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Breast
Treatment
Focused Issues in Treatment
Contralateral Breast Cancer
Contralateral Breast Cancer
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Contralateral breast cancer (CBC)

          • Definitions

            • Synchronous contralateral breast cancer (SCBC): Defined variably as simultaneous, within 3 months, or within 1 year of incident tumor diagnosis; nearly always 2nd primary BC
            • Metachronous contralateral breast cancer (MCBC): 2nd primary cancer diagnosed after incident tumor treatment; range from > 3 months to many years following initial breast cancer diagnosis/treatment
            • Histopathology includes invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), ductal carcinoma in situ (DCIS), and pleomorphic lobular carcinoma in situ (PLCIS)
            • Breast-conserving treatment (BCT): Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (XRT)

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Kim SY et al: Breast cancer detected at screening US: survival rates and clinical-pathologic and imaging factors associated with recurrence. Radiology. 284(2):354-64, 2017
                                          2. Gierach GL et al: Association of adjuvant tamoxifen and aromatase inhibitor therapy with contralateral breast cancer risk among US women with breast cancer in a general community setting. JAMA Oncol. 3(2):186-193, 2017
                                          3. Houssami N et al: Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer. Breast Cancer Res Treat. 165(2):273-283, 2017
                                          4. Kuchenbaecker KB et al: Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 317(23):2402-2416, 2017
                                          5. Marmor S et al: Prognostic factors for metachronous contralateral breast cancer: implications for management of the contralateral breast. Breast J. 23(3):299-306, 2017
                                          6. Raghavendra A et al: Mammographic breast density is associated with the development of contralateral breast cancer. Cancer. 123(11):1935-1940, 2017
                                          7. Reiner AS et al: Hormone receptor status of a first primary breast cancer predicts contralateral breast cancer risk in the WECARE study population. Breast Cancer Res. 19(1):83, 2017
                                          8. Robson ME et al: Association of common genetic variants with contralateral breast cancer risk in the WECARE study. J Natl Cancer Inst. 109(10), 2017
                                          9. Langballe R et al: Systemic therapy for breast cancer and risk of subsequent contralateral breast cancer in the WECARE study. Breast Cancer Res. 18(1):65, 2016
                                          10. Kim JY et al: Unilateral breast cancer: screening of contralateral breast by using preoperative MR imaging reduces incidence of metachronous cancer. Radiology. 267(1):57-66, 2013
                                          11. Berg WA et al: Comparative effectiveness of positron emission mammography and MRI in the contralateral breast of women with newly diagnosed breast cancer. AJR Am J Roentgenol. 198(1):219-32, 2012
                                          12. Plana MN et al: Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol. 22(1):26-38, 2012
                                          13. Saltzman BS et al: Estrogen receptor, progesterone receptor, and HER2-neu expression in first primary breast cancers and risk of second primary contralateral breast cancer. Breast Cancer Res Treat. 135(3):849-55, 2012
                                          14. Alkner S et al: Prediction of outcome after diagnosis of metachronous contralateral breast cancer. BMC Cancer. 11:114, 2011
                                          15. Houssami N et al: Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA. 305(8):790-9, 2011
                                          16. Metcalfe K et al: Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 104(9):1384-92, 2011
                                          17. Morrow M et al: MRI for breast cancer screening, diagnosis, and treatment. Lancet. 378(9805):1804-11, 2011
                                          18. Vichapat V et al: Prognosis of metachronous contralateral breast cancer: importance of stage, age and interval time between the two diagnoses. Breast Cancer Res Treat. 130(2):609-18, 2011
                                          19. Brem RF et al: Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol. 17(6):735-43, 2010
                                          20. Cuzick J et al: Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol. 11(12):1135-41, 2010
                                          21. Brennan ME et al: Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 27(33):5640-9, 2009
                                          22. Li CI et al: Adjuvant hormonal therapy for breast cancer and risk of hormone receptor-specific subtypes of contralateral breast cancer. Cancer Res. 69(17):6865-70, 2009
                                          23. Sorbero ME et al: Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 16(6):1597-605, 2009
                                          24. Kim SJ et al: Application of sonographic BI-RADS to synchronous breast nodules detected in patients with breast cancer. AJR Am J Roentgenol. 191(3):653-8, 2008
                                          25. Lehman CD et al: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 356(13):1295-303, 2007
                                          26. Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365(9472):1687-717, 2005
                                          27. Gilroy JS et al: Breast-conserving therapy in patients with bilateral breast cancer: do today's treatment choices burn bridges for tomorrow? Int J Radiat Oncol Biol Phys. 62(2):379-85, 2005
                                          28. Kahla PB et al: Bilateral synchronous breast cancer in a male. Mt Sinai J Med. 72(2):120-3, 2005
                                          29. Lehman CD et al: Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol. 92(1):9-15; discussion 15-6, 2005
                                          30. Pediconi F et al: CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer. Radiol Med (Torino). 110(1-2):61-8, 2005
                                          31. Stolier AJ et al: Newly diagnosed breast cancer patients choose bilateral mastectomy over breast-conserving surgery when testing positive for a BRCA1/2 mutation. Am Surg. 71(12):1031-3, 2005
                                          32. Yamauchi C et al: Bilateral breast-conserving therapy for bilateral breast cancer: results and consideration of radiation technique. Breast Cancer. 12(2):135-9, 2005
                                          33. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                          34. Horwich A et al: Second primary breast cancer after Hodgkin's disease. Br J Cancer. 90(2):294-8, 2004
                                          35. Intra M et al: Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution. Cancer. 101(5):905-12, 2004
                                          36. Lee SG et al: MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology. 226(3):773-8, 2003
                                          37. Liberman L et al: MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol. 180(2):333-41, 2003
                                          38. Moon WK et al: Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 224(2):569-76, 2002
                                          39. Brown H et al: Histopathologic features of bilateral and unilateral breast carcinoma: a comparative study. Mod Pathol 13:18A, 2000
                                          40. Fisher B et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90(18):1371-88, 1998
                                          41. Fischer U et al: Prognostic value of contrast-enhanced MR mammography in patients with breast cancer. Eur Radiol. 7(7):1002-5, 1997
                                          42. Roubidoux MA et al: Women with breast cancer: histologic findings in the contralateral breast. Radiology. 203(3):691-4, 1997
                                          43. Murphy TJ et al: Bilateral breast carcinoma: mammographic and histologic correlation. Radiology. 195(3):617-21, 1995
                                          44. Roubidoux MA et al: Bilateral breast cancer: early detection with mammography. Radiology. 196(2):427-31, 1995
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Contralateral breast cancer (CBC)

