Early detection of second breast cancers (prior to symptoms) results in a diagnosis of early-stage cancer and improves survival by 27-47%, according to the results of a study published in the Annals of Oncology.
Breast cancer survivors are at an increased risk of developing secondary breast cancers, either in the same breast if they have undergone breast-conserving surgery or in the opposite breast. As a result, it is important that this population of women undergoes regular screening. However, the impact of early detection of second cancers remains unknown. Some research has indicated that breast cancer survivors are inconsistent with mammography screening in the years following cancer treatment.
Researchers in Florence, Italy, used the clinical and pathology archives of the Centro per lo Studio e la Prevenzione Oncologica (CSPO) to identify 1,044 women who survived breast cancer only to be diagnosed with a second breast cancer more than six months later. CSPO is the main breast screening and diagnostic center in Florence and follows a standard protocol for follow-up screening after treatment for breast cancer:
Women treated with lumpectomy are followed up with clinical examination every six months and annual mammography for the first five years. After five years, these women undergo annual clinical examination and annual or biannual mammography.
Women treated with mastectomy undergo annual clinical examination and annual or biannual mammography.
Upon diagnosis of the second cancer, 699 women (67%) were asymptomatic and 345 (33%) had symptoms. The researchers found that mammography was more sensitive than clinical examination, with 86% of second cancers detected by mammography versus 57% by clinical examination. However, 13.8% of second cancers were only identified by clinical examination. Asymptomatic cancers tended to be smaller than those that were symptomatic and they were also more likely to be early-stage cancers: 58% of asymptomatic cancers were early-stage, and 23% of symptomatic cancers were early stage. There was also a lower incidence of metastatic disease among the asymptomatic women.
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The researchers concluded that early detection of second breast cancers, when they are still asymptomatic, leads to the detection of early-stage cancer and improves relative survival by 27-47%.
 Houssami N, Ciatto S, Martinelli F, et al. Early detection of second breast cancers improves prognosis in breast cancer survivors. Annals of Oncology [early online publication]. March 17, 2009. Doi: 10.1093/annonc/mdp037.
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