Top

Published in:

12-06-2023 | Ovarian Cancer | Original Article

Synchronous and Metachronous Breast and Ovarian Cancers: Experience from a Single Tertiary Care Cancer Centre in India

Authors: Shalaka Joshi, Sridevi Murali-Nanavati, T. S. Shylasree, Rohini Hawaldar, Sagar Tripathi, Ayushi Sahay, Jarin Noronha, Urvashi Jain, Anand Thomas, Pradnya Kowtal, Vaibhav Vanmali, Nita S. Nair, Vani Parmar, Rajendra A. Badwe, Rajiv Sarin

Published in: Indian Journal of Surgical Oncology | Issue 4/2023

Abstract

Women with either breast cancer (BC) or ovarian cancer (OC) have a 1.5–2 times higher risk of developing the other. Discerning discrete primaries versus metastases from either can be challenging. Clinico-pathological and outcome details of patients diagnosed with both BC and OC from December 1994 to August 2018 were retrospectively evaluated at a single tertiary cancer centre. We report the pattern of presentation and recurrences with case-based illustrations. Out of 139 patients, presentation was BC-first in 66.2%, OC-first in 24.5% and synchronous cancers (SC) in 9.3% of women. The median age at diagnosis in BC-first, OC-first and SC was 42 years, 48 years and 49 years, respectively. The most common histological subtype was invasive breast carcinoma-no special type (74.8%) in BC and serous cystadenocarcinoma (81.3%) in OC. BC presented at an early stage in 67.6% while OC presented at an advanced stage in 48.2% of patients. Germline mutation results were available in 82% with 61.4% of the cohort exhibiting a mutation- BRCA1 mutation being the most common. The median time to development of second cancer was 77.4 months and 39.4 months in BC-first and OC-first, respectively. At a median follow-up of 9.47 years, disease-free survival was 32.6%, 32.4% and 30.8% in BC-first, OC-first and SC, respectively (p < 0.001). In hereditary breast and ovarian cancer, BC-first patients have a better prognosis while synchronous malignancies have worse oncological outcomes. Deaths are mainly due to OC progression. Appropriate surveillance and prophylactic intervention in young patients with breast cancer may improve overall outcomes.

Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424CrossRefPubMed

Dhillon PK, Mathur P, Nandakumar A et al (2018) The burden of cancers and their variations across the States of India: the global burden of disease study 1990–2016. Lancet Oncol 19(10):1289–1306CrossRef

Disaia P (2002) Epithelial ovarian cancer. Clin Gynecol Oncol 289–350

Mavaddat N, Barrowdale D, Andrulis IL et al (2011) Pathology of breast and ovarian cancers among BRCA1 and BRCA2 mutation carriers: results from the consortium of investigators of modifiers of BRCA1/2 (CIMBA). Cancer Epidemiol Biomark Prev 21(1):134–147CrossRef

Network CGA (2012) Comprehensive molecular portraits of human breast tumours. Nature 490(7418):61–70. https://doi.org/10.1038/nature11412CrossRef

Engel C, Rhiem K, Hahnen E et al (2018) Prevalence of pathogenic BRCA1/2 germline mutations among 802 women with unilateral triple-negative breast cancer without family cancer history. BMC Cancer 18(1):265. https://doi.org/10.1186/s12885-018-4029-yCrossRefPubMedPubMedCentral

Singer CF, Tan YY, Muhr D et al (2019) Association between family history, mutation locations, and prevalence of BRCA1 or 2 mutations in ovarian cancer patients. Cancer Med 8(4):1875–1881. https://doi.org/10.1002/cam4.2000CrossRefPubMedPubMedCentral

Prior P, Waterhouse JA (1981) Multiple primary cancers of the breast and ovary. Br J Cancer 44(5):628–36CrossRefPubMedPubMedCentral

King M-C, Marks JH, Mandell JB (2003) Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302(5645):643–6

10.

Shah S, Evans DG, Blair V et al (1993) Assessment of relative risk of second primary tumors after ovarian cancer and of the usefulness of double primary cases as a source of material for genetic studies with a cancer registry. Cancer 72(3):819–827CrossRefPubMed

11.

