NIAGARA-ON-THE-LAKE, Ontario, CanadaFemale survivors of childhood cancer are generally at
increased risk of developing secondary breast cancer years after their initial
disease. New research, presented at the 7th International Conference for
Long-Term Complications of Treatment of Children and Adolescents for Cancer,
hosted by Roswell Park Cancer Institute, is shedding light on this issue and
helping practitioners determine how to best screen this population.
"We have found that the greatest increased risk for
secondary breast cancer, compared to women in the general population, appears
10 to 14 years after the initial diagnosis," said Lisa B. Kenney, MD, MPH,
David B. Perini Jr. Quality of Life Clinic, Dana-Farber Cancer Institute. "This
time frame matches the latency period for radiation-induced cancers, but we
need to examine if therapeutic radiation exposure is the only factor to explain
the risk of breast cancer in this population."
The Childhood Cancer Survivor Study (CCSS) is a resource
designed to investigate the long-term effects of cancer treatment among 5-year
survivors of childhood and adolescent cancer. For the purposes of this study,
the records of 6,068 female participants were reviewed; 95 women had 111
pathology-confirmed breast cancers.
Eligible cases included 5-year survivors of Hodgkin’s
disease, Wilms tumor, sarcoma (soft tissue and bone), central nervous system
malignancies, non-Hodgkin’s lymphoma (NHL), acute leukemia, and neuroblastoma.
The median age at breast cancer diagnosis was 34 years (range, 20 to 49) and
the median time from initial cancer diagnosis was 19 years (range, 7 to 28).
"Using standardized incidence ratios and 95% confidence
intervals, we found a statistically significant increased risk of breast cancer
for survivors of Hodgkin’s disease, bone sarcomas, soft-tissue sarcomas, NHL,
and Wilms tumor [see Figure]. This remained true even after
accounting for prior treatment with chest irradiation," Dr. Kenney said.
She noted that the majority of the breast cancer cases were
seen in survivors of Hodgkin’s disease." Women with prior pelvic radiation had
a decreased risk of secondary breast cancer (P = .003), and there were
no cases of breast cancer diagnosed in women who had a bone marrow transplant.
Additionally, the data did not show any protection for girls diagnosed at a
much younger age.
"It is generally believed that breast cancer risk is
greatest for girls treated between the ages of 10 and 14. However, our data
show that age at diagnosis is not protective," Dr. Kenney said.