Food for Breast Cancer

The current prospective study was designed to investigate the impact of radiation treatment on patients with triple-negative breast cancer. Triple negative breast cancer is estrogen receptor negative (ER-), progesterone receptor negative (PR-), and does not overexpress human epidermal growth factor receptor 2 (HER2/neu-). The study included 77 triple negative breast cancer patients for whom data collection began in 2004. Study participants had all phases of their therapy (surgery, chemotherapy, and radiation treatment) at one institution with a minimum of two months of follow-up (median follow-up was 23.2 months). Women with all types of surgery (lumpectomy/mastectomy), chemotherapy (neoadjuvant/adjuvant), and radiation treatment (tangents only/comprehensive nodal irradiation) were included. A patient was given radiation treatment if she had a lumpectomy or after mastectomy if the primary tumor was at least 5 cm in size and/or four or more positive lymph nodes were found. The women were assigned to two groups for statistical analysis, based on whether or not they received radiation treatment (53 (69%) received radiotherapy). Among patients that did not die during follow-up, the median follow-up period was 25.6 months (range: 2.0 to 63.1). Patients who received radiation treatment were significantly more likely to be of a higher American Joint Committee on Cancer (AJCC) stage (p < 0.001) than those who did not receive radiotherapy. Of the study participants who underwent radiation treatment, 33 (61.1%) did so after lumpectomy. For the entire study group, one-year overall survival was 90.9% and three-year overall survival was 86.3%. The three-year actuarial locoregional relapse-free survival probability for patients who received radiation (79.6%) was higher than among those who did not receive radiation (57.9%, p = 0.049). The authors conclude that, despite significantly lower AJCC stage, patients with triple-negative breast cancer who do not undergo radiation treatment have a significantly higher risk of locoregional recurrence.

The present Korean retrospective study was designed to evaluate the need for an individualized surveillance and follow-up based on breast cancer subtype and risk of relapse in breast cancer patients after initial treatment. At least five distinct breast cancer subtypes have been identified using gene expression profiles from DNA microarrays. These subtypes tend to have specific profiles in terms of relapse patterns, typical metastatic sites, and the risk of progression to stage IV breast cancer. However, the follow-up programs which are currently used do not take into account the differences among subtypes. In the study, the clinicopathologic characteristics and outcomes of 1,879 patients with invasive breast cancer who received breast cancer surgery during the period 2000 to 2004 at the Samsung Medical Center were analyzed. A total of 316 (17%) of the patients relapsed during a median follow-up period of 75 months. HER2 overexpression (hazard ration (HR) = 2.3; p < 0.0001), triple negative subtype (HR = 1.6; p = 0.007), high histological grade (HR = 1.6; p = 0.001), and TNM stage 3 (HR = 3.7; p < 0.0001) were identified as independent risk factors for breast cancer recurrence. The authors developed a scoring system based on these risk factors as follows: score 0 = no risk factor; score 1 = 1 risk factor; score 2 = 2 risk factors; and score 3 = 3 risk factors. Patients with a score of 0 to 2 were found to have relatively low risk of relapse, whereas those with a score of 3 were at high risk. The high-risk group was comprised of two subgroups: (1) HER2 positive breast cancer patients with a high histological grade and TNM stage 3; and (2) triple negative breast cancer with a high histological grade and TNM stage 3. The overall relapse rate of the low-risk group was 16%, with a 12% rate of distant metastasis. The relapse rate for the high-risk group was 53%, with a 51% rate of distant metastasis. The median relapse-free survival period for high-risk patients was 49 months whereas it had not been reached for the low risk group as of the end of the study period (p < 0.0001). The majority of recurrences occurred within three years of surgery for high-risk patients. The five-year survival rate among the high-risk patients was 65% compared to 96% for those with low risk. The authors conclude that there is a need to implement individualized surveillance protocols based on breast cancer subtypes and risk of relapse, with more focus on patients with a high risk of relapse.