Gronwald J, Byrski T, Huzarski T et al (2008) Hereditary breast and ovarian cancer. Hered Cancer Clin Pract 88(6). https://doi.org/10.1186/1897-4287-6-2-88

12.

Szabo CI, King MC (1997) Population genetics of BRCA1 and BRCA2. Am J Hum Genet 60(5):1013–1020PubMedPubMedCentral

13.

Lee MI, Jung YJ, Kim DI et al (2021) Metastasis to breast from ovarian cancer and primary ovarian cancer concurrently diagnosis. Gland Surg 10(5):1806–1811. https://doi.org/10.21037/gs-20-640

14.

Tasca G, Dieci MV, Baretta Z et al (2020) Synchronous and metachronous breast and ovarian cancer: experience from two large cancer center. Front Oncol 10:608783

15.

Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS (2007) Spectrum of breast cancer in Asian women. World J Surg 31(5):1031–1040. https://doi.org/10.1007/s00268-005-0585-9

16.

Kriplani D, Patel MM (2013) Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary. South Asian Journal of Cancer 02(04):254–258

17.

Lotan TL, Ye H, Melamed J et al (2009) Immunohistochemical panel to identify the primary site of invasive micropapillary carcinoma. Am J Surg Pathol 33(7):1037–1041

18.

Bennett JA, Young RH, Chuang A-Y et al (2018) Ovarian metastases of breast cancers with signet ring cells. Int J Gynecol Pathol 37(6):507–515

19.

Al-Agha OM, Nicastri AD (2006) An in-depth look at Krukenberg Tumor: an overview. Arch Pathol Lab Med 130(11):1725–1730

20.

Caruso G, Musacchio L, Santangelo G et al (2020) Ovarian Cancer Metastasis to the Breast: a Case Report and Review of the Literature. Case Rep Oncol 31(3):1317–1324. https://doi.org/10.1159/000509770

21.

Phung, H.T, Q.P.T, Van Nguyen T et al (2022) Recurrent ovarian cancer presenting with isolated axillary lymph node metastasis: a rare case report. Annals of Medicine and Surgery 77. https://doi.org/10.1016/j.amsu.2022.103640

22.

López F, Rodrigo JP, Silver CE et al (2016) Cervical lymph node metastases from remote primary tumor sites. Head Neck 38. https://doi.org/10.1002/hed.24344

23.

Zuhdy M, Alghandour R, Abdelazeem G et al (2019) Axillary nodal metastasis in ovarian cancer: A report of three cases and review of literature. J Egypt Natl Canc Inst 31(1)

24.

Caruso G, Musacchio L, Santangelo G et al (2020) Ovarian cancer metastasis to the breast: A case report and review of the literature. Case Reports in Oncology 13(3):1317–1324

25.

Espinosa I, Gallardo A, D’Angelo E et al (2015) Simultaneous carcinomas of the breast and ovary. Int J Gynecol Pathol 34(3):257–265

26.

Liu H, Shi J, Prichard JW et al (2014) Immunohistochemical evaluation of GATA-3 expression in ER-negative breast carcinomas. Am J Clin Pathol 141(5):648–655

27.

Cimino-Mathews A (2020) Novel uses of immunohistochemistry in breast pathology: Interpretation and pitfalls. Modern Pathology 34(S1):62–77PubMed

28.

Peng Y, Butt YM, Chen B et al (2017) Update on immunohistochemical analysis in breast lesions. Archives of Pathology & Laboratory Medicine 141(8):1033–1051

29.

Antoniou A, Pharoah PDP, Narod S et al (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for Family history: A combined analysis of 22 studies. Am J Hum Genet 72(5):1117–30CrossRefPubMed

30.

Foulkes WD (2008) Inherited susceptibility to common cancers. N Engl J Med 359(20):2143–2153CrossRefPubMed

31.

Peshkin BN, Alabek ML, Isaacs C et al (2011) BRCA1/2 mutations and triple negative breast cancers. Breast Dis 32(1–1):25–33

32.

Saxena S, Chakraborty A, Kaushal M et al (2006) Contribution of germline BRCA1 and BRCA2sequence alterations to breast cancer in Northern India. BMC Med Genet 7(1)

33.

