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J Clin Oncol. 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.

Author information

1
Chaya S. Moskowitz, Joanne F. Chou, Suzanne L. Wolden, Jonine L. Bernstein, Danielle Novetsky Friedman, Nidha Z. Mubdi, Colin B. Begg, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Jyoti Malhotra, Mount Sinai Medical Center, New York, NY; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Marilyn Stovall and Susan A. Smith, University of Texas MD Anderson Cancer Center, Houston, TX; Sue Hammond, Nationwide Children's Hospital, Columbus, OH; Tara O. Henderson, University of Chicago Medicine Comer Children's Hospital, Chicago, IL; John D. Boice, Vanderbilt-Ingram Cancer Center, Nashville; Melissa M. Hudson and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; Lisa R. Diller and Lisa B. Kenney, Dana-Farber Cancer Institute, Boston, MA; Smita Bhatia, City of Hope National Medical Center, Duarte, CA; and Joseph P. Neglia, University of Minnesota Masonic Cancer Center, Minneapolis, MN. moskowc1@mskcc.org.
2
Chaya S. Moskowitz, Joanne F. Chou, Suzanne L. Wolden, Jonine L. Bernstein, Danielle Novetsky Friedman, Nidha Z. Mubdi, Colin B. Begg, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Jyoti Malhotra, Mount Sinai Medical Center, New York, NY; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Marilyn Stovall and Susan A. Smith, University of Texas MD Anderson Cancer Center, Houston, TX; Sue Hammond, Nationwide Children's Hospital, Columbus, OH; Tara O. Henderson, University of Chicago Medicine Comer Children's Hospital, Chicago, IL; John D. Boice, Vanderbilt-Ingram Cancer Center, Nashville; Melissa M. Hudson and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; Lisa R. Diller and Lisa B. Kenney, Dana-Farber Cancer Institute, Boston, MA; Smita Bhatia, City of Hope National Medical Center, Duarte, CA; and Joseph P. Neglia, University of Minnesota Masonic Cancer Center, Minneapolis, MN.

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.

PMID:
24752044
PMCID:
PMC4100937
DOI:
10.1200/JCO.2013.54.4601
[Indexed for MEDLINE]
Free PMC Article

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