Biomedical subjects

J C Durand

Publications and source records attributed to J C Durand.

At least 19 recordsLinked to original sources

PubMed2001

[Relevance of combined radiation and surgical treatment of early invasive carcinoma of the cervix].

The aim of this study was to assess the result and the postherapeutic complications rates of preoperative radiation therapy and radical surgery in association, for stage IB to IIB cervical carcinoma. For 1983 to 1990, 314 patients were treated at the Institut Curie for stage IB to IIB cervical carcinoma. For small lesions, less than 4 cm, preoperative uterovaginal brachytherapy was performed (60 to 65 Gy), followed, 6 weeks later, by a modified radical hysterectomy (Piver type 2) with pelvic lymphadenectomy. Larger tumors were treated with pelvic radiotherapy (36 Gy), then by brachytherapy (30 Gy), followed, 6 weeks later, by the same surgical procedure. 82% of the tumors were 4 cm or smaller. 64% of tumors were completely sterilised by the preoperative radiation. 5 and 10-year actuarial survival rates were respectively 81% and 70 %. 5-year actuarial survival rate was 87.5% for stage I and 63% for stage II patients. 5-year local disease free survival rate was 88% for stage I and 73% for stage II patients. All complications were prospectively recorded. The early post operative complication rate was 6.3%, with no urinary complications. The late complication rate was 3.3%, mainly grade 2 sequelae. No ureteral fistulas were observed. By combined preoperative radiotherapy and surgery, adapting the dosimetry and the radicality of the procedure, we obtained cure rates and recurrence rates identical to those obtained with exclusive surgery or radiotherapy alone. However, the complication rate of the association of both adapted treatments, has considerably reduced the early and late complication rate.

Adult↗

PubMed1999

Second look for ovarian cancer: laparoscopy or Laparotomy? A prospective comparative study.

OBJECTIVE: The objective of this study was to evaluate, for patients with ovarian cancer, the feasibility, reliability, and complications of a laparoscopic second look and to compare them with those of a second look by laparotomy. METHODS: Twenty patients treated by initial surgery and adjuvant chemotherapy for ovarian carcinoma underwent a laparoscopic second look, immediately followed by a comparative laparotomy. All were in complete remission after chemotherapy. Both operations were performed according to a predefined checklist, identical for both surgical techniques and for each patient: after liberation of adhesions, an exhaustive intraperitoneal inspection was performed, with systematic peritoneal cytology and biopsies. Each patient therefore was her own control for the two techniques. RESULTS: The positive predictive value of laparoscopy for the diagnosis of residual disease was 100% (6 of 6 cases), while the negative predictive value was 86% (2 false-negative cases out of 14). Because of the presence of postoperative adhesions, the rate of complete intraperitoneal investigation was 95% for laparotomy versus 41% for laparoscopy. The complication rate of laparoscopy requiring laparotomy was 5.3%. CONCLUSIONS: After treatment of ovarian cancer, a laparoscopic second look appears to be less reliable than one performed by laparotomy. The presence of severe postoperative adhesions is the main obstacle to an exhaustive, reliable, and safe laparoscopic second look.

Adult↗

PubMed1999

Remote tumor cells in the case of breast cancers: significance of their presence for prognosis [corrected].

Through two clinical studies, tumor cells were searched for in the bone biopsies and cytapherisis of patients suffering from inflammatory tumors and who had undergone intensive therapy and autografts (Pegase 2 program). In these studies we used immunocytochemical test with two monoclonal antibodies. The results have shown the presence of tumor cells in 14% of the patients (respectively 18%), with no correlation to the appearance of metastases after 4 years in the first study. Nevertheless, the presence of these tumor cells seems to be an important factor in the number of relapses. It seems important to develop research into tumor contamination especially in the selection of grafts over the next few years.

Adult↗

PubMed1999

[Conservative treatment of multifocal breast cancer: a comparative study].

