New primary breast cancer after prior breast RT?

Fourminor · November 2014

Hi,

I'm curious how many women may have this scenario. 6 years ago I was diagnosed with DCIS in my left breast, under 1 cm, intermediate grade. I had lumpectomy, margin was less than 1mm, re-excision, and then was advised to RT. I was not sure about the idea of such a strong therapy for such a tiny non-invasive cancer and went to three RTs to see what they advised. Under questioning, one admitted that there was no way to know for sure if I needed RT, that some studies were on to see who could skip it, but the data was not available yet. Last RT requisitioned my slides, said that it looked like by measurement of the slides it could be a little bigger than gross path, and that this type could have skip lesions (i.e., some gaps between tumor) and she really thought I should do the whole breast RT. I went along with it and did therapy with her.

Five years later I have ILC (new primary, not recurrence) diagnosed 3-4 cm away from the earlier lumpectomy. On final path there is also LCIS and ADH ,none of which was noted on prior pathology. No DCIS found in my breast.

I see a lot of mention of slight risk of contralateral breast cancer from breast RT, and the real rare birds of sarcomas. Nowhere do I see any studies published about second primary breast cancer in the treated breast. And yet surely this must be possible, if it can cause cancer in the adjacent untreated breast. Are there any other women out there who had RT and then had a totally new cancer show up in the same breast?

grace163 · December 2014

Hi

Just diagnosed with a second primary tumor in the same radiated breast after 13 years. I thought I was done with this......This is a new primary of the same type, triple negative infiltrating ductal. My onc referred to a new study that was showing radiation gave around 15 years of protection to ductal cancers, but I haven't been able to find any references. Anyone heard about this?

She · December 2014

Oh, it's possible ...

'96 Rt Breast IDC Grade 2 Tripleneg Stage 2b lumpectomy, wide excision, AC, RT

'01 Lt Breast DCIS Grade 1 ER+/PR+ HER- Stage 1 lumpectomy, partial mast, RT 15 mths tamoxifen

'09 Lt Breast DCIS (different primary) Grade 1 ER+/PR+ HER- stage 1 bilateral mastectomies with immediate DIEPs recon, medical onc refused to prescribe further treatment, did not get clear surgical margins

'13 Lt Breast chest wall recurrence of '09, infiltrating the pectoral muscle; mass 4.5cm x 4cm x 3.5cm with 2.8cm tumour in the centre. Stage 4, surgery to remove mass and affected pectoral (roughly 60%). Now at 19 mths on Letrozole , continuing until it stops working. Scanning next month, waiting for markers as I type.

Fourminor · December 2014

Dear She,

OMG! You had bilateral RT so they could no longer give RT when you had the recurrence even with positive margin? That's another thing I don't like about RT, the whole, once only thing. I don't know, it seems well accepted that lump + RT has equivalent outcome to mastectomy but I wonder why RT doesn't cause new primaries sometimes? I know I wish i had a mastectomy instead of lump and RT and if I have a third primary on the other side I will not bother with RT again. Maybe I'm wrong, I don't know.

I'm so sorry She. I hope for good news for you.

Lulu22 · December 2014

Waiting to hear the path report on a new lump on the other side of the same breast, less than 3 years after lumpectomy, chemo and radiation. Don't have the final word yet but the MO said "I don't like the looks of this", the radiologist was giving me sympathetic glances, and the surgeon was checking her schedule. This bites.

Because we've already irradiated the breast and because I've developed this so quickly (no sign of it on mammo 1 year ago or physical exams by MO and RO 12 and 10 weeks ago) I'm facing a BMX if the report comes back malignant. Even if it's reported as benign my BS wants to do a lumpectomy to take it out. That tells me she definitely thinks it's cancer. :-(

I'm still glad I went with a lumpectomy the first time around. I think a MX would have been very traumatic at the time, while today the idea makes me sad and anxious but I feel like I can handle it. Last time I was a weeping mess. This time I'm calmer, knowing I have a good team in place and that my family can handle surgery and chemo if that becomes my path.

Fourminor · December 2014

Lulu,

So sorry. Like you I was not ready for mastectomy the first go round as it was stage 0 under 1 cm. But this time, you are right, there is no choice, if its cancer, the whole breast has to go. However for me the mastectomy was not the hardest part, just the decision to go one or both. The surgery itself was not too bad. In hindsight I guess I should have had a mastectomy back then and I would not be here now. I went uni mastectomy and if anything ever shows up on the other side I will not bother with lumpectomy and RT again.

