Study Describes Women With 'Double Cancer Syndrome'

SAN FRANCISCO--Approximately 6% of all women diagnosed with ovariancancer have had a previous diagnosis of breast cancer, JeffreyG. Schneider, MD, said at the annual conference of the Societyof Gynecologic Oncologists.

Research from Memorial Sloan-Kettering Cancer Center has shownthat women susceptible to this "double cancer syndrome"are more likely to have had good prognosis breast cancer at arelatively early age.

"The double-cancer syndrome--a breast cancer followed byan ovarian cancer--is a significant problem and has not been previouslycharacterized," Dr. Schneider, a medical oncologist formerlyat Sloan-Kettering and now at Winthrop University Hospital, Mineola,NY, told Oncology News International.

The findings from the study may be used to develop a screeningprotocol for women with breast cancer, to facilitate early detectionof subsequent ovarian cancers, he said.

Dr. Schneider and his colleagues at Sloan-Kettering reviewed anovarian cancer database that included 887 women who presentedto Sloan-Kettering with a diagnosis of epithelial ovarian cancer.Of that group, 53 (6%) had a previous history of breast cancer.

In this 53-patient cohort, breast cancer presented, on average,a decade earlier than in typical patients, Dr. Schneider said.The median age for breast cancer diagnosis in the cohort was 44years; a third of the patients were younger than 40 at the timeof diagnosis.

The patients tended to have small tumors, and three quarters hadnegative axillary lymph node dissections. These patients had alow propensity for developing metastatic disease. However, almostone quarter developed a new primary cancer in the contralateralbreast.

Possible Effects of Tamoxifen

Dr. Schneider reported that the median interval between the breastcancer diagnosis and the onset of ovarian cancer was 9.2 years."In a multiple factor regression analysis, tamoxifen [Nolvadex]use emerged as the only factor that was significantly associatedwith the duration of this interval," he said.

Nine of the cohort's recorded ovarian cancers occurred in womenwho were using tamoxifen, with a median interval of 1.9 years,compared with 10 years for non-tamoxifen users.

Although he stressed that the finding is preliminary and was derivedfrom a retrospective chart analysis, Dr. Schneider believes thatidentification of this apparent link between tamoxifen use andthe shortening of the interval may be important for patients whoare genetically predisposed to both cancers.

"The other striking feature," Dr. Schneider said, "wasthat the interval from breast cancer diagnosis to ovarian cancerdiagnosis was very short--6 months or less--in the three premenopausalpatients who received tamoxifen."

Most Had Advanced Stage Disease

Dr. Schneider's most disappointing observation was that the womenin the cohort did not benefit from their prior entrée intothe oncology arena as breast cancer patients.

"More than three quarters of the patients were diagnosedwith ovarian cancer, not during routine follow-up, but becauseof their own reporting of symptoms," he said. Eighty-threepercent presented with advanced stage disease and a bleak prognosis.

Dr. Schneider stressed that the 10 women in the study cohort whohad been diagnosed by their physicians after a routine follow-upall had early stage ovarian cancer.

"We are about to embark on an era in which the common geneticpredisposition to breast and ovarian cancers will become widelyappreciated and testable in the laboratory," he said.

Dr. Schneider's take-home message is that "we must alertourselves to this heightened cancer risk, not only in membersof classic family pedigrees but also in those whom we may havecured of a prior breast cancer."