A Second Cancer After Breast Cancer

Individuals who have been diagnosed with breast cancer may have an increased risk of developing a second primary cancer. Second primary cancers are different from recurrent cancers as they are an entirely different cancer from the first. Recurrent cancer occurs when a cancer comes back after treatment, which may happen years after the initial treatment. The risk of a second cancer can be influenced by various factors, including genetic predisposition, lifestyle choices and treatment received for the initial breast cancer.

Some common second primary cancers that may occur after breast cancer include:

• Contralateral breast cancer

This refers to a new cancer that develops in the opposite breast from the one initially affected. The risk of contralateral breast cancer is higher in individuals with a family history of breast cancer or specific genetic mutations like BRCA1 and BRCA2.

• Ovarian cancer

There is an increased risk of ovarian cancer in women with certain genetic mutations (e.g. BRCA1, BRCA2) or a strong family history of breast and ovarian cancer.

• Endometrial cancer

Some studies suggest that women with breast cancer may have an elevated risk of endometrial cancer. Factors like hormone replacement therapy, obesity, and specific genetic syndromes may influence this risk. For example, tamoxifen is a type of hormone therapy that may be used after breast cancer treatment to reduce the risk of breast cancer returning. However, it can also increase your risk of developing endometrial cancer. Fortunately, the risk of this happening is very low and the benefits of taking tamoxifen as a risk-reducing strategy outweigh this risk.

• Lung cancer

Studies have shown an elevated risk of lung cancer in breast cancer survivors, particularly those with a history of smoking and/or radiation therapy.

• Colorectal cancer

Breast cancer survivors may face a slightly increased risk of colorectal cancer, especially if they have a family history of the disease.

• Melanoma and skin Cancers

Some studies suggest a slightly elevated risk of melanoma and non-melanoma skin cancers in individuals with a history of breast cancer.

• Thyroid cancer

Evidence suggests a small increased risk of thyroid cancer after breast cancer, particularly in survivors who received radiation therapy.

• Hematologic cancers (e.g. Leukemia, Lymphoma)

Some studies have found a slightly higher risk of certain hematologic cancers in breast cancer survivors, potentially related to treatment with certain chemotherapies.

• Sarcomas

While rare, there have been cases of sarcomas occurring as second cancers in breast cancer survivors.

As with all cancers, it is impossible to completely prevent any cancer. However, there are ways that may reduce the risk of a second cancer. Reducing the risk of developing a second cancer involves a combination of lifestyle choices, regular medical check-ups, and, in some cases, specific medical interventions. Here are some general steps you can take to lower your risk.

Regular check-ups and screenings

Follow your healthcare provider's recommendations for cancer screenings and check-ups. These can detect early signs of cancer or precancerous conditions. Attend regular follow-up appointments as advised by your healthcare team.

Maintain a healthy lifestyle

• Avoid/quit smoking

Smoking is a significant risk factor for numerous types of cancer.

• Limit alcohol consumption

If you drink alcohol, do so in moderation. Excessive alcohol consumption is linked to an increased risk of several cancers.

• Eat a balanced diet

Prioritize fruits, vegetables, whole grains, and lean proteins. Limit processed foods, sugary drinks, and excessive red or processed meat.

• Stay physically active

Regular exercise can help reduce the risk of various cancers. Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week.

• Maintain a healthy weight

Being overweight or obese is associated with an increased risk of many types of cancer. Making dietary and lifestyle changes can help in maintaining a healthy body weight.

Consider genetic testing and counseling

If you have a family history of certain cancers or known genetic mutations (e.g. BRCA1, BRCA2), consider genetic counseling and testing. This can help assess your risk and guide personalized screening and prevention strategies, especially since certain genetic mutations are risk factors for multiple cancers.

Adhere to medical recommendations

Follow your healthcare provider's advice regarding medications, hormonal treatments, and lifestyle modifications specific to your situation.

Medical interventions

Certain medical interventions may be recommended for high-risk cases to lower the risk of specific second cancers. For example, individuals with BRCA gene mutations may be recommended a mastectomy for the unaffected breast to lower the risk of a second breast cancer or an oophorectomy to remove the ovaries and fallopian tubes to prevent ovarian cancer.

Remember, while these steps can help reduce the risk of developing a second cancer, they cannot completely eliminate it. Consistent communication with your healthcare team is essential for personalized advice and care. They can help tailor a plan that is most appropriate for your individual situation and health history.

It's important to note that while there is an increased risk of these second cancers, the overall risk is still relatively low. Additionally, advances in early detection and treatment have significantly improved outcomes for many cancer types. Regular follow-up with a healthcare provider, appropriate cancer screenings, and lifestyle modifications can help manage these risks.

Each person's situation is unique, so it's crucial for breast cancer survivors to discuss their risk factors and screening recommendations with their healthcare team. They can provide the most tailored advice based on the specific type of breast cancer, treatment received, and any underlying genetic predispositions.