Latest Research Update According to a database analysis presented at the Endocrine Society’s 2015 Annual Meeting (ENDO2015) on March 7 of this year by Jennifer Hong Kuo, MD, assistant professor of surgery at Columbia University in New York, it shows that.
1. an increased risk of primary thyroid cancer in breast cancer survivors compared to the general population
2. breast cancer patients who develop thyroid cancer are younger and have smaller, more aggressive breast tumors
3. the risk of developing thyroid cancer is that longer radiation exposure or closer surveillance follow-up of breast cancer patients has played a role in the increase in tumors. kuo suggested that the prognosis for breast cancer has improved dramatically, with the 5-year survival rate now reaching 89.2%. Therefore, now for breast cancer survivors, we should focus not only on metastatic recurrence, but also on second primary cancer, because after long-term follow-up studies on breast cancer survivors, we found that postoperative mortality of breast cancer is mainly related to second primary cancer and third primary cancer (collectively referred to as multiple primary cancers).
The U.S. SEER Medicare database suggests that the definition of multiple primary cancers should take into account the primary site, the presentation of the tumor, the histology, the side on which it occurs if it is bilateral, and the time of diagnosis. Multiple primary carcinomas (MPC), also known as double primary carcinomas, refers to two or more primary malignant tumors occurring simultaneously or sequentially in the same organ or in different organs. The diagnostic criteria for MPC, as determined by Warren and Gates in 1932, are still in use today.
1. Each tumor must have positive pathological evidence of malignancy.
2. each tumor must occur at a different site and have a unique pathological pattern.
MPC is classified into simultaneous MPC and heterochronic MPC according to the time interval between the appearance of the two cancers, and those with an interval of less than 6 months between the diagnosis of the two cancers are considered as simultaneous MPC and those with an interval of more than 6 months are considered as heterochronic MPC.
Related mechanisms Overall, the risk of second primary cancer in breast cancer survivors is about 18-30%. Most second primary cancer risks are mediated by hormones, including ovarian and uterine malignancies, but the mechanisms of thyroid cancer induction are more complex. An increased incidence of thyroid cancer has been reported in patients with breast cancer, as well as an increased incidence of breast cancer in patients with thyroid cancer, but the exact mechanism is unclear and may be related to the mechanism of active transport of iodine by the epithelial cell membranes of breast and thyroid tissues. It has been found that the breast and thyroid are subject to similar hormonal effects, with abundant TSH receptors in breast tissue; also, estrogen affects the development, physiology and pathology of the thyroid. This may be the physiological basis for the development of MPC in the breast and thyroid.
In the conference study, a total of 707,678 women with breast cancer and 52,939 women with thyroid cancer were included in the SEER database (Surveillance epidemiology and end results) between 1973 and 2011, representing approximately 9% of the total U.S. population, of which 1,526 had breast cancer followed by thyroid cancer and 704,405 had breast cancer only. For breast cancer patients in their 40s, the risk of developing thyroid cancer within 10 years was 16.0%, compared with 0.33% for the general cohort; when diagnosed in their 50s, these figures were 12.0% and For breast cancer patients in their 60s and 70s, the risk of thyroid cancer is not increased. Among breast cancer survivors who developed thyroid cancer later in life, more received adjuvant radiation therapy (48% 44%, P=0.21), but it was not an independent predictor of secondary primary tumor. The occurrence of second primary carcinoma may be due to the following.
1, breast cancer survivors receiving long-term close investigative follow-up.
2, genetic mutations and behavioral risk factors caused by the primary cancer.
3. the impact of postoperative treatment of breast cancer, especially chemotherapy and radiotherapy.
Risk factors for when a second primary cancer is likely to occur.
1, breast cancer diagnosed before age 50, ER positive, P53 gene mutation associated with thyroid disease.
2, increased risk of thyroid cancer with radiation therapy to the upper body after breast cancer in 1950s
3. women with thyroid cancer who have not had children to feed have an increased probability of breast cancer, and close follow-up mammography is recommended.
The above studies are not sufficient to address the following questions: whether thyroid cancer found after breast cancer is pre-existing and subsequent close observation increases the chance of its detection or whether there is some correlation between breast cancer and thyroid cancer in terms of the mechanism of occurrence; the histology of thyroid cancer recurring after breast cancer tends to show high cellular variation in papillary thyroid cancer, eosinophilic follicular thyroid cancer, and undifferentiated carcinoma, which Whether differences in histologic type with primary thyroid cancer have some correlation with breast and thyroid cancer prognosis; whether there is a causal link between breast and thyroid cancer or whether treatment of breast cancer induces or increases the risk of thyroid cancer emergence.
At present, breast cancer and most malignant tumors still focus only on the treatment of primary cancer, but the research and treatment of second primary cancer is not widely carried out, and even rarely draws people’s attention. In the future, based on our treatment of primary cancer, we should pay proper attention to the second primary cancer in order to achieve the best treatment and avoid pressing the gourd to start the ladybug again.
What we can do A study from the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University concluded that color ultrasound is an easy and effective examination method to detect second cancers. Patients with thyroid cancer should routinely rule out the possibility of breast cancer, and patients with breast cancer should also have their thyroid examined at the same time and be taken seriously if a tumor is found. Especially for patients diagnosed with breast cancer before the age of 50, ER positive, P53 gene mutation, radiation therapy to the upper part of the body after breast cancer surgery, and thyroid cancer in women who have not had children to feed should be checked for the other gland. Even the intensity of that treatment is used to intervene in their possible future development of a second primary cancer at the time of treatment of the primary cancer. In addition, it has been found that weight (BMI-body mass index, weight kg/height squared m2 controlled at 21-23) and maintaining a happy mood are important for improving prognosis to improve the quality of patient survival.