The current retrospective study was designed to investigate the impact of age at diagnosis on the prognosis of patients with triple negative breast cancer. Triple negative breast cancer is characterized by lack of expression of estrogen and progesterone receptors as well as absence of overexpression or amplification of HER2/neu. The study included 1,896 patients with primary triple negative breast cancer who were divided into groups based on age at diagnosis (40 or younger, 41 to 50, 51 to 60, over 60). Information regarding tumor size, nodal stage, nuclear grade, treatment characteristics including adjuvant chemotherapy, and family history was collected. Chi-square, log-rank, and Kaplan-Meier as well as Cox regression methods were used to analyze the data. Triple negative breast cancer patients 40 or younger were more likely to have been diagnosed with grade 3 tumors (93.5% compared to 82.5%, p<0.0001), have received cytotoxic neoadjuvant (36.2% compared to 24.4%, p=0.004) or adjuvant chemotherapy (62.0% compared to 43.0%, p<0.0001) than patients older than 60. Response rates to neoadjuvant chemotherapy were not found to vary between age groups (p=0.898). Patients up to age 40 at diagnosis had significantly lower median disease-free survival (p<0.001), distant disease-free survival (p<0.001) and overall survival (p=0.002) than older patients. In multivariate analysis, age 40 or younger independently predicted decreased disease-free survival, as well as large tumor size, positive lymph node status, tumor grade, and family history, with a trend for grade 3 tumors (p=0.059). The authors conclude that age younger than 40 years at diagnosis comprises an important and clinically significant unfavorable prognostic factor among patients with triple negative breast cancer independent of nodal status, tumor size and use of chemotherapy.

The present study was designed to investigate whether triple negative (ER-, PR-, not HER2 overexpressing) breast cancer has an especially poor prognosis. The study comprised a review of 464 consecutive patients who underwent surgery for primary invasive breast cancer between January 2002 and July 2004. Follow-up data was available for 455 of these patients for a minimum of five years. Immunohistochemical staining was used to determine estrogen receptor (ER), progesterone receptor (PR) and c-erbB2/HER2 status. A staining score of 0 or 1+ was used to define HER2 negative status. A total of 361 of the patients were estrogen receptor positive (ER+), and 236 were HER2-positive. Eighty patients experienced a recurrence and 44 of them died of their disease. Logistic regression was used to perform multivariate analysis, with breast cancer recurrence and then cancer-specific survival as the dependent variables and triple negative status, age under 50 at diagnosis, tumor size (>3 cm), high tumor-grade and lymph node status (> 3 lymph nodes involved) as the explanatory variables. Recurrence was found to be influenced primarily by age under 50 at diagnosis (odds ratio (OR) = 1.79; 95% confidence interval (CI) = 1.02 - 3.15, p = 0.04) and more than three positive lymph nodes (OR = 4.2; 95% CI = 2.22 - 7.94, p < 0.0001) but not by tumor size, tumor grade or triple negative status. The median time period until relapse (when it did occur) was 16 months (interquartile range (IQR) = 15 - 50) for triple negative breast cancer, compared to 34 months (IQR = 22–48) for all other receptor combinations (p = 0.06). The median time to death (specifically from breast cancer) following recurrence was 17 months (IQR = 13 - 25) for triple negative cancer compared to 37 months (IQR = 22 - 56) for the other receptor combinations (p = 0.0247). Lymph node (>3 lymph nodes involved) status (OR = 2.9; 95% CI = 1.28 - 6.13; p = 0.0051) and tumor size >3 cm (OR = 5.29; 95% CI = 2.56 - 10.49; p ≤ 0.0001) were independent predictors of breast cancer-specific death. However, by five years after diagnosis, patients with triple-negative breast cancer were no more likely to relapse or die than patients with other receptor profiles. The authors conclude that patients with triple negative breast cancer are no more likely to relapse or die of cancer than patients with other receptor profiles. However, when relapse occurs, it tends to be earlier and subsequent death sooner than other receptor groups.

The current study examined the prevalence of the eight possible combinations of ER/PR/HER2 status in California breast cancer patients in conjunction with five-year survival. Breast cancer generally is categorized according to the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The California Cancer Registry was used to classify 61,309 women with primary invasive breast cancer according to ER/PR/HER2 status and five-year relative survival was computed for all possible combinations of subtypes. Odds ratios (ORs) were estimated using multivariate logistic regression. Women who were younger than 50 at diagnosis, African American, Hispanic, of low socio-economic status, and/or with stage IV undifferentiated tumors were more likely to have breast cancer with an ER-negative subtype (ER-/PR-/HER2+ or ER-/PR-/HER2- (triple negative)). Asian Pacific Islanders also had increased odds of having the ER-/PR-/HER2+ subtype (OR = 1.41; 95% confidence interval (CI) = 1.26–1.57). Stage III tumors (OR = 1.25; 95% CI = 1.08–1.44) and stage IV tumors (OR = 1.58; 95% CI = 1.27–1.98) were more likely than stage I tumors of being ER-/PR-/HER2+. Stage IV tumors were much less likely to be of the ER-/PR-/HER2- subtype (OR = 0.54; 95% CI = 0.44–0.67). Poorly differentiated and undifferentiated tumors were found to be more than 20 times as likely as well-differentiated tumors to be hormone receptor negative. Survival was found to vary from 96% for hormone receptor-positive/HER2 negative breast cancer (ER+/PR+/HER2-) to 76% for hormone receptor-negative breast cancer (including both ER-/PR-/HER2+ and triple negative). The four subtypes found to have the poorest survival were all ER-. The authors recommend reporting breast cancer as an ER/PR/HER2 subtype and precisely documenting demographic and tumor characteristics.

