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Researcher: Hyuna Sung, PhD
Institution: American Cancer Society
Area of Focus: Surveillance & Health Equity Science
“Most women live decades after being diagnosed with breast cancer, but some women may develop a new primary cancer years after successful treatment. Currently, there’s limited knowledge about the factors associated with a higher or lower risk for new primary cancers specific to breast cancer survivors, and there’s no established tool that predicts an individual’s risk of developing a new cancer.
"In this study, we found that the risk of developing a new primary cancer varies by the subtype of breast cancer a woman has as well as the age she was when she was first diagnosed with breast cancer. This result both highlights the need for tailored recommendations for preventing and screening for new primary cancers in breast cancer survivors based on their specific, personal risks and provides information to help establish such guidelines.” –Hyuna Sung, PhD
The Challenge: Invasive breast cancer is the most commonly diagnosed cancer among women in the United States. In 2019, there were more than 3.9 million survivors of breast cancer in the US. With improvements in the treatment for breast cancer and the increase in the US aging population, the number of breast cancer survivors is expected to increase. Plus, most of those survivors live for many years after their diagnosis. So, it’s more important than ever to take steps to keep improving quality of life after diagnosis and treatment of breast cancer.
One issue affecting breast cancer survivors is the risk of developing a new type of cancer (called a subsequent primary cancer or second cancer). Compared to the general population, breast cancer survivors have a 17% higher risk of developing a new cancer.
However, this increased risk is not the same for all breast cancer survivors. Studies have shown that the level of risk for developing a new type of cancer depends on the:
How these factors interact and contribute to risk of developing a specific type of subsequent primary cancer is not well understood and needs more study.
The Research: A group of researchers from the American Cancer Society (ACS), Dana-Farber Cancer Institute, Mayo Clinic, and Institute for Health & Equity at the Medical College of Wisconsin, recently published their findings after studying the risk of 26 subsequent primary cancers among female breast cancer survivors based on their age when first diagnosed and the cancer’s hormone receptor status.
Their study, led by ACS researcher Hyuna Sung, PhD, looked at data for women who were first diagnosed with invasive breast cancer between 1992 and 2015 and who survived for a year or longer. This included 431,222 women ages 20 to 84 years.
To evaluate women’s risks, they compared the risk of developing subsequent primary cancers among survivors versus the risk expected in the general population of the same age and race.
Most common subsequent cancers. Sung and her colleagues found that regardless of a woman’s breast cancer hormone receptor status, survivors were more likely than the general population to be diagnosed with 7 types of cancers:
How hormone status and age affect risk. The researchers found that compared to the general public, breast cancer survivors had a greater risk of developing a subsequent primary cancer when their breast cancer had been:
Subsequent primary breast cancers. 1 in 20 survivors developed a new primary breast cancer, with 70% occurring in the other breast (contralateral).
Cancer types linked with specific risks:
Why Does It Matter? These findings suggest that the risk of breast cancer survivors developing a subsequent primary cancer differs greatly based on the initial HR subtype and a woman’s age at diagnosis. That knowledge can be used to develop survivorship care plans with more targeted approaches for cancer prevention and early detection, which can help ease the burden of new cancers among breast cancer survivors.