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Breast cancer risk among childhood cancer survivors treated with radiation higher than previously thought
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Females who underwent chest irradiation during treatment for childhood cancer are at the same risk for breast cancer later in life than women with BRCA mutations, according to study results.
Also, breast cancer-associated mortality among females treated for childhood cancer is substantial, results showed.
The findings suggest breast cancer surveillance at a young age should be considered for these individuals, researchers wrote.
“To our knowledge, [this is the first] side-by-side comparison of these high-risk populations highlights the need to consider providing women treated as children with chest irradiation a model of care involving risk communication and counseling, breast cancer surveillance, and prevention strategies commensurate to the approach used with women who have a high familial risk,” the researchers wrote.
Researchers examined the cumulative breast cancer risk in 1,230 women included in the Childhood Cancer Survivor Study, all of whom underwent chest irradiation. The investigators assessed variations in breast cancer risk based on radiation dose and irradiation field.
Results showed women who received a lower dose of radiation (median, 14 Gy; range, 2-20) delivered to a large volume — meaning the whole-lung field — had a higher risk for breast cancer than previously thought (standardized incidence ratio [SIR]=43.6; 95% CI, 27.2-70.3). Similarly, women treated with high-dose radiation (median, 40 Gy) to the mantle field also demonstrated higher breast cancer risk (SIR=24.2; 95% CI, 20.7 to 28.3).
The cumulative incidence of breast cancer by age 50 was 30% (95% CI, 25-34); among women who survived childhood Hodgkin’s lymphoma, cumulative breast cancer incidence by age 50 was 35% (95% CI, 29-40).
Among all study participants, the rate of breast cancer-specific mortality was 12% (95% CI, 8-18) at 5 years and 19% (95% CI, 13-25) at 10 years.
“Breast cancer after childhood cancer is associated with substantial mortality,” the researchers wrote. “The reasons for this high mortality rate warrant further study. Of note, we are limited by lack of information on breast cancer stage at diagnosis; in the general population, mortality is strongly associated with stage at diagnosis. Nevertheless, this seems to be an opportunity for lifesaving interventions.”
Disclosure: The researchers report no relevant financial disclosures.
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