The incidence of breast cancer following mantle field radiation therapy as a function of dose and technique

Tinger, Alfred; Wasserman, Todd H.; Klein, Eric E.; Miller, Elizabeth A.; Roberts, Tracy E; Piephoff, James; Kucik, Nancy A.

doi:10.1016/s0360-3016(97)00026-6

Cited by 70 publications

(35 citation statements)

References 32 publications

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“…The few other studies that have investigated the relation of risk to dosage have not calculated doses specifically to the part of the breast in which the cancer occurred. Two studies found evidence of a dose -response relation (Bhatia et al, 1996b;Tinger et al, 1997) while one did not (Hancock et al, 1993), although the great majority of person-years in the latter study were in one dose category. There are inaccuracies in retrospective dose allocations in such studies because radiotherapy causes breast shrinkage, leading to changes in breast shape of treated women over time.…”

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confidence: 78%

Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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Although the potential carcinogenic risk of radiotherapy is well known, it has become clear that there is a particularly high risk of radiation-induced breast cancer in women treated for Hodgkin's disease at young ages. Thankfully, death from breast cancer in this population is uncommon, but it is important to understand factors contributing to the risk, including treatment parameters, and to develop a logical and efficient method for medical management of those at risk. In this minireview, we examine the evidence which should inform such a management policy. The prognosis of patients with Hodgkin's disease has been improved dramatically over the last 40 years by the development of extended field radiotherapy techniques and then by combination chemotherapy (DeVita et al, 1980;Rosenberg and Kaplan, 1985). However, long-term follow-up of survivors has demonstrated that a price of this success has been an increased risk of second cancers. Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy. This effect of age is unsurprising, as similar gradients are seen in other cohorts of radiation-exposed women (United Nations Scientific Committee on the Effects of Atomic Radiation, 1994).The size of risk of breast cancer found in Hodgkin's disease patients has varied between studies. For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at...

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confidence: 78%

Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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“…The benign biopsy rates in the two prospective screening studies that reported this parameter were 3.8 and 6.1%, respectively (Diller et al, 2002;NHSBSP, 2007;Kwong et al, 2008). The risk of developing BC after treatment for HL is related to both SRT dose and field (Tinger et al, 1997;Hill et al, 2005). In our cohort, the increased SRT dose received by BC cases was primarily a reflection of the increased incidence of a mantle field rather than an independent effect of dose on BC development.…”

Section: Discussionmentioning

confidence: 59%

“…Thus, the NRASP strategy seems to be capable of detecting BC at an early clinical stage, whereas the range of immunophenotypes suggests that these tumours are not of a universally good prognosis. Although new radiotherapy techniques and treatment strategies have the potential to reduce the future burden of late effects, the population of women reviewed in the NRASP has a mean age approaching that at which BC was diagnosed in the 23 affected women, suggesting that there remains a significant cohort at an increased risk of BC (and other malignancies) in whom continued vigilance is required (Tinger et al, 1997;Hodgson et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

et al. 2009

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BACKGROUND: Supradiaphragmatic radiotherapy (SRT) to treat Hodgkin's lymphoma (HL) at a young age increases the risk of breast cancer (BC). A national notification risk assessment and screening programme (NRASP) for women who were treated with SRT before the age of 36 years was instituted in the United Kingdom in 2003. In this study, we report the implementation and screening results from the largest English Cancer Network. METHODS: A total of 417 eligible women were identified through cancer registry/hospital databases and from follow-up (FU) clinics. Screening results were collated retrospectively, and registry searches were used to capture BC cases. RESULTS: Of the 417 women invited for clinical review, 243 (58%) attended. Of these 417 women, 23 (5.5%) have been diagnosed with BC, a standardised incidence ratio of 2.9 compared with the age-matched general population. Of five invasive BCs diagnosed within the NRASP, none involved axillary lymph nodes compared with 7 of 13 (54%) diagnosed outside the programme (Po0.10). The mean latency for BC cases was 19.5±8.35 years and the mean FU duration for those unaffected by BC was 14.6±9.11 years (Po0.01), suggesting that those unaffected by BC remain at high risk. Recall and negative biopsy rates were acceptable (10.5 and 0.8%, respectively). CONCLUSIONS: The NRASP appears to detect BC at an early stage with acceptable biopsy rates, although numbers are small. Determination of NRASP results on a national basis is required for the accurate evaluation of screening efficacy in women previously treated with SRT.

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“…11 Techniques of radiation applied in the past, the socalled "mantle field" and especially the mandatory irradiation of axillary lymph nodes, are associated with an increased risk of developing radiation-induced breast cancer due to the lack of full protection of the mammary parenchyma. 14,15 Several studies have demonstrated a high incidence of bilateral breast carcinomas (21%) after radiotherapy of lymph chains above the diaphragm. 16,17 No correlation has been established between the dose of fractionation and the risk of development of secondary breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced breast cancer in women with Hodgkin's disease

Александрова¹,

Mihaylova²,

Sergieva³

et al. 2014

Reports of Practical Oncology & Radiotherapy

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Hodgkin's disease Materials and methods:Thirty-nine cases of women with BC that developed after treatment for HD in puberty or adolescence were analyzed retrospectively. The median age at initiation of treatment for HD was 12.9 years (9-21). The median age at diagnosis of the second malignancy -breast carcinoma was 32.4 years (22.9-39). Results:The distribution of patients according to the clinical T stage of breast cancer was as follows: 11 patients with T1 stage BC (28%), 22 with T2 stage (56%) and 6 with stage T3 (16%). Prevalent were tumors localized in the lateral breast quadrants. The observed 5 year survival was 95%. Conclusion:The risk of solid tumors, especially breast cancer, is high among women with HD disease who were treated with radiotherapy in their childhood. In this article, we propose a specific mathematical age formula which could be used as predictive equation when the age of the treatment for HD is in the range between 9 and 21 years. Systematic screening for breast cancer in these patients would be significantly important for their health and could improve their survival.

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The incidence of breast cancer following mantle field radiation therapy as a function of dose and technique

Cited by 70 publications

References 32 publications

Second primary breast cancer after Hodgkin's disease

Second primary breast cancer after Hodgkin's disease

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

Radiation-induced breast cancer in women with Hodgkin's disease

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