Conservative treatment of multifocal breast cancer is still very controversial. This retrospective study concerns 56 patients with stage I or II multifocal breast cancer who underwent conservative treatment at the Institut Curie from January 1983 to December 1989. These patients (group 1) were matched with 132 patients with multifocal lesions treated by mastectomy (group 2). Surgical treatment consisted of a single wide lumpectomy followed by external radiotherapy. Adjuvant systemic therapy and regional nodal irradiation were administered as indicated by current protocols. The actuarial 5-year overall survival rate was 94% 6 in group 1, and 90% 6 in group 2 (NS). The actuarial 5-year ipsilateral breast recurrence rate was 11% 8 in group 1, and 11% 5 in group 2 (NS). In group 1 patients, the ipsilateral breast recurrence rate was related neither to type of multifocality nor to presence of intra ductal breast carcinoma, nodal status, tumor margins, radiotherapy boost, or distance between tumors. Consequently, conservative treatment of multifocal breast cancers which can be completely removed by a single lumpectomy seems, when technically feasible, an alternative to mastectomy.

Adult↗

PubMed1998

Increased expression of prolactin receptor gene assessed by quantitative polymerase chain reaction in human breast tumors versus normal breast tissues.

The role of PRL in human breast tumorigenesis is not well understood. One of the limitations is the difficulty of accurately measuring PRL receptors (PRLR) in human tissues. We established a quantitative PCR method (Q-PCR) in T-47D human breast cancer cells and applied it to 29 patients, 25 of whom presented with either cancer or fibroadenoma. Four patients underwent a mammoplasty, and normal epithelial cells were cultured before Q-PCR. In T-47D cells, 31 x 10(6) messenger RNA molecules were detected per microgram of total RNA. In all patients, expression of the PRLR gene was detected, varying from 1500 to 1 x 10(6) molecules/microgram of RNA in normal tissues and from 4500 to 34.7 x 10(6) molecules/microgram of RNA in tumors. PRLR expression was always greater in tumor than in normal contiguous tissue and similar in cultured mammary epithelial cells and normal breast tissues. Estradiol and progesterone receptor-negative tumors expressed low levels of PRLR transcripts, similar to normal breast tissue from menopausal women. Immunocytochemical analysis of PRLR confirmed stronger staining in almost all tumor samples compared with normal tissues. A messenger RNA encoding locally produced human PRL was also identified by RT-PCR in every sample tested. Our results confirm PRLR gene expression in all tissues studied, and moreover, indicate that this expression is increased in human breast tumors vs. normal contiguous tissues.

Adult↗

PubMed1997

[Breast cancers with central localization: conservative treatment by tumorectomy with ablation of the areolar plaque].

OBJECTIVES: In breast cancer, retroareolar tumors are observed in 5 to 20% of cases; mammectomy is the conventional treatment. Conservative surgery was used in this series of 36 patients with retroareolar cancer situated less than 2 cm from the areola. PATIENTS AND METHODS: Tumorectomy with resection of the areolar plaque was followed by radiotherapy. Six patients had Paget's disease of the nipple, 64% were in classes T0 or T1 and 36% in T2. Chemotherapy or radiotherapy was given for tumor reduction prior to surgery in 8 patients. Wide tumorectomy with resection of the areolar plaque and gland remodeling was performed in all patients. Three plastic surgery techniques were used. Mean tumor size was 17.3 mm (8 to 33 mm). The areola was invaded in 16 patients (44%) and the derma or retroareolar ducts in 26 (72%). RESULTS: The mean distance between the tumor and skin surface was 3.8 mm. The section surface was in healthy tissue in 31 patients and 2 patients underwent subsequent surgery for mammectomy. All patients had either pre-operative (n = 4) or post-operative (n = 32) radio-therapy. Secondary reconstruction of the nipple was performed in 14 patients. CONCLUSION: Histology findings and esthetic results suggested that this conservative approach can be proposed when the tumor is located close to the areola, as confirmed by our series and results from other teams using the same technique.

Adult↗

PubMed1997

S-phase fractions of breast cancer predict overall and post-relapse survival.

We studied the correlation of S-phase fraction (SPF) with clinical outcome in 127 pre- or perimenopausal patients with breast cancers treated by neoadjuvant chemotherapy from October 1986 to June 1990. When the patients were analysed using the median value of the SPF as a threshold, there was a small but non-significant difference in favour of low SPF tumours for metastasis-free survival. SPF was the only parameter predicting overall survival in multivariate analysis (P < 0.002) which included T, N, histopathological grade and steroid hormone receptors. The results of metastasis-free survival contrasted with previous analyses with shorter follow-up, so we tested the time-dependent influence of SPF on prognosis. It was thus shown that SPF significantly predicts metastasis-free survival only during the first 30 months, whereas the relative risk of cancer-related death according to SPF remains significant for 56 months. In order to find an explanation for the difference in predictivity between metastasis-free survival and overall survival, we studied the post-relapse survival. Significantly shorter survival (median 12 months) was associated with tumours presenting pre-treatment high SPF values, compared to the low SPF group for which 60% of the patients were still alive after 30 months of metastasis phase (P = 0.002). Our current results, in a homogeneous series with a median follow-up of over 5 years, emphasise the importance of proliferation-related parameters for breast cancer management.