                                                  • Definitions

                                                    • Synchronous contralateral breast cancer (SCBC): Defined variably as simultaneous, within 3 months, or within 1 year of incident tumor diagnosis; nearly always 2nd primary BC
                                                    • Metachronous contralateral breast cancer (MCBC): 2nd primary cancer diagnosed after incident tumor treatment; range from > 3 months to many years following initial breast cancer diagnosis/treatment
                                                    • Histopathology includes invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), ductal carcinoma in situ (DCIS), and pleomorphic lobular carcinoma in situ (PLCIS)
                                                    • Breast-conserving treatment (BCT): Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (XRT)

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Kim SY et al: Breast cancer detected at screening US: survival rates and clinical-pathologic and imaging factors associated with recurrence. Radiology. 284(2):354-64, 2017
                                                                                  2. Gierach GL et al: Association of adjuvant tamoxifen and aromatase inhibitor therapy with contralateral breast cancer risk among US women with breast cancer in a general community setting. JAMA Oncol. 3(2):186-193, 2017
                                                                                  3. Houssami N et al: Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer. Breast Cancer Res Treat. 165(2):273-283, 2017
                                                                                  4. Kuchenbaecker KB et al: Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 317(23):2402-2416, 2017
                                                                                  5. Marmor S et al: Prognostic factors for metachronous contralateral breast cancer: implications for management of the contralateral breast. Breast J. 23(3):299-306, 2017
                                                                                  6. Raghavendra A et al: Mammographic breast density is associated with the development of contralateral breast cancer. Cancer. 123(11):1935-1940, 2017
                                                                                  7. Reiner AS et al: Hormone receptor status of a first primary breast cancer predicts contralateral breast cancer risk in the WECARE study population. Breast Cancer Res. 19(1):83, 2017
                                                                                  8. Robson ME et al: Association of common genetic variants with contralateral breast cancer risk in the WECARE study. J Natl Cancer Inst. 109(10), 2017
                                                                                  9. Langballe R et al: Systemic therapy for breast cancer and risk of subsequent contralateral breast cancer in the WECARE study. Breast Cancer Res. 18(1):65, 2016
                                                                                  10. Kim JY et al: Unilateral breast cancer: screening of contralateral breast by using preoperative MR imaging reduces incidence of metachronous cancer. Radiology. 267(1):57-66, 2013
                                                                                  11. Berg WA et al: Comparative effectiveness of positron emission mammography and MRI in the contralateral breast of women with newly diagnosed breast cancer. AJR Am J Roentgenol. 198(1):219-32, 2012
                                                                                  12. Plana MN et al: Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol. 22(1):26-38, 2012
                                                                                  13. Saltzman BS et al: Estrogen receptor, progesterone receptor, and HER2-neu expression in first primary breast cancers and risk of second primary contralateral breast cancer. Breast Cancer Res Treat. 135(3):849-55, 2012
                                                                                  14. Alkner S et al: Prediction of outcome after diagnosis of metachronous contralateral breast cancer. BMC Cancer. 11:114, 2011
                                                                                  15. Houssami N et al: Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA. 305(8):790-9, 2011
                                                                                  16. Metcalfe K et al: Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 104(9):1384-92, 2011
                                                                                  17. Morrow M et al: MRI for breast cancer screening, diagnosis, and treatment. Lancet. 378(9805):1804-11, 2011
                                                                                  18. Vichapat V et al: Prognosis of metachronous contralateral breast cancer: importance of stage, age and interval time between the two diagnoses. Breast Cancer Res Treat. 130(2):609-18, 2011