Lulu22 · December 2014

I've already made the decision that if it's malignant I'll go with a BMX. I've been through chemo once and may be facing it again. I don't think I could face a 3rd time. My breasts just aren't that precious to me. I mean, I like them but they're already mangled and I'd rather be around to enjoy life than worry about yet another lump. There's already enough to worry about.

Fourminor · December 2014

Brettsie,

Interesting articles. I wonder why this is not being studied more. I felt strongly that my initial DCIS was so small that I was OK watching to see if any recurrence would occur and then considering mastectomy or RT. But I got talked into RT. Now MO admits that the questions I was asking just 5 years ago are being seen as very legitimate.

I had oncotype of 20 and was not feeling strongly about chemotherapy . However I went along with it a couple of weeks ago due to MO's insistence that since this was a second primary i should be more aggressive. I had an allergic reaction to the 5FU. A few days later I had a ruptured ovarian cyst--maybe coincidence, but maybe not. I felt like my body was taking a stand on this round. Second opinion said although she would have also recommended chemo at first, now it doesn't sit right with her either. I am going forward with Tamoxifen therapy but have decided that re-scrutinizing my diet is also in the cards. Working on cutting out dairy (never ate much meat). Sugar I feel though is the highest priority to exclude.

Hugs to all,

4

kimag · December 2014

hello, one of the side effects of RT can be secondary cancer like in my case where doctors are 99% positive my BC was radiation induced (high chest radiation at the age of 18) , there were many indications that this is the case, for one all my left breast was in microcalcifications, right had none, the tissue =density was different and so on... so if RT can cause BC when taken for other cancer why wouldn't that be true for those who had it for earlier BC? After all the issue is that the breast cells where radiated and can mutated, however the great difference now is that they plan RT very carefully so if it is not entire or large portion of remaining breast the risk is not as high I would think.

Fourminor · December 2014

angiosarc is rare but documented side effect of radiation.

BC after chest RT for Lymphoma also a known published side effect.

I am just confused as to why i do not find anything published about new breast cancer induced by prior RT for previous cancer. Am i missing something?

Curlylocks · January 2015

I had a new primary in same affected breast 8 years later. Receptors were different than first bc..first was estrogen positive. This one triple negative.

I had a left breast lumpectomy, chemo, radiation and Armidex for 5 years. I had ovaries removed in 2008 at age 44.

I had a bilateral mascetomy with DIEP reconstruction in Dec 2013. My 2nd breast cancer was found in the pathology from that surgery.

Michele

Fourminor · January 2015

Sorry you are joining us Curlylocks. I found hearing this for the second time was in some ways worse than the first time. We worry about recurrence, but somehow it didn't seem possible that I could be so unlucky as to have another new one.

I am wondering whether RT in young women (less than 45) maybe has more of a chance of causing this, but I am curious why I am not seeing any published research or statistics on it. The one possible reason might be that if the comparative group had a mastectomy, there is no breast there to have a new primary so of course a woman who underwent breast conservation would have a higher chance of new primary in treated breast. But couldn't someone compare the incidence of new primary in the treated breast versus the contralateral breast in the same woman? Presumably all other environmental factors would be the same.

mrskimber47 · January 2015

Hello fellow fighters and survivors!! I haven't been on the board for a long time... once I started my treatment the first time around, I just had nothing much to say on here accept to give my sympathies to others going through this nasty disease. I have an upcoming appointment with my onc to discuss changes in my remaining breast. Longish lumps and lumps in my armpit.

I cannot even begin to imagine that this could be happening again. WTH. Any advice for me would be appreciated. My biggest question is: without knowing anything more than what I've stated; does having a new primary in the other breast mean that my prognosis will change? In other words, I HAD a 30% chance of the first cancer coming back. What will those chances look like now with a new primary?

funthing42 · January 2015

ugh!!! I'm ready to see another rad oncologist Monday for more Radiation. This time I have no breast only local skin recurrence 5 little lumps /pink. So why in the freaking world do they want to irradiate me. No one seems to want to just remove it consulted two surgeons.

Sorry but Does anyone have anything positive to say about radiation. So far I would say not too many. Or we would have much less recurrences.

Fourminor · January 2015

I don't know how rare it is because my PS told me initially he would never do implant recon on a woman with prior RT to that breast, but eventually some women convinced him to try and now he's done hundreds of them with about a 70 percent success rate. so if he is one PS and has seen this hundreds of times, how rare could it be? So why can't I find a statistic on it?

New primary breast cancer after prior breast RT?

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