Clinical profile and management of bilateral breast cancer

Bilateral breast cancer (BBC) is a rare clinical entity. Unlike unilateral breast cancer there are no clear treatment guidelines for BBC. There are several controversial issues regarding BBC pertaining to the diagnostic criteria, nomenclature, and management policies. To address these issues, a retrospective analysis of breast cancer database at a tertiary care cancer center was performed and the clinical profile, treatment patterns and outcome of patients with BBC were analyzed.

Thirty out of 1100 (2.7%) patients with breast cancer treated between 1993 and 2003 had BBC, of whom 20 patients had metachronous and 10 patients had synchronous BBC. Family history of breast cancer was present in five patients (16%) only. Contralateral breast cancer (CBC) was detected mammographically in three and by clinical examination in 27 patients. Most CBC patients had early-stage disease compared with the index side (73% versus 27%). Fifty-six out of 60 tumors were found to be invasive ductal carcinoma, and none of the patients had lobular carcinoma. Twenty-three patients had bilateral mastectomy, three had unilateral mastectomy and four had a combination of breast conservation and mastectomy. Sixteen patients had unilateral and six had bilateral adjuvant radiotherapy. All patients received adjuvant chemotherapy and/or hormonal therapy both for index and CBC based on the stage and hormone receptor status. At a median follow up of 31.5 months (3–142 months), 23 (76%) patients were disease free and seven (24%) patients had disease relapse. Mean overall survival of patients with MBBC was significantly longer than those with SBBC (30.4 months versus 19.2 months; P = 0.045).

BBC is an uncommon clinical entity. These patients require individualized treatment planning based on the tumor factors and treatment factors of the index lesion. Optimal results can be obtained by using a logical multimodality treatment approach for BBC.