Childhood cancer survivors face increased risk for breast cancer

  • Ehrhardt MJ & al.
  • J Clin Oncol
  • 10 May 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Female childhood cancer survivors face an increased risk for breast cancer, according to the St Jude Lifetime Cohort Study.

Why this matters

  • Surveillance imaging is necessary in this population, preferably with dual imaging (MRI/mammography).
  • Higher doses of anthracyclines and chest irradiation are commonly used to treat lymphoma.

Study design

  • Prospective cohort of 1467 women aged ≥18 years, 10 years postchildhood cancer diagnosis.
  • Funding: NIH; other.

Key results

  • 56 women developed 68 breast cancers (primarily invasive and in situ) at a median age of 38.6 years, with cumulative incidence at age 35 years of 1% (no chest irradiation) and 8% (≥10 Gy of chest irradiation).
  • Breast cancer was associated with:
    • ≥20 Gy of chest irradiation (vs none; aHR, 7.6; P<.001>
    • Anthracycline exposure (vs none; 1-249 mg/m2: aHR, 2.6 [P=.034]; ≥250 mg/m2: HR, 13.4 [P<.001>
    • Having a breast cancer predisposition gene (e.g., BRCA1, BRCA2, and TP53) vs none (aHR, 23.0; P<.001>
  • Anthracyclines 250 mg/m2 remained significantly associated with increased risk for breast cancer in models excluding predisposing genetic mutations, chest radiation 10 Gy, or both. 
  • Sensitivity/specificity was 53.8%/96.3% for mammography alone, 69.2%/91.4% for MRI alone, and 85.8%/99.7% for dual imaging.

Limitations

  • Radiation dosimetry is only available for the chest, not the breast.