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Tumor marker phenotype concordance in second primary breast cancer, California, 1999–2004

  • Epidemiology
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Abstract

Breast cancer is the most common cancer among women. It is estimated that 7% of women who have breast cancer will develop a subsequent second independent breast tumor within 10 years of the first. The status of estrogen (ER), progesterone (PR) and human growth hormone (HER2) receptors, individually and as phenotypic combinations, impacts the clinical course of breast cancer and may impact the course of subsequent primary tumors and patient survival. Our aims were to determine tumor marker phenotype concordance between first and second primary breast cancers (FPBC and SPBC), describe demographic and clinical characteristics, and examine first tumor treatments associated with phenotype concordance. A total of 76,209 cases of female invasive breast cancer were identified in the California Cancer Registry from 1999 to 2004. Of those, 1,407 women who had not undergone a prophylactic mastectomy, had information on the status of three tumor markers, and were diagnosed with an SPBC during the study period were selected. SPBCs were significantly smaller, diagnosed at a higher stage and were node positive. Patients whose FPBC was ER+/−/PR+/−/HER2− and triple negative (TN) (ER−/PR−/HER2−), often had concordant phenotypes for their SPBC. ER+/−/PR+/−/HER2+ and HER2-positive (ER−/PR−/HER2+) FPBCs, often had discordant phenotypes for their SPBC. ER+/−/PR+/−/HER2− SPBCs often lacked HER2 expression and were ER and/or PR positive. Tumor laterality and synchronicity significantly predicted concordance as did having a FPBC whose phenotypes were ER+/−/PR+/−/HER2+, HER2-positive and TN, while first primary tumor treatment with chemotherapy predicted discordance. The relationship between multiple primary breast cancer phenotype concordance and patient prognosis has yet to be determined. Our results indicate that SPBC surveillance strategies include consideration of FPBC phenotype. Although our results are provocative, they may have been influenced by current criteria used to determine tumor independence.

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Abbreviations

PBC:

Primary breast cancer

FPBC:

First primary breast cancer

SPBC:

Second primary breast cancer

ER:

Estrogen receptor

PR:

Progesterone receptor

HER2:

Human epidermal growth hormone receptor 2

TN:

Triple negative

CCR:

California cancer registry

SES:

Socioeconomic status

BCS:

Breast conserving surgery

CI:

Confidence intervals

OR:

Odds ratio

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Acknowledgments

The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California and contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The authors would like to thank Karen Schlaier, Clinical Research Coordinator, with the University of California Davis, and Dee LeTendre Quality Control Specialist II, with the California Cancer Registry, for their technical support; and Dorsey Griffith who inspired this study.

Disclaimer

The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Public Health, the National Cancer Institute and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

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  1. Chronic Disease Surveillance and Research Branch, Public Health Institute/California Department of Public Health, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA

    Monica Brown & Katrina Bauer

  2. Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, 4860 Y Street, Suite 3740, Sacramento, CA, 95817, USA

    Monica Brown

  3. Sutter Cancer Center Sacramento, 2800 L Street, Suite 420, Sacramento, CA, 95816, USA

    Mary Pare

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Correspondence to Monica Brown.

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Brown, M., Bauer, K. & Pare, M. Tumor marker phenotype concordance in second primary breast cancer, California, 1999–2004. Breast Cancer Res Treat 120, 217–227 (2010). https://doi.org/10.1007/s10549-009-0469-z

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