Volume 12 Supplement 3

Royal College of Radiologists Breast Group Annual Scientific Meeting 2010

Open Access

Size matters: second breast cancer size following treatment for primary cancer as a predictor of survival

  • GS MacLennan1,
  • G Lawrence2,
  • C Boachie1,
  • SD Heys3, 4 and
  • FJ Gilbert4
Breast Cancer Research201012(Suppl 3):O3

DOI: 10.1186/bcr2650

Published: 25 October 2010


The purpose of surveillance mammography following primary breast cancer treatment is to detect subsequent cancers at the smallest size. We examined the prognostic effect of size of ipsilateral breast tumour recurrence (IBTR) and metachronous contralateral breast cancer (MCBC) to assess potential benefit of surveillance mammography after breast cancer treatment.


Second cancers (IBTR n = 1,174, MCBC n = 975) diagnosed between 1 January 1990 and 31 January 2007 from the West Midlands Cancer Intelligence Unit Breast Cancer Registry were analysed. Survival from diagnosis of second cancer was examined using Cox regression models. Risk factors included were prognostic factors of the primary tumour and size of the second tumour. Outcomes were time to all-cause death and to breast cancer death. Estimates are hazard ratios (HRs) and 95% confidence intervals.


There were 613 all-cause deaths and 422 breast cancer deaths after IBTR. For both outcomes, second cancers >2 cm had poorer prognosis compared with those <1 cm, HRs were 1.75 (1.29 to 1.37) and 1.99 (1.37 to 2.89). In MCBC there were 358 all-cause deaths, HR 2.14 (1.49 to 3.06), and 23 breast cancer deaths, HR 1.99 (1.38 to 2.83).


With either IBTR or MCBC the size of the second tumour is important, patients with cancers >2 cm in diameter being at a significantly greater risk of death. Lead-time bias from the mode of detection may be a factor in these results. The frequency of surveillance mammography should be considered for maximum benefit.

Authors’ Affiliations

Health Services Research Unit, University of Aberdeen
West Midlands Cancer Intelligence Unit, Birmingham Women’s NHS Foundation Trust
Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen and Aberdeen Royal Infirmary
Aberdeen Biomedical Imaging Centre, University of Aberdeen and Aberdeen Royal Infirmary, NHS Grampian


© MacLennan et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.