Ask the Experts on . . .
Second Breast Cancer: Local Recurrence or New Primary?
How can one determine whether a second breast cancer is a local recurrence or a new primary tumor?
Dava F. Gerard, MD, FACS, MS, MPH
from Joseph A. Sparano, MD, 08/24/00
Differentiation between a recurrence or a new primary is dependent on the involved breast (ipsilateral vs contralateral), and for ipsilateral lesions depends on the disease-free interval, the location of the lesion relative to the original primary, and the histologic and biological features of the tumor.
Most contralateral lesions represent a second primary tumor. Metastasis to the contralateral breast can occur, however, and is often associated with other distant metastases or regional cutaneous, lymphocutaneous, or nodal metastases.
However, most ipsilateral tumors represent recurrences rather than second primaries. In general, ipsilateral recurrences occurring in patients who have had lumpectomy are associated with a more favorable prognosis than local-regional recurrence after mastectomy.
Features associated with a greater likelihood of being a second primary tumor include a long disease-free interval (> 5 years), recurrence in a different segment of the breast from the original primary, and differing clinical or biological characteristics. A careful review of the histologic features with a pathologist is an important component of the evaluation. Other biological features (eg, estrogen/progesterone receptor evaluation, HER2/neu overexpression) may also be useful -- concordance suggests a recurrence, whereas discordance suggests a second primary.
Treatment may consist of mastectomy or reexcision and radiation and will be dependent more on clinical considerations rather than whether the tumor is a recurrence or a second primary.
Recht A, Hayes DF, Everlein TJ, Sadowsky NL. Local-regional recurrence after mastectomy or breast conserving therapy. In: Harris JR, Lippman ME, Morrow M, Hellman S, eds. Diseases of the Breast. Philadelphia, Pa: Lippincott-Raven; 1996:649-668.
J Surg Oncol, 1976
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