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One Breast Cancer Increases Risk for Another

Posted 1/27/2014

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  This is important. I am sorry to bring this information front and center on Monday morning, but it is a topic of interest to us all and strong personal history for me. Having had breast cancer puts us all at higher risk for developing a second, unrelated breast cancer in the future. It surely does not mean it absolutely is going to happen, usually it does not, but it does mean that we need to keep with screening and pay attention.

  My first breast cancer was in 1993. The second was in 2005. The good news was that the second was not a recurrence, was unrelated to the first (something that the pathologists can discern as the cells looked different one from another). The bad news was that it happened,and that is happened in the same breast so that a mastectomy was the only possible surgical treatment. As you likely know, you cannot receive radiation to the same body part or place more than once.

  We all try to figure out the "why"s. As I puzzled over this development, I wondered whether I am at particular risk/sensitivity to radiation and whether it would have been wiser to have a mastectomy in 1993. Of course, there was no medical reason to do so, and I was young, not so interesting in losing a breast. My father had two episodes of radiation exposure (back in the days when no one really worried about that), and eventually developed a kind of non-smoker's lung cancer that is often associated with radiation. I wondered whether that vulnerability had somehow, via a defective gene, been passed down to me. No answer is available, but I have thought it might be possible. Most of us don't have a parent who had that bad luck, but knowing that we are at higher risk than normal to develop a new breast cancer is an unwanted valuable piece of information.

  Here is the introduction to a study published in Women's Imaging.

Importance of a Personal History of Breast Cancer as a Risk Factor for the Development of Subsequent
Breast Cancer: Results From Screening Breast MRI

David V. Schacht, Ken Yamaguchi1, Jessica Lai, Kirti Kulkarni. Charlene A. Sennett, Hiroyuki Abe,
Schacht DV, Yamaguchi

OBJECTIVE. The purposes of this study were to assess the importance of a personal
history of breast cancer as a risk factor for patients referred for screening breast MRI and to
evaluate the importance of this risk factor compared with family history.
MATERIALS AND METHODS. A retrospective review of screening breast MRI performed
from 2004 to 2012 included a total of 702 patients, 465 of whom had undergone annual
MRI and 237 of whom had undergone MRI every 6 months as part of a research protocol.
RESULTS. Of the patients screened, 208 had a personal history of breast cancer, and 345
had a family history as the sole risk factor. An additional 97 patients had both risk factors.
The absolute risk for detection of breast cancer at screening MRI among patients with a personal
history of cancer was 2.8% (95% CI, 0.6–5.2%). The absolute risk for patients with a
strong family history of cancer was 2.0% (95% CI, 0.5–3.5%). The relative risk for detection
of breast cancer given a personal history was 1.42 (95% CI, 0.48–4.17) compared with family
history. The relative risk when both risk factors were present compared with having only
a family history was 3.04 (95% CI, 1.05–8.86).
CONCLUSION. A personal history of breast cancer is an important risk factor for the
development of subsequent breast cancer. Given the results, consideration should be given to
MRI screening of patients with a personal history of breast cancer.


I am unable to post a working link to read the whole article. If you want it, email me, and I will forward it to you (hhill@bidmc.harvard.edu)

 


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