title: Nonbreast second malignancies after treatment of primary breast cancer.
abstract: OBJECTIVE
  To determine the incidence and risk factors for nonbreast second malignancies (NBSMs) in women after treatment for primary breast cancer.
  
  
  METHODS
  Between January 1985 and December 1995, a total of 1,084 breast cancer patients were analyzed for NBSMs. Detailed analysis was carried out for age, family history, disease stage, radiation therapy, chemotherapy, hormone therapy, other clinical/pathologic characteristics, and site of NBSMs. The Cox proportional hazard regression model was used to estimate the relative risk of NBSMs.
  
  
  RESULTS
  Median follow-up was 12 years. In total, 33 cases of NBSMs were noted in 29 patients. The overall incidence of NBSM was 3%, and the median time for NBSMs was 7 years. The most common NBSMs were gynecologic (22 patients), gastrointestinal (4 patients), head and neck (3 patients), hematologic (2 patients), lung (1 patient), and thyroid (1 patient). The NBSMs rate at 12 years was 2.4% for both mastectomy and radiation therapy groups. In the subset of patients less than 45 years of age at the time of treatment, the NBSMs rate was 0.7% as compared with 4.6% in patients more than 45 years of age (p = 0.001). Statistically significant higher incidences of endometrial and ovarian cancer were seen in patients with hormonal therapy (5.2%) as compared with patients without hormonal therapy (1.8%, p = 0.002). Women with a family history of breast cancer had a higher incidence (6%) of endometrial and ovarian malignancy compared with women without such a history (2.1%, p = 0.003). Chemotherapy did not affect the risk of second malignancy.
  
  
  CONCLUSIONS
  The most common NBSMs in this study were gynecologic. Family history of breast cancer was a high risk factor for NBSMs. No risk of NBSMs with radiotherapy was observed.
authors.affiliation: Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India. drbudhi@gmail.com
authors.forename: Budhi S
authors.initials: BS
authors.lastname: Yadav
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Sharma
authors.forename: Firuza D
authors.initials: FD
authors.lastname: Patel
authors.forename: Sushmita
authors.initials: S
authors.lastname: Ghoshal
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Rajinder
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000209:etiology; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology