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Risk of second primary breast cancers among women with ductal carcinoma in situ of the breast

  • Epidemiology
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Abstract

Background The diagnosis of ductal carcinoma in situ (DCIS) has become increasingly common, but it is not clear which factors predict the development of subsequent breast cancers in these women. The risk of second primary breast tumors was examined in a large, ethnically diverse population-based cohort of women with DCIS. Methods California Cancer Registry data on 23,547 women with first DCIS diagnosed in 1988–1999 were examined to estimate the incidence of second DCIS and invasive breast cancer relative to women in the general population. Relative risks were calculated using Poisson regression to estimate which women with DCIS were likely to develop a second DCIS or invasive breast cancer. Results Compared to the general population, women with DCIS had significantly increased risk of contralateral DCIS (standardized incidence ratio [SIR] 4.2, 95% confidence interval [CI] 3.7–4.7), contralateral invasive cancer (SIR 1.4, 95% CI 1.2–1.5), ipsilateral DCIS (SIR 4.2, 95% CI 3.5–5.0), and ipsilateral invasive cancer (SIR 1.7, 95% CI 1.4–2.1). Variation by race/ethnicity, age, time, and tumor and treatment characteristics were observed. Black women were 1.9-fold more likely to develop ipsilateral invasive cancer than white women. Young age at onset, comedo histology and having received partial mastectomy only or having neither surgical nor radiation treatment for first DCIS were predictive of ipsilateral cancers. Conclusions Close follow-up of women with DCIS is warranted, particularly those who are Black or diagnosed at young age. Investigations should continue to clarify the underlying mechanisms of racial, age, and other differences in second cancer risk.

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Acknowledgments

This research was supported by contract SEER-N01-PC-65107 from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute and by the Estonian Ministry of Education and Research (target funding SF0940026s07). Cancer incidence data have been collected under a subcontract with the Public Health Institute. The subcontract is supported by the California Department of Health Services as part of its statewide cancer reporting program, mandated by Health and Safety Code Section 103875 and 103885. The ideas and opinions expressed herein are those of the authors, and no endorsement of the State of California, Department of Health Services or the Public Health Institute is intended or should be inferred. The authors thank Mark Allen for technical support.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, Tallinn, 11619, Estonia

    Kaire Innos

  2. Estonian Centre of Behavioural and Health Sciences, Tartu-Tallinn, Estonia

    Kaire Innos

  3. Northern California Cancer Center, Fremont, California, USA

    Pamela L. Horn-Ross

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  1. Kaire Innos
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Correspondence to Kaire Innos.

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Innos, K., Horn-Ross, P.L. Risk of second primary breast cancers among women with ductal carcinoma in situ of the breast. Breast Cancer Res Treat 111, 531–540 (2008). https://doi.org/10.1007/s10549-007-9807-1

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