Adult↗

PubMed1996

Decreased frequency of HLA-DRB1 13 alleles in Frenchwomen with HPV-positive carcinoma of the cervix.

Specific types of human papillomaviruses (HPV) are associated with most cases of pre-invasive and invasive neoplasia of the uterine cervix. HLA phenotype influences susceptibility and resistance to viral infections and may therefore influence the course of HPV-associated tumors. Some data suggest that specific HLA class-II alleles may be associated with protection from or susceptibility to papillomavirus-associated lesions, but these results are still controversial. Using molecular probes, we looked for associations between specific DQA1, DQB1, DRB1 HLA class-II alleles, HPV types and cervical cancer. The analysis was performed on a population of 126 patients with invasive cervical cancer. For HLA typing, 165 healthy individuals were taken as controls. The DRB1 1301/02 allele frequency significantly decreased in patients (11%) as compared to controls (29%). This difference in frequency was dependent on the HPV-positive status of tumors and was no longer significant in the group of HPV-negative lesions. The same trends were observed with the DRB1 1301/02-DQA1 0103-DQB1 0603 haplotype frequency. An increase in the frequency of the DRB1 1401/07 and DRB1 03 alleles was observed in patients under 40. Contrary to what has been reported in the literature, no increase in the DRB1 15 allele frequency was observed in our series and only a slight increase in the DQB1 03 frequency was found in patients (70%) compared to controls (58%). In our study, no positive correlations between cervical cancer in Frenchwomen and specific HLA DR-DQ haplotypes has been found. In contrast, a negative correlation between DRB1 1301/ 02 alleles and HPV-positive tumors has been observed. This may suggest a protective effect of DR13 against HPV-associated lesions of the cervix.

Adult↗

PubMed1996

Laparoscopic unilateral ovarian transposition prior to irradiation: prospective study of 20 cases.

BACKGROUND: The objective of this study was to evaluate the feasibility, morbidity, and efficacy of unilateral laparoscopic ovarian transposition on the preservation of hormonal function in premenopausal patients requiring pelvic irradiation (external and/or intracavity by brachytherapy). METHODS: This prospective study was based on 20 patients: 17 presenting with cervical cancer, 2 with Hodgkin's disease, and 1 with ependymoma of the cauda equina. The operative technique consisted of releasing the right ovary from its pelvic attachments, and placing it as high and as laterally as possible in the right paracolic gutter, after creating a pedicle on the infundibulopelvic ligament. The follow-up of ovarian function was more than 1 year for 14 patients. RESULTS: The therapeutic protocol was not modified as a result of ovarian transposition. No intraoperative or postoperative complications were observed. The mean dose of irradiation received by the transposed ovary was 1.75 gray (Gy) (range 0.4-3.7). Mean follow-up was 2 years. Two cases of menopause (14.7%), in the only 2 patients older than 40 years, were observed among the 14 patients followed for more than 1 year. The success rate was 100% for patients younger than age 40 years. CONCLUSIONS: Laparoscopic ovarian transposition is a simple and reliable method, which does not complicate subsequent therapeutic protocol. Its short term efficiency is comparable to results obtained by laparotomy, with a lesser morbidity. Although long term evaluation is necessary, laparoscopic surgery should be considered as an alternative to laparotomy for ovarian transposition.

Adult↗

PubMed1996

Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns.

BACKGROUND: The clinicopathologic features of infiltrating lobular carcinoma (ILC), which represents 5% to 15% of all breast cancers, are still controversial. In particular, the high frequency of multicentric lesions has led to questioning of the effectiveness of conservative treatment for this type of cancer. By studying a large number of cases, we aimed to compare the clinicopathological features of ILC with those of nonlobular infiltrating carcinoma (NLIC) and to assess the advisability of conservative therapy in the management of ILC. METHODS: The population analyzed included 726 cases of ILC, 249 cases of mixed ILC/invasive ductal carcinoma (ILC/IDC), and 10,061 cases of NLIC. The age of patients, TNM status, estrogen- and progesterone-receptor status (ER, PR), and histologic grades of the 3 groups were compared. The follow-up was carried out on a subgroup of 5846 cases. RESULTS: At diagnosis, ILC tumors were found to be larger on average and were detected in patients older than those with NLIC, but the degree of lymph node involvement was lower in patients with ILC than in NLIC. In ILC, tumors are more frequently grade I and ER-positive than in NLIC. Multicentric lesions were not significantly more frequent in ILC than in NLIC. The overall survival, locoregional control, disease free interval, and metastatic spread rates were not different among the three groups neither by univariate nor multivariate analysis, but the pattern of metastatic dissemination was different. In 480 cases of ILC considered for conservation therapy, the local recurrence and overall survival rates were similar to those observed for IDC. CONCLUSIONS: Our analysis specifies the clinicopathological features of ILC and confirms that conservation therapy may be an appropriate treatment for this type of cancer.

Breast Neoplasms↗

PubMed1996

Immediate breast reconstruction by prosthesis: a safe technique for extensive intraductal and microinvasive carcinomas.

BACKGROUND: Immediate breast reconstruction (IBR) by prosthesis is frequently proposed after mastectomy. However, due to the morbidity of this operation, especially the early implant removal rate, its indications remain controversial. METHODS: We have performed 141 IBR by prosthesis (saline or gel-filled implant, tissue expander) in a homogeneous population of patients with extensive intraductal or microinvasive carcinoma, diagnosed after an initial local excision. This prospective study was designed to assess the feasibility and morbidity of IBR for an "ideal" population, allowing wide cutaneous preservation, without preoperative or postoperative treatment. RESULTS: The early prosthesis removal rate (< 2 months) was 0.7%, with only 2.1% of early surgical revisions and 3% of lymphoceles. Cutaneous complications (5%) were significantly correlated with the type of incision. Cosmetic results at 1 year were good or very good in 66% of cases, similar to the percentage observed after delayed reconstruction by prosthesis. CONCLUSIONS: In this selected population, IBR by prosthesis did not induce any additional morbidity compared with mastectomy without reconstruction. IBR by prosthesis can be systematically proposed in cases of extensive intraductal or microinvasive carcinoma.

Breast Implants↗

PubMed1996

Isolated axillary recurrences after conservative treatment of breast cancer.

This retrospective study presents the diagnostic, prognostic and therapeutic problems raised by axillary recurrences (AR). 1589 cases of breast cancer measuring less than 3 cm, treated at the Institut Curie between 1981 and 1987, were studied by a combination of surgery and radiotherapy. Treatment of the breast always included wide local excision associated with irradiation. The axilla was treated either by dissection (865 cases) or by irradiation (724 cases) and 159 patients received chemotherapy. 26 patients (2%) developed AR, confirmed by fine needle aspiration cytology in 92% of cases. None of these 26 patients had initially received chemotherapy. The treatment of the AR was variable, adapted to the initial treatment. 22 patients retained their breast during treatment of the AR and none subsequently developed a local recurrence. 4 mastectomies were performed and histological examination revealed a subclinical local recurrence in 2 cases. The TNM classification, menopausal status, size of the tumour and hormonal receptor status were not risk factors for AR. Young age (P = 0.01) and high histological grade (P = 0.03) were significant risk factors for AR. The AR rate was similar whether axillary dissection or axillary irradiation had been performed. The overall 5-year survival after initial treatment was 85% for AR and 95% for the reference population. The overall 4-year survival after recurrence was 69% and the incidence of metastasis was markedly increased (P = 0.002). 2 of the 26 patients developed lymphoedema of the arm after treatment of AR. We confirm that AR worsens the prognosis, but not significantly more than local recurrence. Young age and the modified histological grading of Scarff Bloom and Richardson were risk factors for AR. Although excision of the AR is necessary to ensure local control, mastectomy is unnecessary when clinical examination and mammography are normal.

Age Factors↗

PubMed1996

[Intraductal cancer of the breast in women under age 35 years].

