FaCD Online Syndrome Fact Sheet

Last updated: 01 Sep 2008

Name: Breast Cancer, Multiple Primary Malignancies in Patients with

Tumor features

breast cancer
endometrial cancer
lung/bronchial cancer
malignant fibrous histiocytoma
non-Hodgkin lymphoma
thyroid cancer

Tumor features (possible)

colon cancer
esophageal cancer
gastric cancer
melanoma, cutaneous
renal cell cancer


A range of tumors have been reported to occur in excess in breast cancer patients: ovarian cancer[1-3], thyroid cancer[1;4], non-Hodgkin lymphoma (increased risk after chemotherapy)[1], lung cancer (increased risk after radiotherapy[5;6] and breast cancer diagnosis before age 50[3]), bone sarcomas and soft tissue sarcomas (following radiotherapy[7]) and endometrial cancer (after tamoxifen therapy[2;8], also true for treatment after DCIS[9]). A wide range of other tumors have been reported as well[2,10]: leukemia, renal cancer, melanoma, esophagus, stomach, colon, rectum, bladder cancers, and acute myeloid leukemia (AML)[ see reference 10 for discussion of effect on tumor type by type of breast cancer treatment). Evans et al.[3] observed significantly elevated risks for 9 cancer sites in women diagnosed with breast cancer before age 50: esophagus, stomach, lung, bone, connective tissue, breast, corpus uteri, ovary and myeloid leukemia, whereas only corpus uteri and myeloid leukemia were increased in women diagnosed after age 49.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal,...) related effects
- Possible bias because of increased surveillance and autopsy findings.


[1] Tanaka H, Tsukuma H, Koyama H, Kinoshita Y, Kinoshita N, Oshima A. Second primary cancers following breast cancer in the Japanese female population. Jpn J Cancer Res 2001; 92(1):1-8.
[2] Rubino C, De Vathaire F, Diallo I, Shamsaldin A, Le MG. Increased risk of second cancers following breast cancer: role of the initial treatment. Breast Cancer Res Treat 2000; 61(3):183-195.
[3] Evans HS, Lewis CM, Robinson D, Bell CMJ, Moller H, Hodgson SV. Incidence of multiple primary cancers in a cohort of women diagnosed with breast cancer in southeast England. British Journal of Cancer 2001; 84(3):435-440.
[4] Li CI, Rossing MA, Voigt LF, Daling JR. Multiple primary breast and thyroid cancers: role of age at diagnosis and cancer treatments (United States). Cancer Causes Control 2000; 11(9):805-811.
[5] Inskip PD, Stovall M, Flannery JT. Lung cancer risk and radiation dose among women treated for breast cancer [see comments]. J Natl Cancer Inst 1994; 86(13):983-988.
[6] Zablotska LB, Neugut AI. Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Cancer 2003; 97(6):1404-1411.
[7] Pendlebury SC, Bilous M, Langlands AO. Sarcomas following radiation therapy for breast cancer: A report of three cases and a review of the literature. Int J Radiat Oncol Biol Phys 1995; 31:405-410.
[8] Matsuyama Y, Tominaga T, Nomura Y, Koyama H, Kimura M, Sano M, Miura S, Takashima S, Mitsuyama S, Ueo H, Ohashi Y. Second cancers after adjuvant tamoxifen therapy for breast cancer in Japan. Ann Oncol 2000; 11(12):1537-1543.
[9] Robinson D, Holmberg L, Møller H. The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ. British journal of cancer 2008; 99(4):611-5.
[10] Schaapveld M, Visser O, Louwman MJ, de Vries EG, Willemse PH, Otter R, van der Graaf WT, Coebergh JW, van Leeuwen FE. Risk of new primary nonbreast cancers after breast cancer treatment: a Dutch population-based study. Journal of clinical oncology 2008; 26(8):1239-46.