存活率接近100%。然而，与普通人群中女性罹患第一次乳腺癌的风险相比，DCIS幸存者罹患第二次乳腺癌的风险高出3.4至8.6倍。最近DCIS发病率的快速上升导致了DCIS幸存者的大量且不断增加的人口，他们特别容易发展为第二次乳腺癌。并不是所有的DCIS患者都会继续发展成第二次乳腺癌，所以DCIS的某些手术和辅助治疗组合对那些第二次乳腺癌风险较低的患者构成了过度治疗，而对于那些高风险患者则构成了治疗不足。然而，目前缺乏有意义的预后指标来表明哪些DCIS幸存者发生第二次乳腺癌的风险较高或较低。这些预测指标可能是帮助这些患者和他们的临床医生选择最合适的疗程和后续护理的重要指南。我们建议调查DCIS的流行病学、临床和组织病理学特征如何影响DCIS幸存者中发生第二原发癌的风险。我们将招募515名确诊为DCIS的患者和随后确诊的第二原发原位或浸润性乳腺癌患者，以及由1030名仅被诊断为DCIS的患者组成的对照组，以解决以下具体目标：1)乳腺癌的流行病学风险因素，包括生殖特征、人体测量、外源性激素的使用、乳房X光检查密度和乳腺癌家族史，如何影响DCIS幸存者患第二原发乳腺癌、对侧第二原发乳腺癌和同侧第二原发癌的风险？2)DCIS的临床和组织病理学特征，包括治疗方法、肿瘤分级和组织亚型，如何影响DCIS幸存者中总体上第二原发癌、对侧第二原发癌和同侧第二原发癌的风险？这项拟议的研究将为迅速增长的DCIS幸存者提供重要信息，因为它的结果可能有助于调节他们发展为第二原发乳腺癌的风险，并为他们关于DCIS治疗和随后的乳腺癌筛查的决策提供信息。 公共卫生相关性：在美国，所有确诊的乳腺癌中约有20%是一种称为导管原位癌(DCIS)的类型。DCIS患者存活率很高，但也有发生第二次乳腺癌的高风险，对于哪些DCIS幸存者会和不会继续发生第二次乳腺癌知之甚少。这项研究的主要目标是确定可能与第二次乳腺癌风险相关的流行病学、临床和组织病理学特征，以帮助DCIS幸存者做出关于他们的治疗和随访的决定。