Mittal A, Deo SVS, Gogia A et al (2022) Profile of Pathogenic Mutations and Evaluation of Germline Genetic Testing Criteria in Consecutive Breast Cancer Patients Treated at a North Indian Tertiary Care Center. Ann Surg Oncol 29(2):1423–1432. https://doi.org/10.1245/s10434-021-10870-w

34.

Soumittra N, Meenakumari B, Parija T et al (2009) Molecular genetics analysis of hereditary breast and ovarian cancer patients in India. Hereditary Cancer in Clinical Practice 7(1)

35.

Daly MB, Pal T, Berry MP et al (2021) Genetic/familial high-risk assessment: Breast, ovarian, and pancreatic, version 2.2021 NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 19(1):77–102

36.

Daly MB, Pilarski R, Berry M et al (2016) NCCN guidelines insights: Genetic/familial high-risk assessment: Breast and ovarian, version 2.2017. Natl Compr Cancer Netw 15(1):9–20

37.

Liou W-S, Hamilton CA, Cheung MK et al (2006) Outcomes of women with metachronous breast and ovarian carcinomas. Gynecol Oncol 103(1):190–194

38.

Metcalfe KA, Lynch HT, Ghadirian P et al (2005) The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol 96(1):222–226

39.

Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. JNCI Journal of the National Cancer Institute 101(2):80–87

40.

Domchek SM, Jhaveri K, Patil S et al (2012) Risk of metachronous breast cancer after brca mutation-associated ovarian cancer. Cancer 119(7):1344–1348CrossRefPubMed

41.

Heemskerk-Gerritsen BA, Seynaeve C, van Asperen CJ et al (2015) Breast cancer risk after salpingo-oophorectomy in healthy BRCA1/2 mutation carriers: Revisiting the evidence for risk reduction. JNCI: Journal of the National Cancer Institute 107(5)

42.

Kotsopoulos J, Huzarski T, Gronwald J et al (2016) Bilateral oophorectomy and breast cancer risk in brca 1 and brca 2 mutation carriers. JNCI: Journal of the National Cancer Institute 109(1)

43.

Cvelbar M, Hocevar M, Vidmar G et al (2011) BRCA1/2 status and clinicopathologic characteristics of patients with double primary breast and ovarian cancer. Neoplasma 58(3):198–204CrossRefPubMed

44.

Fishman A, Dekel E, Chetrit A et al (2000) Patients with double primary tumors in the breast and ovary— clinical characteristics and BRCA1–2 mutations status. Gynecol Oncol 79(1):74–78

45.

McGee J, Giannakeas v, Karlan B et al (2017) Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: Is preventive mastectomy warranted? Gynecol Oncol 145(2):346–351

Title: Synchronous and Metachronous Breast and Ovarian Cancers: Experience from a Single Tertiary Care Cancer Centre in India
Authors: Shalaka Joshi
Sridevi Murali-Nanavati
T. S. Shylasree
Rohini Hawaldar
Sagar Tripathi
Ayushi Sahay
Jarin Noronha
Urvashi Jain
Anand Thomas
Pradnya Kowtal
Vaibhav Vanmali
Nita S. Nair
Vani Parmar
Rajendra A. Badwe
Rajiv Sarin
Publication date: 12-06-2023
Publisher: Springer India
Keywords: Ovarian Cancer
Ovarian Cancer
Breast Cancer
Breast Cancer
Published in: Indian Journal of Surgical Oncology / Issue 4/2023
Print ISSN: 0975-7651
Electronic ISSN: 0976-6952
DOI: https://doi.org/10.1007/s13193-023-01749-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Synchronous and Metachronous Breast and Ovarian Cancers: Experience from a Single Tertiary Care Cancer Centre in India

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2023

Latissimus Dorsi kiss Flap for Reconstruction of Large Chest Wall Defect—an Underutilized Option?

Syringocystadenocarcinoma Papilliferum of Thigh—a Rare Cutaneous Malignancy with Unusual Histology and Clinical Presentation

NLP AI Models for Optimizing Medical Research: Demystifying the Concerns

Ki-67 Index and Its Correlation with Clinical and Pathological Variables in Breast Cancer

Epigenetic Silencing of p16INK4a gene in Sporadic Breast Cancer

Psoas Muscle Resection During RPLND for NSGCT Testis — Going the Extra Mile Is Worth It!