Abstract
Background:As breast cancer survival improves, the incidence of additional malignancies will likely rise. Identification of a lung nodule in a patient with known breast cancer poses a challenging diagnostic problem. This study outlines the management of such patients and identifies factors that correlate with survival.Methods:From 1977 through 2002, 35 patients with known breast cancer were identified with an additional primary lung cancer. Data were collected from a retrospective chart review. Median and 2- year survival were determined by the Kaplan-Meier method and Cox regression analysis identified independent predictors of survival.Results:Nineteen patients (54%) were asymptomatic at the time of diagnosis and had their lung cancer discovered during workup and/or follow-up of their breast cancer. The diagnosis of lung cancer was made by preoperative biopsy in 23 patients (82%). Nineteen patients (54%) were successfully treated with surgery. Mean follow-up was 2.3 years. Median survival for all patients was 1.8 years. Factors associated with a statistically significant improvement in survival included asymptomatic presentation of lung cancer (P = 0.003), absence of tobacco use (P = 0.021), and stage I lung cancer (P = 0.009). Multivariate analysis revealed that tobacco use (RR = 3.6, P = 0.047) and advanced stage of lung cancer (II-IV) at the time of diagnosis (RR = 2.2, P < 0.001) were independent predictors of decreased survival.Conclusion:The presentation of a lung nodule in patients with breast cancer warrants a comprehensive evaluation to differentiate between primary lung and metastatic breast cancers, as diagnosis and resection of an early stage lung cancer is associated with improved survival.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. La Francis IE, Cooper RB. Second primary malignancies associated with primary female breast cancer: a review of the Danbury Hospital experience. Conn Med 1992;56:411–414.La FrancisIE]]CooperRBSecond primary malignancies associated with primary female breast cancer: a review of the Danbury Hospital experience.Conn Med199256411-4142. Robinson E, Adler Z, Nasrallah S, et al. Clinical characteristics of second primary tumors following breast cancer. Isr J Med Sci 1995;31:169–171.RobinsonE]]AdlerZ]]NasrallahS&etal;Clinical characteristics of second primary tumors following breast cancer.Isr J Med Sci199531169-1713. Lee YT. Additional malignant neoplasms in patients with breast carcinoma. J Surg Oncol 1986;31:199–203.LeeYTAdditional malignant neoplasms in patients with breast carcinoma.J Surg Oncol198631199-2034. Volk N, Pompe-Kirn V. Second primary cancers in breast cancer patients in Slovenia. Cancer Causes Control 1997;8:764–770.VolkN]]Pompe-KirnVSecond primary cancers in breast cancer patients in Slovenia.Cancer Causes Control19978764-7705. Buiatti E, Crocetti E, Acciai S, et al. Incidence of second primary cancers in three Italian population-based cancer registries. Eur J Cancer 1997;33:1829–1834.BuiattiE]]CrocettiE]]AcciaiS&etal;Incidence of second primary cancers in three Italian population-based cancer registries.Eur J Cancer1997331829-18346. Okamoto N, Morio S, Inoue R, et al. The risk of a second primary cancer occurring in five-year survivors of an initial cancer. Jpn J Clin Oncol 1987;17:205–213.OkamotoN]]MorioS]]InoueR&etal;The risk of a second primary cancer occurring in five-year survivors of an initial cancer.Jpn J Clin Oncol198717205-2137. Andersson M, Jensen MB, Engholm G, et al. Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977–2001. Acta Oncol 2008;47:755–764.AnderssonM]]JensenMB]]EngholmG&etal;Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977–2001.Acta Oncol200847755-7648. Kirova YM, De Rycke Y, Gambotti L, et al. Institut Curie Breast Cancer Study Group. Second malignancies after breast cancer: the impact of different treatment modalities. Br J Cancer 2008;98:870–874.KirovaYM]]De RyckeY]]GambottiL&etal;Institut Curie Breast Cancer Study GroupSecond malignancies after breast cancer: the impact of different treatment modalities.Br J Cancer200898870-8749. Raymond JS, Hogue CJ. Multiple primary tumours in women following breast cancer, 1973–2000. Br J Cancer 2006;94:1745–1750.RaymondJS]]HogueCJMultiple primary tumours in women following breast cancer, 1973–2000.Br J Cancer2006941745-175010. Matesich SM, Shapiro CL. Second cancers after breast cancer treatment. Semin Oncol 2003;30:740–748.MatesichSM]]ShapiroCLSecond cancers after breast cancer treatment.Semin Oncol200330740-74811. Galper S, Gelman R, Recht A, et al. Second nonbreast malignancies after conservative surgery and radiation therapy for early-stage breast cancer. Int J Radiat Oncol Biol Phys 2002;52:406–414.GalperS]]GelmanR]]RechtA&etal;Second nonbreast malignancies after conservative surgery and radiation therapy for early-stage breast cancer.Int J Radiat Oncol Biol Phys200252406-41412. Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv 2008;2:73–78.GrenaderT]]GoldbergA]]ShavitLSecond cancers in patients with male breast cancer: a literature review.J Cancer Surviv2008273-7813. Suster S, Moran CA. Unusual manifestations of metastatic tumors to the lungs. Semin Diagn Pathol 1995;12:193–206.SusterS]]MoranCAUnusual manifestations of metastatic tumors to the lungs.Semin Diagn Pathol199512193-20614. Kanashiki M, Satoh H, Ishikawa H, et al. Outcome of patients with lung cancer detected incidentally. Oncol Rep 2004;12:945–948.KanashikiM]]SatohH]]IshikawaH&etal;Outcome of patients with lung cancer detected incidentally.Oncol Rep200412945-94815. Kaufmann O, Deidesheimer T, Muehlenberg M, et al. Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites. Histopathology 1996;29:233–240.KaufmannO]]DeidesheimerT]]MuehlenbergM&etal;Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites.Histopathology199629233-24016. Raab SS, Berg LC, Swanson PE, et al. Adenocarcinoma in the lung in patients with breast cancer. A prospective analysis of the discriminatory value of immunohistology. Am J Clin Pathol 1993;100:27–35.RaabSS]]BergLC]]SwansonPE&etal;Adenocarcinoma in the lung in patients with breast cancer. A prospective analysis of the discriminatory value of immunohistology.Am J Clin Pathol199310027-3517. Bejarano PA, Baughman RP, Biddinger PW, et al. Surfactant proteins and thyroid transcription factor-1 in pulmonary and breast carcinomas. Mod Pathol 1996;9:445–452.BejaranoPA]]BaughmanRP]]BiddingerPW&etal;Surfactant proteins and thyroid transcription factor-1 in pulmonary and breast carcinomas.Mod Pathol19969445-45218. Khoor A, Whitsett JA, Stahlman MT, et al. Utility of surfactant protein B precursor and thyroid transcription factor 1 in differentiating adenocarcinoma of the lung from malignant mesothelioma. Hum Pathol 1999;30:695–700.KhoorA]]WhitsettJA]]StahlmanMT&etal;Utility of surfactant protein B precursor and thyroid transcription factor 1 in differentiating adenocarcinoma of the lung from malignant mesothelioma.Hum Pathol199930695-70019. Bohinski RJ, Bejarano PA, Balko G, et al. Determination of lung as the primary site of cerebral metastatic adenocarcinomas using monoclonal antibody to thyroid transcription factor-1. J Neurooncol 1998;40:227–231.BohinskiRJ]]BejaranoPA]]BalkoG&etal;Determination of lung as the primary site of cerebral metastatic adenocarcinomas using monoclonal antibody to thyroid transcription factor-1.J Neurooncol199840227-23120. Ludwig C, Stoelben E, Hasse J. Disease-free survival after resection of lung metastases in patients with breast cancer. Eur J Surg Oncol 2003;29:532–535.LudwigC]]StoelbenE]]HasseJDisease-free survival after resection of lung metastases in patients with breast cancer.Eur J Surg Oncol200329532-53521. Friedel G, Pastorino U, Ginsberg RJ, et al. International Registry of Lung Metastases, London, England. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases. Eur J Cardiothorac Surg 2002;22:335–344.FriedelG]]PastorinoU]]GinsbergRJ&etal;International Registry of Lung Metastases, London, England. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases.Eur J Cardiothorac Surg200222335-34422. Hurria A, Leung D, Trainor K, et al. Screening chest imaging studies are not effective in the follow-up of breast cancer patients. J Oncol Manag 2003;12:13–15.HurriaA]]LeungD]]TrainorK&etal;Screening chest imaging studies are not effective in the follow-up of breast cancer patients.J Oncol Manag20031213-1523. Cahan WG, Castro EB. Significance of a solitary lung shadow in patients with breast cancer. Ann Surg 1975;181:137–143.CahanWG]]CastroEBSignificance of a solitary lung shadow in patients with breast cancer.Ann Surg1975181137-14324. Casey JJ, Stempel BG, Scanlon EF, et al. The solitary pulmonary nodule in the patient with breast cancer. Surgery 1984;96:801–805.CaseyJJ]]StempelBG]]ScanlonEF&etal;The solitary pulmonary nodule in the patient with breast cancer.Surgery198496801-805
