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. 2014 Jul 20;32(21):2217-23.
doi: 10.1200/JCO.2013.54.4601. Epub 2014 Apr 21.

Breast cancer after chest radiation therapy for childhood cancer

Chaya S Moskowitz  1 , Joanne F Chou  2 , Suzanne L Wolden  2 , Jonine L Bernstein  2 , Jyoti Malhotra  2 , Danielle Novetsky Friedman  2 , Nidha Z Mubdi  2 , Wendy M Leisenring  2 , Marilyn Stovall  2 , Sue Hammond  2 , Susan A Smith  2 , Tara O Henderson  2 , John D Boice  2 , Melissa M Hudson  2 , Lisa R Diller  2 , Smita Bhatia  2 , Lisa B Kenney  2 , Joseph P Neglia  2 , Colin B Begg  2 , Leslie L Robison  2 , Kevin C Oeffinger  2
Affiliations

Breast cancer after chest radiation therapy for childhood cancer

Chaya S Moskowitz et al. J Clin Oncol. .

Abstract

Purpose: The risk of breast cancer is high in women treated for a childhood cancer with chest irradiation. We sought to examine variations in risk resulting from irradiation field and radiation dose.

Patients and methods: We evaluated cumulative breast cancer risk in 1,230 female childhood cancer survivors treated with chest irradiation who were participants in the CCSS (Childhood Cancer Survivor Study).

Results: Childhood cancer survivors treated with lower delivered doses of radiation (median, 14 Gy; range, 2 to 20 Gy) to a large volume (whole-lung field) had a high risk of breast cancer (standardized incidence ratio [SIR], 43.6; 95% CI, 27.2 to 70.3), as did survivors treated with high doses of delivered radiation (median, 40 Gy) to the mantle field (SIR, 24.2; 95% CI, 20.7 to 28.3). The cumulative incidence of breast cancer by age 50 years was 30% (95% CI, 25 to 34), with a 35% incidence among Hodgkin lymphoma survivors (95% CI, 29 to 40). Breast cancer-specific mortality at 5 and 10 years was 12% (95% CI, 8 to 18) and 19% (95% CI, 13 to 25), respectively.

Conclusion: Among women treated for childhood cancer with chest radiation therapy, those treated with whole-lung irradiation have a greater risk of breast cancer than previously recognized, demonstrating the importance of radiation volume. Importantly, mortality associated with breast cancer after childhood cancer is substantial.

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Figures

Fig 1.
Fig 1.
Cumulative risk of breast cancer among women treated for childhood cancer with chest irradiation (A) overall and by childhood cancer therapy: (B) chest radiation dose; (C) chest irradiation field; (D) ovaries in concurrent irradiation field; (E) alkylating agents.
Fig 2.
Fig 2.
Cumulative risk of breast cancer. Breast cancer risk among women treated for childhood cancer with chest irradiation contrasted with breast cancer risk in female carriers of BRCA1 or BRCA2 deleterious mutations and women in general US population, with a birth-year distribution reflective of CCSS (Childhood Cancer Survivor Study) participants. (*) Insufficient follow-up in this group to provide reliable estimates of cumulative risk of breast cancer by age 50 years.
Fig 3.
Fig 3.
Death after breast cancer among childhood cancer survivors treated with chest irradiation. All-cause and breast cancer–specific mortality after breast cancer after chest radiotherapy for childhood cancer compared with expected mortality, age and year standardized to US population.
See this image and copyright information in PMC

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