title: Patients with a history of epithelial ovarian cancer presenting with a breast and/or axillary mass.
abstract: OBJECTIVE
  A breast and/or axillary mass in a patient with epithelial ovarian cancer (EOC) may be due to an EOC breast metastasis or a second primary breast cancer. We sought to review our experience with patients with a history of EOC presenting with a breast and/or axillary mass to determine if clinical features differed between these entities.
  
  
  METHODS
  Between 1/90 and 10/07, 29 women with epithelial EOC presented with a breast or axillary mass, including 10 patients with EOC metastatic to the breast and/or axilla and 19 patients with a second primary breast cancer following their original EOC diagnosis. Clinicopathologic factors/survival were retrospectively abstracted from medical records.
  
  
  RESULTS
  The mean EOC disease-free survival (DFS) was 14.9 mo versus 77.4 mo (P<0.001) for patients with recurrent epithelial ovarian cancer metastatic to the breast and/or axilla and patients with a second primary breast cancer, respectively. Similarly, the mean interval between diagnosis of EOC and the breast and/or axillary event was 31.2 mo versus 70.7 mo for those patients who had metastatic recurrent EOC and those patients with breast cancer (P=0.02). Patients with a second primary breast cancer were more likely to be diagnosed on mammogram and have a family history of breast and ovarian carcinoma than patients with metastatic EOC to the breast and/or axilla (14/19 [73.7%] versus 2/9 [22.8%], P=0.02; and 12/18 [66.7%] versus 2/10 [20%], P=0.05, respectively). Median overall survival for patients with EOC metastasis was 26 mo but was not yet reached for those patients with a second primary breast cancer. On univariate analysis, an ovarian cancer DFS of 12 mo or more and the performance of breast/axillary surgery were associated with a significantly longer overall survival (P=0.01 and 0.02, respectively), whereas an elevated CA125 level at the time of the breast/axilla event and the presence of EOC metastases to the breast and axilla were significant negative predictors of survival (P=0.01 and 0.05, respectively).
  
  
  CONCLUSIONS
  The interval between EOC diagnosis and the breast and/or axilla event, an elevated CA125 level, and a family history of breast and/or ovarian cancer may help differentiate patients with metastatic EOC to the breast and/or axilla from those patients with a second primary breast cancer. The presence of a metastatic EOC portends a poor prognosis.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI Suite 10-26, New York, NY 10065, USA.
authors.forename: Amer K
authors.initials: AK
authors.lastname: Karam
authors.forename: Michelle
authors.initials: M
authors.lastname: Stempel
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Mary L
authors.initials: ML
authors.lastname: Gemignani
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000556:secondary*; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000473:pathology*; D012189:Retrospective Studies