The incidence of intraductal carcinomas (IDC) of the breast is increasing. However, few cases have been reported in young women. Based on a series of 13,168 women treated for breast cancer at the Institut Curie over a 12-year period, this article analyses the prevalence, clinical presentation, prognosis and treatment of IDC in patients younger than 35 years. Of this series of 13,168 cancers, 882 occurred in women under the age of 35 years (6.7%). Sixteen of these cases (2%) were strictly intraductal lesions and therefore constituted the study population. The frequency of IDC in women under the age of 35 years was identical to that of IDC in the general population of this study. The circumstances of discovery were: palpable tumour in seven cases (44%), mammographic discovery in four cases (25%), nipple discharge in five cases (31%). Histological examination revealed a well-differentiated IDC in two cases, moderately differentiated in seven cases and poorly differentiated in five cases (two cases not specified). Conservative treatment by lumpectomy and irradiation was performed in nine patients, and another seven patients were treated by mastectomy and low axillary lymph node dissection. The mean follow-up was 83 months (range: 5 to 156 months). A single patient has relapsed: an isolated invasive mammary recurrence, 6 years after conservative treatment. This patient in now in complete remission after mastectomy. All patients are therefore alive, with no evidence of disease, at 83 months. In the group of women younger than 35, the frequency of IDC appeared to be identical to that observed in the general population. Their prognosis after treatment is excellent, and identical to that of IDC in older women. Conservative treatment is justified in localized forms, but mastectomy with immediate reconstruction must be performed in the presence of extensive disease.

Adolescent↗

PubMed1996

[Contralateral breast cancer: metastasis or second primary cancer?].

Metachronous contralateral breast cancer (CBC) is defined as a tumour in the opposite breast which was diagnosed more than 6 months following the detection of the first cancer. We screened, for factors that might predict the risk of developing CBC, a cohort series of 4748 women who had invasive unilateral breast cancer, clinical stage I-IIIa and had been treated at Institut Curie (Paris) between 1981 and 1987. Two hundred and eighty two CBC had been diagnosed with a median follow-up of 80 months. The cumulative rate of CBC was 4.1% at 5 years. We studied relationships between CBC and family history of breast cancer, age at diagnosis of first cancer, menopausal status, tumour size, node involvement, histological type, Scarff Bloom Richardson grade, estrogen and progesterone receptor measurements, as well as the type of primary treatment. Due to competing risks between the occurrence of CBC, local recurrence and metastasis, several options for multivariate analysis were considered. In model I, we focused on the occurrence of CBC, and ignored others events. In model II, only CBC, if first site of failure was taken into account, and in model III we considered others events as time-dependant covariates. Whichever the model we chose, age less than 55 years (RR = 1.40) as well as the presence of lobular type carcinoma (RR = 1.50), were associated with an increased risk of developing a tumour in the contralateral breast. In contrast, the risk of CBC was significantly decreased by adjuvant chemotherapy (RR = 0.54). Neither tumor stage or lymph node involvement influence the risk of CBC. These results suggested that CBC is a second primary breast cancer.

Adult↗

PubMed1995

[Breast cancer without palpable tumor revealed by microcalcifications. Prognosis and treatment].

OBJECTIVES: Routine screening mammography has greatly increased the number of breast cancers detected in the form of clumped microcalcifications without a palpable tumour. METHODS: From 1964 to 1989, 315 breast cancers revealed by microcalcifications without contralateral cancer, treated at the Institut Curie. Cancers were observed in 40% of the microcalcifications excised. Treatment was conservative in 57.5% of cases and mutilating in 42.5% of cases; these rates have changed only very slightly with time. Histologically, 50% of the tumours were intraductal cancers, 25% were microinvasive, 24% were infiltrating and 1% were lobular in situ carcinomas. The therapeutic indication can be defined on the basis of the histological result of the initial tumour excision, as the initial examination underestimated the lesions in only 5.6% of cases. Lymph node invasion was observed in 1.8% of intraductal cancers, 5.3% of microinvasive cancers and 14.8% of invasive cancers. RESULTS: The overall survival was 99% at 5 years and 89.9% at 10 years. The prognosis of invasive cancer was less favourable than that of intraductal and microinvasive cancers (p = 0.03). Survival was not influenced by the radical or conservative nature of treatment. The presence of lymph node invasion severely worsened the prognosis. The 5 year recurrence rate was 4.2% for intraductal, 4.6% for microinvasive and 6.1% for invasive. The incomplete nature of the resection increased the local recurrence rate: 11.9% at 5 years instead of 5%. CONCLUSION: Conservative treatment of cancers revealed by microcalcifications without a palpable tumour therefore appears to be justified provided the lesion is radiologically localized, with a histologically satisfactory resection and in the absence of residual microcalcifications on postoperative mammography.

