Contralateral Breast Primary in Breast Cancer Survivors-An Experience from a Tertiary Care Centre in Thiruvananthapuram, Kerala, India

Abstract

Introduction: Improved life expectancy after breast cancer treatment has led to increased incidence of contralateral breast cancers. There are no well established guidelines for the management of these cancers. There is a paucity of Indian data regarding contralateral breast cancers. Aim: To describe the clinicopathological profile and prognostic outlook of patients with contralateral breast cancers. Materials and Methods: This was a retrospective cross-sectional study in which all patients who underwent surgery for non metastatic breast cancer between January 2006-December 2010 at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, were identified. The follow-up data of these patients (6240 patients) were retrieved from medical records division in January 2020. The medical records of all these patients who developed contralateral breast cancer were analysed. Results: A total of 98 patients (1.57%) developed contralateral breast cancer. Most of the second breast cancers were presented at a lower stage than index cancer. Twenty five patients (25.51%) contralateral breast cancers were detected after five years. A total of 58 patients (59.18%) had interval cancer. Among them, 32 (55.17%) were detected by the treating doctor and 26 patients (44.83%) were symptomatic. The median duration of follow-up was 98 months (range 24-150 months). The five year Overall Survival (OS) was 80.5% and five year Disease Free Survival (DFS) was 62.8%. The patients who developed contralateral breast cancer within three years had lower five year OS when compared to those who developed after three years (75.5% vs 86.7% p=0.85). Five year OS was 74.8%, 81% and 85% for patient reported interval cancer, physician detected interval cancers and mammogram detected cancers respectively (p=0.9). Conclusion: Most contralateral breast cancers presented in a lower stage than index cancer. Contralateral breast cancer has got a reasonably good five year OS. There is no significant OS difference between mammogram detected second cancer and interval cancer. There was a need for more frequent clinical breast examination even after five years to detect contralateral primary in an early stage. Cost effectiveness of frequent follow- up mammogram examinations compared to clinical examination should be evaluated in future prospective studies.