This review discusses the effects of resveratrol, an antioxidant found in grapes and red wine, against UV radiation exposure and resveratrol's role as a sensitizer to enhance the impact of radiation treatment. UV radiation is a known cause of the majority of skin cancers and precancerous conditions such as actinic keratosis. Chemoprevention with botanical antioxidants is an approach that might be a plausible strategy for preventing sun damage, including photocarcinogenesis. Resveratol has been shown to protect against UVB exposure-related damages in vitro and in vivo. In addition, resveratrol has been shown to act as a sensitizer to enhance the therapeutic effects of ionizing radiation against cancer cells. The authors conclude that, based on the available literature, resveratrol may be useful for (1) prevention of UVB-mediated damages including skin cancer; and (2) enhancing the response of radiation therapies against hyperproliferative, precancerous and neoplastic conditions.

The present study was designed to investigate how postdiagnosis diet quality is related to biomarkers of inflammation and adipose tissue-derived hormones among breast cancer survivors. The study also sought to determine how physical activity or body size influenced any observed associations. Inflammation and immune response may affect the prognosis of breast cancer survivors. The study included 746 women diagnosed with stage 0 to IIIA breast cancer who completed food frequency questionnaires 30 months after diagnosis. Diet quality was scored with the Healthy Eating Index (HEI)-2005. The HEI is a measure of diet quality that assesses conformance to federal dietary guidance. The HEI-2005 translates recommendations in the 2005 Dietary Guidelines into specific, quantified recommendations for levels of intake of fruits, total vegetables, dark green and orange vegetables, grains and whole grains, and calories from solid fat, alcohol, and added sugar, among other dietary elements. Participants provided fasting blood samples, which were used to measure serum concentrations of C-reactive protein (CRP), serum amyloid A, leptin, and adiponectin. Multivariate models were used to regress log biomarker values on quartiles of HEI-2005 scores, and β scores were exponentiated and expressed as geometric averages within quartiles of HEI-2005 scores. Women with better versus poor quality postdiagnosis diets (as defined by quartile 4 versus quartile 1 HEI-2005 scores) were found to have lower concentrations of CRP (1.6 mg/L versus 2.5 mg/L), but no significant differences were found in serum levels of amyloid A, leptin, or adiponectin. When the influence of exercise was examined, the association between high quality diet and low CRP held for women who did not exercise after diagnosis but was not significant for those who did. Among women not taking part in recreational physical activity, better diet quality was associated with lower CRP concentrations (2.5 mg/L versus 5.0 mg/L), but no association was found among women engaging in any recreational physical activity (1.4 mg/L versus 1.6 mg/L; P heterogeneity = 0.03). The authors conclude that a better-quality diet appears to be associated with lower levels of chronic inflammation among breast cancer survivors. Lower levels of chronic inflammation have been associated with improved survival after breast cancer.

