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Study: The chance of a second breast cancer is higher among some Hawai'ian women

Women diagnosed with ductal carcinoma in situ (DCIS), an early form of breast cancer, are more likely to have a second breast cancer diagnosis if they are of Native Hawai'ian, Filipino or Japanese ancestry than women of other racial or ethnic groups. (posted 3/15/22)

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Contents

At a glance Clinical trials
Study findings Guidelines
Strengths and limitations Questions for your doctor
What does this mean for me? Resources
In depth  

 

STUDY AT A GLANCE

What is this study about?

This study is about determining the risk of second breast cancers after a diagnosis of among women who are Native Hawai'ian.

 

Why is this study important?

Cases of ductal carcinoma in situ (DCIS), an breast cancer, have increased as breast screening has improved. Most women with DCIS can be cured and have no subsequent breast cancer. However, 40 percent of women with DCIS develop a second breast cancer—28 percent of those second breast cancers are invasive.

Concerns about overtreatment of DCIS for patients with low risk are weighed against concerns about undertreatment of patients with higher risk. To better understand the risk of a second breast cancer among women with DCIS, the researchers of this study evaluated cancer rates among different racial or ethnic groups within Hawai'i. Hawai'i is the most ethnically diverse U.S state with the greatest percentage of Native Hawai'ian and Pacific Islander (NHPI) women.

Some studies have shown that Asian American and Pacific Islander women have similar rates of second breast cancers compared to white women. However, experts now recognize that grouping Native Hawai'ian and Pacific Islander women with Asian American women may mask underlying differences.

When studied as a separate group, NHPI people have one of the highest mortality rates from cancer, highest chronic disease rate and shortest life spans of groups in the U.S. NHPI women are four times more likely to develop breast cancer than Asian American women.

In this study, researchers looked at the rate of second breast cancers among women from the state of Hawai'i who were diagnosed with DCIS.

 

Study findings

Researchers gathered Information from 6,221 women with DCIS from the Hawai'ian Tumor Registry. The patients included:

  • 2,207 Japanese women (37%)
  • 1,411 white women (23%)
  • 840 Filipino women (14%)
  • 821 Native Hawai'ian women (13%)
  • 491 Chinese women (8%).
  • Information about 388 patients of other races or ethnicities (6%) were combined.

 

For each woman, researchers looked at information about the original DCIS diagnosis, treatment received and whether a second breast cancer was diagnosed. Because the second diagnosis could have been a recurrence or residual cancer from the original DCIS, women were excluded if they had a second breast cancer diagnosis within six months of their DCIS diagnosis.

  • 93% of women with DCIS did not have a second breast cancer.
  • Women who were under age 50 at the time of their original diagnosis were more likely to have a second breast cancer after DCIS than women over age 50.
  • The frequency of second breast cancers differed among different racial and ethnic groups. Among women from Hawai'i included in the Hawai'ian Tumor Registry:
    • Native Hawai'ian, Filipino and Japanese women were up to 2-fold more likely to have a second breast cancer than white women.
    • Chinese women had similar rates of second breast cancer in the same breast as their DCIS and a lower risk of breast cancer in the opposite breast than white women.
  • The rate of a second breast cancer after DCIS varied among women who received different treatments for their DCIS.
    • Women who had breast-conserving surgery (BCS) alone ( with no radiation therapy) were less likely to develop a second breast cancer than those who had no treatment. 
    • Women who had breast-conserving therapy (lumpectomy and radiation therapy) had fewer second breast cancers in the same breast than those who only had BCS.
  • However, rates of breast cancer in the opposite breast were similar among women who had BCS with or without radiation therapy.
    • Women who had BCS and were less likely to have a second breast cancer in either breast than women who only had BCS.
    • Women who had a mastectomy rather than BCS were 4-fold less likely to have a second breast cancer in the same breast and 1.4-fold less likely to have a second breast cancer in the opposite breast.
       

Strengths and limitations

Strengths

  • This study looked at a large group of racially and ethnically diverse women, including those with Native-Hawai'ian, Filipino, Chinese and Japanese ancestry. This study allows more accurate determination of risk for several groups.

Limitations

  • This was a anonymous analysis, so some information was incomplete. Hormone-receptor status was missing for 40% of patients, preventing conclusions about its impact on second breast cancers.
  • This study used data from the Hawai'ian Tumor Registry and may not reflect rates of second breast cancers in other geographical regions of the U.S. or among racial groups (e.g., African American or Hispanic American women).

 

What does this mean for me?

If you are a person of Hawai'ian, Filipino or Japanese ancestry who has been diagnosed with DCIS, you may be at greater risk of a second breast cancer. It is important to inform your doctor of your heritage because it may help them better understand your risk of subsequent cancers and help you decide together what treatment reduces your risk and best fits your situation.

If you have a family history of breast or other cancers, your risk of breast cancer may be higher. You might consider consulting with a genetic counselor to better understand your cancer risk, whether genetic testing could be helpful and whether there are preventive steps you may want to consider.

 

References

Taparra K, Fukui J, Kileen J, et al. Racial and Ethnic Disparities in Rates of Invasive Second Breast Cancer Among Women With Ductal Carcinoma In Situ in Hawaiʻi. JAMA Network Open 2021; 4(10):e2128977. doi:10.1001/jamanetworkopen.2021.28977.

 

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board before publication to assure scientific integrity.

 

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posted 3/15/22

Expert Guidelines

The National Comprehensive Cancer Network (NCCN) guidelines include the following options for treatment of DCIS:

  • Breast-conserving therapy (lumpectomy followed by radiation therapy) without lymph node surgery.
  • Total mastectomy with or without lymph node surgery.
  • Breast-conserving surgery without lymph node surgery followed by accelerated partial breast irradiation.
  • Breast-conserving surgery without lymph node surgery (and without radiation therapy).   

Following surgery, the NCCN recommends that patients:

  • Consider endocrine therapy for 5 years for people with ER-positive DCIS who:
    • received breast conservation and radiation therapy.
    • were treated with surgical excision only. 
  • Receive counseling regarding risk reduction.

Updated: 03/12/2022

Questions To Ask Your Doctor

  • I have DCIS and am of Native Hawai'ian, Filipino or Japanese ancestry. What is my risk of a second breast cancer?
  • What treatment for DCIS best fits my personal and family history?
  • Would I benefit from genetic counseling?
  • How does my age at diagnosis affect my DCIS treatment?
  • What are the risks or benefits of different treatments for DCIS?

Open Clinical Trials

The following clinical research studies focus on addressing in cancer:

Updated: 01/13/2025

Peer Support

The following organizations offer peer support services for people with or at high risk for breast cancer:

Updated: 05/07/2024

Who covered this study?

Scope

Native Hawaiian resident shines a light on health disparities This article rates 4.0 out of 5 stars

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