Adult↗

PubMed1995

Breast tumour response to primary chemotherapy predicts local and distant control as well as survival.

The purpose of the present paper was to evaluate correlations between clinical response to chemotherapy and outcome in a subgroup analysis of premenopausal patients with tumours considered too large for breast conserving surgery, treated with primary chemotherapy (n = 200) from a previously published trial (Scholl S.M., Fourquet A., Asselain B, et al. Eur J Cancer 1994, 30A, 645-652). Objective response rates amounted to 65% following four courses. In a multivariate Cox regression analysis, comparing seven parameters, the following variables were associated with poor survival: clinically involved nodes [N1b:RR: 2.7 (95% CI 1.3-5.3)], the failure to respond to chemotherapy [D:RR: 2.62 (95% CI 1.3-5)] and a raised S phase fraction [SPF > 5%: RR: 2.4 (95% CI 1.2-5)]. Parameters associated with increased metastatic recurrence rates, by order of entry in the model, were: young age [< 35: RR: 2.46 (95% CI 1.2-5)], large clinical tumour size [T3: RR: 2.02 (95% CI 1.2-3.4)], poor histological grade (SBR III: RR: 1.93 (95% CI 1.1-3.3)] and the failure to respond to chemotherapy [D: RR: 1.91 (95% CI 1-3.4)]. The assessment of both tumour cell proliferation rates as well as possibly drug resistance markers (although not available in the present study) should be helpful in selecting patients likely to benefit from intensified chemotherapy regimens. The most accurate predictor of response in the present study appeared to be the response to chemotherapy treatment itself.

Adult↗

PubMed1995

Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors.

Conservative treatment of breast cancers confined to the lower quadrants often leaves a residual deformity. In order to prevent these poor cosmetic results, 20 patients with lower quadrant cancers have been treated since 1986 at the Institut Curie by wide lumpectomy combined with immediate remodeling of the gland by nipple-bearing superior pedicle mammaplasty and preoperative (9 cases) or postoperative (11 cases) irradiation. The contralateral breast was always rendered symmetrical at the same time. The mean weight of resection was 248 gm, and the resection margins were always free of tumor. The treatment protocols were not modified by the addition of mammaplasty to lumpectomy, and this combination did not induce any significant complications. The mean follow-up was 4.5 years (range 1 to 7.5 years). There was one case of local recurrence; there were four cases of metastases. In this series, the oncologic results were identical to those of conventional treatment by lumpectomy and irradiation. The cosmetic result was good or very good in 75 percent of patients and 91 percent of patients in the group in which mammaplasty was performed prior to irradiation. Treatment of breast cancers by superior pedicle reduction mammaplasty and irradiation is indicated in tumors located in the lower quadrants, whose size in relation to the breast volume is such that conventional conservative treatment by lumpectomy and irradiation would achieve a poor cosmetic result.

Adult↗

PubMed1995

Contralateral breast cancer: annual incidence and risk parameters.

PURPOSE: To screen for factors that might predict the risk of developing metachronous contralateral breast cancer (CBC), taking into account the influence of local or distant recurrence, and to assess the annual incidence of CBC. PATIENTS AND METHODS: Of 4,748 women with invasive unilateral breast cancer, clinical stage I to IIIa, treated between 1981 and 1987, 282 metachronous CBCs were diagnosed. Due to competing risks between the occurrence of CBC and other events, several options for multivariate analysis were considered. RESULTS: The median follow-up time was 80 months (range, 1 to 158). The cumulative rate of CBC was 4.1% +/- 0.3% at 5 years, and the annual incidence rate of CBC increased slowly, while the risk of local recurrence and metastases decreased after the fourth year. Whichever model we chose, age less than 55 years (relative risk [RR] = 1.40) at the time of diagnosis of the first breast cancer, as well as the presence of lobular type carcinoma (RR = 1.50), was associated with an increased risk of developing a tumor in the contralateral breast. Adjuvant chemotherapy significantly decreased (RR = 0.54) the risk of CBC. CONCLUSION: Lobular histology and age less than 55 years are found to increase the risk of CBC, while adjuvant chemotherapy significantly decreased the risk of CBC. The progressive rise in the annual incidence rates of CBC, together with the absence of a link between clinical prognostic factors of the first cancer and CBC, suggested that CBC can be considered as a second primary breast cancer.

Adult↗