The current prospective study was designed to investigate the association between breast cancer recurrence and vegetable intake, with a focus on the impact on those using tamoxifen. The protective effect of vegetables on the risk of breast cancer recurrence has not been established. Previous reports of anti-carcinogenic activity of phytochemicals in cruciferous vegetables in combination with tamoxifen led the authors to include specific evaluation of this class of vegetables in the study. The study included 3,080 breast cancer survivors enrolled in the Women's Healthy Eating and Living (WHEL) Study. Vegetable intake based on repeat 24-hour dietary recalls were examined as a secondary analysis in the cohort. The women were 23.5 months post-diagnosis, on average, at time of enrollment. The hazard of recurrence with vegetable intake was assessed in the overall study group and separately for women taking tamoxifen, while controlling for relevant clinical and demographic variables. Participants reported baseline average intakes of 3.1 +/- 0.05 servings per day of vegetables, and 0.5 +/- 0.02 servings per day of cruciferous vegetables. Vegetable intake was divided into thirds. Vegetable intake in the highest compared to the lowest thirds was found to be associated with a lower adjusted hazard ratio (HR) for breast cancer recurrence of 0.69 (95% confidence interval (CI) = 0.55-0.87). Among women taking tamoxifen, HR = 0.56 (95% CI = 0.41-0.77) for total vegetable intake and HR = 0.65 (95% CI = 0.47-0.89) for cruciferous vegetable intake. For women using tamoxifen who had above median cruciferous vegetable intake, as well as being within the highest third of total vegetable intake, HR = 0.48 (95% CI = 0.32-0.70). The authors conclude that baseline vegetable intake may be associated with a reduction in the risk of breast cancer recurrence or new events, particularly for those using tamoxifen. The associations deserve further study since it is possible that vegetable intake is simply a surrogate for other health-promoting behaviors.

The current study was designed to evaluate the relationship between circulating markers of inflammation and breast cancer survival. Chronic inflammation has been reported to contribute to breast cancer development and subsequent progression. C-reactive protein (CRP) and serum amyloid A (SAA) are measures of low-grade chronic inflammation and therefore potential predictors of cancer survival. The study used data concerning 734 disease-free breast cancer survivors in the Health, Eating, Activity, and Lifestyle (HEAL) Study (a multiethnic prospective cohort study of women diagnosed with stage 0 to IIIA). Circulating CRP and SAA were assessed approximately 31 months after breast cancer diagnosis. Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios (HRs) and 95% confidence intervals (CIs) to investigate associations between CRP and SAA and disease-free survival (approximately 4.1 years of follow-up) and overall survival (6.9 years). Elevated SAA and CRP were found to be associated with reduced overall survival (SAA P trend < .0001; CRP P trend = .002); the results were adjusted for age, tumor stage, race, and body mass index. The results for SAA and CRP tertiles suggested a threshold effect on survival, rather than a dose-response relationship (for highest versus lowest tertile SAA, HR = 3.15, 95% CI = 1.73-5.65; for highest versus lowest tertile CRP, HR = 2.27, 95% CI = 1.27-4.08). Associations were comparable and still significant after adjusting for history of (self-reported) cardiovascular events and censoring deaths from cardiovascular disease. Elevated CRP and SAA were also found to be associated with reduced disease-free survival, although these associations were of borderline significance (SAA P trend = .04; CRP P trend = .07). The authors conclude that circulating SAA and CRP may be important prognostic markers for long-term survival in breast cancer patients, independent of race, tumor stage, and body mass index.

Some population studies have found a diet high in vegetables to be associated with less likelihood of recurrence in breast cancer survivors. Carotenoids, which are found primarily in vegetables and fruit, are thought to have biological activities that may specifically reduce the progression of breast cancer. The present study was designed to examine the relationship between plasma carotenoids at enrollment and at points in time one, two or three, four, and six years, and breast cancer-free survival. Cases were 3,043 participants in the Women's Healthy Eating and Living Study who had been diagnosed with early-stage breast cancer. The primary end point was time to either a second breast cancer recurrence or a new primary breast cancer. The analysis was adjusted for prognostic and other confounding factors. 508 (16.7%) breast cancer events (recurrence or new primary breast cancer) took place over a median 7.12 years of follow up. Compared with the lowest third, the hazard ratio for the medium/high plasma carotenoid tertiles was 0.67 (95% confidence interval, 0.54-0.83). The authors conclude that higher biological exposure to carotenoids was associated with greater likelihood of breast cancer–free survival when assessed over the time frame of the study.