                                                                                  19. Brem RF et al: Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol. 17(6):735-43, 2010
                                                                                  20. Cuzick J et al: Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol. 11(12):1135-41, 2010
                                                                                  21. Brennan ME et al: Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 27(33):5640-9, 2009
                                                                                  22. Li CI et al: Adjuvant hormonal therapy for breast cancer and risk of hormone receptor-specific subtypes of contralateral breast cancer. Cancer Res. 69(17):6865-70, 2009
                                                                                  23. Sorbero ME et al: Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 16(6):1597-605, 2009
                                                                                  24. Kim SJ et al: Application of sonographic BI-RADS to synchronous breast nodules detected in patients with breast cancer. AJR Am J Roentgenol. 191(3):653-8, 2008
                                                                                  25. Lehman CD et al: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 356(13):1295-303, 2007
                                                                                  26. Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365(9472):1687-717, 2005
                                                                                  27. Gilroy JS et al: Breast-conserving therapy in patients with bilateral breast cancer: do today's treatment choices burn bridges for tomorrow? Int J Radiat Oncol Biol Phys. 62(2):379-85, 2005
                                                                                  28. Kahla PB et al: Bilateral synchronous breast cancer in a male. Mt Sinai J Med. 72(2):120-3, 2005
                                                                                  29. Lehman CD et al: Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol. 92(1):9-15; discussion 15-6, 2005
                                                                                  30. Pediconi F et al: CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer. Radiol Med (Torino). 110(1-2):61-8, 2005
                                                                                  31. Stolier AJ et al: Newly diagnosed breast cancer patients choose bilateral mastectomy over breast-conserving surgery when testing positive for a BRCA1/2 mutation. Am Surg. 71(12):1031-3, 2005
                                                                                  32. Yamauchi C et al: Bilateral breast-conserving therapy for bilateral breast cancer: results and consideration of radiation technique. Breast Cancer. 12(2):135-9, 2005
                                                                                  33. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                                                                  34. Horwich A et al: Second primary breast cancer after Hodgkin's disease. Br J Cancer. 90(2):294-8, 2004
                                                                                  35. Intra M et al: Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution. Cancer. 101(5):905-12, 2004
                                                                                  36. Lee SG et al: MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology. 226(3):773-8, 2003
                                                                                  37. Liberman L et al: MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol. 180(2):333-41, 2003
                                                                                  38. Moon WK et al: Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 224(2):569-76, 2002
                                                                                  39. Brown H et al: Histopathologic features of bilateral and unilateral breast carcinoma: a comparative study. Mod Pathol 13:18A, 2000
                                                                                  40. Fisher B et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90(18):1371-88, 1998
                                                                                  41. Fischer U et al: Prognostic value of contrast-enhanced MR mammography in patients with breast cancer. Eur Radiol. 7(7):1002-5, 1997
                                                                                  42. Roubidoux MA et al: Women with breast cancer: histologic findings in the contralateral breast. Radiology. 203(3):691-4, 1997
                                                                                  43. Murphy TJ et al: Bilateral breast carcinoma: mammographic and histologic correlation. Radiology. 195(3):617-21, 1995
                                                                                  44. Roubidoux MA et al: Bilateral breast cancer: early detection with mammography. Radiology. 196(2):427-31, 1995