If a woman smoked, contracted breast cancer, and was treated with
radiation before 1980, her risk of lung cancer has been dramatically
increased. Even if she did not smoke, her chances for lung cancer
rose. These are the findings of a preliminary study conducted
at the Columbia University College of Physicians & Surgeons
by Alfred I. Neugut, MD, PhD, an associate professor of clinical
medicine and public health.
The study compared 89 breast cancer patients diagnosed with lung
cancer since 1986 with more than 1,000 breast cancer patients
diagnosed with nonsmoking, nonradiation related malignancies during
the same period. Neugut showed that the smokers with breast cancer
had more than 30 times the risk of lung cancer compared with those
who didn't smoke and had not received radiation.
"This is the first time that a combined risk for lung cancer
from cigarette smoking and therapeutic radiation has been shown,"
Neugut said. "That the excess lung cancer was on the same
side as the breast that was irradiated strongly indicates a causal
relationship and not a statistical fluke."
Now that radiation therapy has improved, delivering narrower,
more focused and contoured beams, the associated risks may be
considerably lower, Neugut notes. In the widely used radiation
techniques following lumpectomy, the beam is directed toward the
breast tissue, away from the chest wall and lung.
Neugut's study confirms his earlier findings which showed a doubling
of lung cancer risk following breast cancer radiation therapy.
The current study extends these findings to stress the higher
risk of lung cancer for smokers.
Still, he says, the results must be considered preliminary because
there were some gaps in the data and the numbers were small. "However,
the magnitude of the risk and the consistency of the findings
both within the study and with our prior knowledge of the effect
of radiation on the lung support the validity of the findings,"
To verify these results, he is planning a larger scale study.
Additionally, Neugut and his colleagues are exploring the combined
effects of radiation therapy and smoking on patients with Hodgkin's
disease and lung cancer to see if they find a similar effect.