Breast cancer after chest radiation therapy for childhood cancer

Chaya S. Moskowitz, Joanne F. Chou, Suzanne L. Wolden, Jonine L. Bernstein, Jyoti Malhotra, Danielle Novetsky Friedman, Nidha Z. Mubdi, Wendy M. Leisenring, Marilyn Stovall, Sue Hammond, Susan A. Smith, Tara O. Henderson, John D. Boice, Melissa M. Hudson, Lisa R. Diller, Smita Bhatia, Lisa B. Kenney, Joseph P. Neglia, Colin B. Begg, Leslie L. RobisonKevin C. Oeffinger

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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.

Original languageEnglish (US)
Pages (from-to)2217-2223
Number of pages7
JournalJournal of Clinical Oncology
Volume32
Issue number21
DOIs
StatePublished - Jul 20 2014

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Radiotherapy
Thorax
Breast Neoplasms
Survivors
Neoplasms
Radiation
Incidence
Lung
Mortality
Hodgkin Disease

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Moskowitz, C. S., Chou, J. F., Wolden, S. L., Bernstein, J. L., Malhotra, J., Friedman, D. N., ... Oeffinger, K. C. (2014). Breast cancer after chest radiation therapy for childhood cancer. Journal of Clinical Oncology, 32(21), 2217-2223. https://doi.org/10.1200/JCO.2013.54.4601

Breast cancer after chest radiation therapy for childhood cancer. / Moskowitz, Chaya S.; Chou, Joanne F.; Wolden, Suzanne L.; Bernstein, Jonine L.; Malhotra, Jyoti; Friedman, Danielle Novetsky; Mubdi, Nidha Z.; Leisenring, Wendy M.; Stovall, Marilyn; Hammond, Sue; Smith, Susan A.; Henderson, Tara O.; Boice, John D.; Hudson, Melissa M.; Diller, Lisa R.; Bhatia, Smita; Kenney, Lisa B.; Neglia, Joseph P.; Begg, Colin B.; Robison, Leslie L.; Oeffinger, Kevin C.

In: Journal of Clinical Oncology, Vol. 32, No. 21, 20.07.2014, p. 2217-2223.

Research output: Contribution to journalArticle

Moskowitz, CS, Chou, JF, Wolden, SL, Bernstein, JL, Malhotra, J, Friedman, DN, Mubdi, NZ, Leisenring, WM, Stovall, M, Hammond, S, Smith, SA, Henderson, TO, Boice, JD, Hudson, MM, Diller, LR, Bhatia, S, Kenney, LB, Neglia, JP, Begg, CB, Robison, LL & Oeffinger, KC 2014, 'Breast cancer after chest radiation therapy for childhood cancer', Journal of Clinical Oncology, vol. 32, no. 21, pp. 2217-2223. https://doi.org/10.1200/JCO.2013.54.4601
Moskowitz CS, Chou JF, Wolden SL, Bernstein JL, Malhotra J, Friedman DN et al. Breast cancer after chest radiation therapy for childhood cancer. Journal of Clinical Oncology. 2014 Jul 20;32(21):2217-2223. https://doi.org/10.1200/JCO.2013.54.4601
Moskowitz, Chaya S. ; Chou, Joanne F. ; Wolden, Suzanne L. ; Bernstein, Jonine L. ; Malhotra, Jyoti ; Friedman, Danielle Novetsky ; Mubdi, Nidha Z. ; Leisenring, Wendy M. ; Stovall, Marilyn ; Hammond, Sue ; Smith, Susan A. ; Henderson, Tara O. ; Boice, John D. ; Hudson, Melissa M. ; Diller, Lisa R. ; Bhatia, Smita ; Kenney, Lisa B. ; Neglia, Joseph P. ; Begg, Colin B. ; Robison, Leslie L. ; Oeffinger, Kevin C. / Breast cancer after chest radiation therapy for childhood cancer. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 21. pp. 2217-2223.
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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.",
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T1 - Breast cancer after chest radiation therapy for childhood cancer

AU - Moskowitz, Chaya S.

AU - Chou, Joanne F.

AU - Wolden, Suzanne L.

AU - Bernstein, Jonine L.

AU - Malhotra, Jyoti

AU - Friedman, Danielle Novetsky

AU - Mubdi, Nidha Z.

AU - Leisenring, Wendy M.

AU - Stovall, Marilyn

AU - Hammond, Sue

AU - Smith, Susan A.

AU - Henderson, Tara O.

AU - Boice, John D.

AU - Hudson, Melissa M.

AU - Diller, Lisa R.

AU - Bhatia, Smita

AU - Kenney, Lisa B.

AU - Neglia, Joseph P.

AU - Begg, Colin B.

AU - Robison, Leslie L.

AU - Oeffinger, Kevin C.

PY - 2014/7/20

Y1 - 2014/7/20

N2 - 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.

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