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Distribution of Second Primary Malignancies Suggests a Bidirectional Effect Between Breast and Endometrial Cancer: A Population-Based Study
  1. Laura Cortesi, MD*,
  2. Elisabetta De Matteis, MD*,
  3. Ivan Rashid, PhD,
  4. Claudia Cirilli, PhD,
  5. Manuela Proietto, MD*,
  6. Francesco Rivasi, MD and
  7. Massimo Federico, MD*
  1. *Dipartimento di Oncologia ed Ematologia, Università di Modena e Reggio Emilia, Italy;
  2. Registro Tumori di Modena, Italy; and
  3. Dipartimento di Diagnostica di Laboratorio, Università di Modena e Reggio Emilia, Italy.
  1. Address correspondence and reprint requests to Laura Cortesi, MD, Dipartimento di Oncologia ed Ematologia, Università degli Studi di Modena e Reggio Emilia, Centro Oncologico Modenese, Via del Pozzo 71, 41100, Modena, Italy. E-mail: hbc{at}


Introduction: The aim of this study was to investigate the incidence of second primary tumors in patients with breast cancer (BC), with particular regard to bidirectional risk for endometrial cancer (EC).

Methods: A total of 7512 and 343 patients with first and second primary BC, respectively, were referenced to the expected number of cases calculated using the standardized incidence ratio (SIR) over the same period, to evaluate the observed and expected ratio between the groups. Data on tamoxifen use were also considered.

Results: A total of 499 women with primary BC developed a second tumor. The total SIR, that is, the ratio between observed second primary cancer among patients with BC and the expected primary cancers in the general population, was significantly higher (SIR = 1.23; 95% confidence interval, 1.12-1.34; P = 0.007), particularly for melanoma (2.25), EC (2.15), ovarian cancer (1.74), hematologic malignancies (1.36), and bilateral BC (1.25). A greater risk of BC after thyroid (2.22) and EC (1.62) was also observed. Furthermore, the risk of developing EC was higher in patients treated with tamoxifen (SIR = 2.50 vs 1.34).

Conclusions: Bidirectional risk of endometrial cancer was not exclusively related to tamoxifen use.

  • Breast cancer
  • Endometrial cancer
  • Cancer registry
  • Tamoxifen
  • Second cancer

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  • This study was supported by grants from the Associazione "Angela Serra" per la Ricerca sul Cancro.

  • The authors declare that there are no conflicts of interest.