The current prospective study was designed to estimate reductions in breast and ovarian cancer risks and mortality resulting from prophylactic mastectomy and salpingo-oophorectomy (removal of the ovaries and fallopian tubes). These surgeries are widely used by BRCA1 and BRCA2 mutation carriers to reduce their risks of breast and ovarian cancer. The study was conducted at 22 clinical and research genetics centers in Europe and North America. Study participants included 2,482 women whose BRCA1 or BRCA2 mutations were confirmed by genetic testing between 1974 and 2008. The women were followed until year-end 2009. Breast and ovarian cancer risk, cancer-specific mortality, and overall mortality were the main outcome measures. None of the 247 women who underwent risk-reducing mastectomy were diagnosed with breast cancer during the follow-up period. On the other hand, 98 of the 1,372 women who did not have risk-reducing mastectomy were diagnosed with breast cancer. Compared with women who did not undergo prophylactic salpingo-oophorectomy, women who had salpingo-oophorectomy had a lower risk of ovarian cancer, including those with prior breast cancer (6% vs. 1%, respectively; hazard ratio (HR) = 0.14, 95% confidence interval (CI) = 0.04-0.59) and those without prior breast cancer (6% vs. 2%; HR = 0.28, 95% CI = 0.12-0.69), and a lower risk of first diagnosis of breast cancer in BRCA1 mutation carriers (20% vs. 14%; HR = 0.63, 95% CI = 0.41-0.96) and BRCA2 mutation carriers (23% vs. 7%; HR = 0.36, 95% CI = 0.16-0.82). Compared with women who did not undergo prophylactic salpingo-oophorectomy, undergoing salpingo-oophorectomy was associated with lower mortality from all causes (10% vs. 3%; HR = 0.40, 95% CI = 0.26-0.61), breast cancer–specific mortality (6% vs. 2%; HR = 0.44, 95% CI = 0.26-0.76), and ovarian cancer–specific mortality (3% vs. 0.4%; HR = 0.21, 95% CI = 0.06-0.80). The authors conclude that among a cohort of women with BRCA1 and BRCA2 mutations, the use of risk-reducing mastectomy was associated with a lower risk of breast cancer. In addition, risk-reducing salpingo-oophorectomy was associated with a lower risk of ovarian cancer, first diagnosis of breast cancer, all-cause mortality, breast cancer–specific mortality, and ovarian cancer–specific mortality.

The present study was designed to evaluate the potential prognostic benefit of contralateral mastectomy in BRCA1/2 mutation carriers who develop breast cancer in one breast. Risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer is known to significant reduce the risk of developing contralateral breast cancer (cancer in the other breast). However, the outcome regarding distant metastasis-free survival and overall survival has not been established. The study included 375 breast cancer patients (283 with BRCA1 mutations and 92 with BRCA2). Cancer characteristics and follow-up information through year-end 2008 were obtained from medical records. Eventually, 111 of the BRCA1 and 33 of the BRCA2 mutation carriers underwent risk-reducing mastectomy. Patients contributed person-years of observation to the non-risk-reducing mastectomy group from the date of the first visit at the clinic or primary breast cancer diagnosis (whichever came last) to the date of risk-reducing mastectomy, diagnosis of metastatic disease, death, or last follow-up. Similarly, patients contributed person-years of observation to the risk-reducing mastectomy group from the date of risk-reducing mastectomy until diagnosis of metastatic disease, death, or last follow-up. No differences in age at diagnosis, hormone-receptor status, and adjuvant systemic treatment were found between the non-risk-reducing mastectomy and risk-reducing mastectomy groups with respect to the initial (primary) beast cancer. Distribution of TNM stages 0, I, II and III, was 4%, 37%, 46% and 13%, respectively, in the non-risk-reducing mastectomy group, compared to 4%, 51%, 38% and 7% in the risk-reducing mastectomy group (p < 0.05). More women in the risk-reducing mastectomy group underwent risk-reducing removal of the fallopian tubes and ovaries (74% compared to 46% in the non-risk-reducing mastectomy group; p < 0.001). With an average follow-up of 7.4 years, 72 contralateral breast cancer cases occurred in the non-risk-reducing mastectomy group, while no contralateral breast cancer occurred after risk-reducing mastectomy. During 1,956 person-years of observation, 54 patients in the non-risk-reducing mastectomy group developed metastatic cancer versus 16 patients during 655 person-years of observation in the risk-reducing mastectomy group. Concerning the overall survival, 51 women died during 2,092 person-years of observation in the non-risk-reducing mastectomy group, compared to 15 women in the risk-reducing mastectomy group during 692 person-years of observation. BRCA1 and BRCA2 mutation carriers were found to have similar results. The effect of risk-reducing mastectomy on distant disease free survival and overall survival taking into account the influence of variables such as tumor characteristics, mutation status, and risk-reducing salpingo-oophorectomy is currently being analyzed and will be presented at the meeting. The authors conclude that risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer does not appear to improve distant disease free survival and overall survival, despite resulting in great reduction of contralateral breast cancer occurence. Further research is warranted to identify a set of prognostic factors enabling selection of subgroups of breast cancer patients who possibly may benefit from risk-reducing mastectomy with respect to distant disease free survival and overall survival.

