Contralateral BC, Recurrence, Survival, PBM

nevaeh

Contralateral BC, Recurrence, Survival, PBM

nevaeh

My bs is involved in a study of 29,000 women over the last 9 years and will be publishing a paper approx this April on contralateral bc.  He is from a major teaching hospital.

On my visit with him two days ago we discussed PBM.  He informed me of the following based on the above study:

• I have a 1 in 100 chance over the next 9 years of getting bc in my contralateral breast.

My survival odds would not be improved by mastectomy to either breast

• Second tumors are the same stage.  Because I am Stage 1 if I were to get a bc in the contralateral breast it will be of the same Stage
• Stage II, higher first plus second tumors have a better survival rate than do first and second Stage 1 tumors
• If I get a second tumor it will most likely show up within the next 36 months
• If a second tumor does show up, it was already there at original dx and it will mean it will be resistant to hormanal treatment (as I will have been on that during the next 36 month period)
• Because of this resistant it will be a very biological nasty cancer, it will have already done it's dirty work (METS, if any) and thus the reason the survival rate goes down.

I am passing this along by way of information, and not gospel.  And, looking for comments  and observations.

I also had LCIS left after re-excision.  This bs considers that a pre-cursor marker not pre-cancer.  When I asked about the contralateral breast he told me I probably have LCIS there also.

nash

Thanks for sharing this. I'm confused, though, about the part where "second tumors would be the same stage". How could that be? Staging depends on size and spread, so that would be dependent on when the new primary was caught. I'm not following the logic on that--can you clarify?

I'm also lost on the first and second primary Stage II and higher tumors having a better survival than first and second primary Stage I tumors. Why would that be?

I would assume a lot of women in the study had IDC? I wonder what percentage had ILC.

I have a lot of LCIS left in the bad boob. The presurgery MRI didn't show anything in the good boob, but I wouldn't be surprised about LCIS over there, too.

I wonder how sure they can be about LCIS being a presursor, not a precancer. My LCIS and ILC were both the pleomorphic variety, and my LCIS was growing into the pectoral muscle. The ILC was surrounded by LCIS. As far as I can tell, my ILC arose directly from my LCIS. And LCIS that wants to invade muscle sounds nasty to me. But obviously this is all speculation on my part, and all of this deserves more research on the part of the docs.

It would be interesting if you'd post your conversation with the bs over on the second/third cancers board and see what those gals have to say from their own experiences with new primaries. 

gracejon

Interesting comments.  My invasive cancer had another aea of LCIS.  My preventative mastectomy had all four quadrants of LCIS along with atypical lobular and ductal hyperplasia.  My surgeon was very suprised at these findings but totally concurred that removing the contralateral side retrospectively was a very very good decision.  Regardless of this paper's result, I think I made a good decision and will have no remorse even with this paper's results.

TenderIsOurMight

Wow, this IS dense!



29,000 women is a massive study (can't tell, but possibly prospective study (forward looking from 9 years ago on to conclusion time for data analysis and outcomes), and then saw your comment thinking it includes ILC and IDC which is probable given its size.



Maybe you can post the title of the study when it's released, April, 2008, yes?. It would be interesting to read...



I get the contralateral statistic, as I've always heard 1% per year, which is 1 in 100 per year. Each year must be independent of past years for it to stay 1% per year, not additive. So that confirms what is pretty much quoted regarding contralateral risk.



Second tumors occur at same stage. Interesting. I think this would be some new news to the breast cancer community. Yet the majority of women are diagnosed stage 0 or stage 1 (75% of diagnosis) so since the majority are in the early stages, a new tumor in the contralateral breast has the same statistic apply, again the majority being stage 0 to 1. So, perhaps statistics may help explain this finding somewhat.



Stage II, higher first plus second tumors have a better survival rate than do first and second Stage 1 tumors. Gosh, this is counter-intuitive and counter survival statistics that I know of. No way you inverted the 1 and 11, is there nevaeh? Did your doctor offer any explaination of this?



Second tumors being more chemo and hormonal resistant is not incomprehensible, as if the tumors were sensitive to chemo and hormones one would expect regression and/or complete resolution of unknown second tumors when primary tumor was treated.



Thanks for posting this. It gives one pause.



Tender



Edit addendum: One thought on the puzzling second stage do better than first stage is this: if "stage migration" occurs due to sentinel node showing a few microscopic cells, or greater than .2mm but less than .5mm, then these women would theoretically be given chemotherapy etc.. when they would not have received it if no IHC revealed such cells. So, in this regard, now stage 11 they are more aggresively treated, and this may well translate into longer disease free survival and overall survival, and cure. So, perhaps this may be reflected in this research paper to be published; stage migration with more aggressive treatment, resulting in better outcome. Just a thought. Tender

nevaeh

I understand my surgeon's paper on this study per will be published sometime April 2008 and when it is, I will certainly post it (or a link).  The name of the study is OSCAR being done at OHSU in Portland, Oregon. 

Tender wrote:  "Stage II, higher first plus second tumors have a better survival rate than do first and second Stage 1 tumors. Gosh, this is counter-intuitive and counter survival statistics that I know of. No way you inverted the 1 and 11, is there nevaeh? Did your doctor offer any explaination of this?"

The explanation I was given was a view of a chart showing that the statistics for survival dropped more for the Stage 1 + Stage 1 than for higher Stages.  The surgeon said these second Stage 1 cancers are fast growing, biologically nasty, and are already present at time of original dx.

Tender, your addendum also makes sense.  I will try to get more info and post if I do