한빛사논문
Hakyoung Kim, MD1,2; Tae In Yoon, MD3; Seonok Kim, MSc4; Sae Byul Lee, MD, PhD1; Jisun Kim, MD, PhD1; Il Yong Chung, MD, PhD1; Beom Seok Ko, MD, PhD1; Jong Won Lee, MD, PhD1; Byung Ho Son, MD, PhD1; Young Jin Lee, MD1; Sungchan Gwark, MD, PhD5; Hee Jeong Kim, MD, PhD1
1Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
2Department of Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
3Division of Breast Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Republic of Korea
4Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
5Department of Surgery, Ewha Woman’s University College of Medicine, Ewha Woman’s University Mokdong Hospital, Seoul, Republic of Korea
Corresponding Author: Hee Jeong Kim, MD, PhD
Abstract
Importance: Young patients with breast cancer have higher risk for developing contralateral breast cancer (CBC) and have epidemiologic characteristics different from those of older patients.
Objective: To examine the incidence and peak occurrence of CBC according to age at primary breast cancer (PBC) surgery.
Design, setting, and participants: This cohort study included patients who were diagnosed with and underwent surgery for unilateral nonmetastatic breast cancer at Asan Medical Center, Korea, between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2018. Data were analyzed from December 1, 2021, through April 30, 2023. Patients were divided into 2 groups according to their age at surgery for PBC: younger (≤35 years) vs older (>35 years).
Main outcomes and measures: The main outcomes were cumulative incidence and hazard rate of CBC in the entire study population and in subgroups divided by cancer subtype, categorized according to hormone receptor (HR) and ERBB2 status.
Results: A total of 16 251 female patients with stage 0 to III breast cancer were analyzed; all patients were Korean. The mean (SD) age was 48.61 (10.06) years; 1318 patients (8.11%) were in the younger group, and 14 933 (91.89%) were in the older group. Median follow-up was 107 months (IQR, 79-145 months). Compared with the older group, the younger group had significantly higher incidence of CBC (10-year cumulative incidence, 7.1% vs 2.9%; P < .001) and higher risk (hazard ratio, 2.10; 95% CI, 1.62-2.74) of developing CBC. The hazard rate, which indicates risk for developing CBC at a certain time frame, differed according to the subtype of primary cancer. In patients with the HR+/ERBB2- subtype, the risk increased continuously in both age groups. In patients with the triple negative subtype, the risk increased until approximately 10 years and then decreased in both age groups. Meanwhile, in the HR-/ERBB2+ subtype, risk peaked earlier, especially in the younger group (1.7 years since first surgery in the younger group and 4.8 years in the older group).
Conclusions and relevance: In this cohort study, patients aged 35 years or younger with breast cancer had a higher risk of developing CBC than older patients. Moreover, young patients with the HR-/ERBB2+ subtype tended to have a shorter interval for developing CBC. These findings might be useful in guiding treatment decisions, such as contralateral prophylactic mastectomy.
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