The current study was designed to determine whether gene expression in normal breast tissue differs between breast cancer patients and women with normal risk of breast cancer who are undergoing breast reduction surgery. The authors hypothesized that histologically normal epithelium would differ between breast cancer patients and usual-risk controls undergoing reduction mammoplasty, and that gene expression in epithelium from cancer-free prophylactic mastectomy samples from high-risk women would resemble histologically normal gene expression. Gene expression was analyzed in 73 epithelium samples microdissected from frozen tissue. Using 42 of the samples, the authors used microarrays to compare gene expression between 18 breast reduction patients and 18 age-matched histologically normal (nine estrogen receptor estrogen receptor positive (ER+) and nine ER-) and six prophylactic mastectomy patients. A total of 98 probe sets (86 genes) were found to be differently expressed between breast reduction surgery and histologically normal samples. In performing hierarchical analysis with these 98 probe sets, it was found that the prophylactic mastectomy and histologically normal samples clustered together, away from the breast reduction surgery samples. qPCR validation of independent samples was high (84%) and consistent in breast reduction compared to histologically normal patients; qPCR validation was lower (58%), but more heterogeneous, in breast reduction compared to prophylactic mastectomy patients. The 86 genes that were expressed differently were involved in many processes, including transcription and the MAPK pathway. The authors summarize that gene expression differs between the epithelium of breast cancer cases and controls. The profile of cancer cases can be discerned in high-risk epithelium from cancer-free breasts. This suggests that the profile is not an effect of the tumor, but may be a mark of increased risk and reveal the earliest genomic changes of breast cancer.

The present study was designed to examine the associations between contralateral prophylactic mastectomy (removal of the cancer-free breast after a cancer diagnosis in the opposite breast) and five-year survival from breast cancer based on certain predictive factors. The U.S. Surveillance, Epidemiology, and End Results database was used to identify 107,106 women with breast cancer who underwent mastectomy for treatment of the cancer between 1998 and 2003, including 8,902 women who underwent contralateral prophylactic mastectomy during the period. Cox regression analysis was used to assess associations between predictor variables and the likelihood of undergoing contralateral prophylactic mastectomy, taking into account estrogen receptor (ER) status, cancer stage, and patient age. Based on unadjusted single variable analysis, contralateral prophylactic mastectomy was found to be associated with improved disease-specific survival (hazard ratio (HR) of death = 0.63; 95% confidence interval (CI) = 0.57 - 0.69; P < .001). After taking into account ER status, stage and age, this result was found to be due primarily to a reduction in breast cancer-specific mortality in women aged 18 to 49 years with stages I and II ER- tumors (HR of death = 0.68; 95% CI = 0.53 - 0.88; P = .004). Five year breast cancer survival for this group of women was improved with contralateral prophylactic mastectomy compared to without (88.5% versus 83.7%). Rates of contralateral breast cancer among young women with stages I or II disease undergoing contralateral prophylactic mastectomy were found to be independent of ER status. However, women with ER+ breast cancer who did not undergo prophylactic mastectomy also had a slightly lower overall risk for contralateral breast cancer than women with ER- tumors (0.46% versus 0.90%, P < .001). The authors conclude that contralateral prophylactic mastectomy is associated with a small improvement in five-year survival from breast cancer primarily in premenopausal women with early-stage ER- breast cancer. This survival effect is related to a higher baseline risk of contralateral breast cancer for women in this group.

The present study was designed to evaluate the long-term incidence of breast cancer following breast reduction surgery. While it has been shown that prophylactic mastectomy reduces the incidence of breast cancer among high risk women, many such women consider this disfiguring surgery unacceptable. Another approach may be breast reduction surgery. The present study extends the follow-up period of an earlier study by nine years, resulting in a mean follow-up period of almost 16 years. The study included 30,444 Swedish women who underwent elective cosmetic breast reduction surgery between 1965 and 1993. Cancer incidence through year-end 2002 was determined using the Swedish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were estimated comparing the study participants with women in the general Swedish population. Breast cancer occurred in 443 women versus the 624 expected during follow up, for a reduced SIR = 0.71 (95% CI = 0.65 - 0.78). Stratification by age at surgery, time since surgery, and calendar year of surgery produced similar results. The authors conclude that their study of more than 30,000 women with long-term follow-up provides further evidence that women undergoing breast reduction surgery have reduced breast cancer risk.