Breast cancer after chest radiation therapy for childhood cancer Journal Article


Authors: Moskowitz, C. S.; Chou, J. F.; Wolden, S. L.; Bernstein, J. L.; Malhotra, J.; Friedman, D. N.; Mubdi, N. Z.; Leisenring, W. M.; Stovall, M.; Hammond, S.; Smith, S. A.; Henderson, T. O.; Boice, J. D.; Hudson, M. M.; Diller, L. R.; Bhatia, S.; Kenney, L. B.; Neglia, J. P.; Begg, C. B.; Robison, L. L.; Oeffinger, K. C.
Article Title: Breast cancer after chest radiation therapy for childhood cancer
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. © 2014 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer chemotherapy; child; controlled study; treatment outcome; leukemia; bone tumor; major clinical study; cancer risk; multimodality cancer therapy; cancer radiotherapy; radiation dose; cancer diagnosis; breast cancer; alkylating agent; brca1 protein; brca2 protein; cancer mortality; central nervous system tumor; childhood cancer; hodgkin disease; radiation exposure; cancer survivor; nonhodgkin lymphoma; whole body radiation; neuroblastoma; dosimetry; long term care; soft tissue sarcoma; cancer epidemiology; intraductal carcinoma; longitudinal study; nephroblastoma; thorax; standardized incidence ratio; tumor invasion; whole lung irradiation; human; female; priority journal; article; thorax radiation
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 21
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-07-20
Start Page: 2217
End Page: 2223
Language: English
DOI: 10.1200/jco.2013.54.4601
PROVIDER: scopus
PMCID: PMC4100937
PUBMED: 24752044
DOI/URL:
Notes: Export Date: 2 September 2014 -- CODEN: JCOND -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    149 Chou
  2. Nidha Zareen Mubdi
    3 Mubdi
  3. Colin B Begg
    231 Begg
  4. Suzanne L Wolden
    417 Wolden
  5. Chaya S. Moskowitz
    171 Moskowitz
  6. Kevin Oeffinger
    251 Oeffinger
  7. Jonine L Bernstein
    100 Bernstein