Chaya S Moskowitz1, Joanne F Chou2, Suzanne L Wolden2, Jonine L Bernstein2, Jyoti Malhotra2, Danielle Novetsky Friedman2, Nidha Z Mubdi2, Wendy M Leisenring2, Marilyn Stovall2, Sue Hammond2, Susan A Smith2, Tara O Henderson2, John D Boice2, Melissa M Hudson2, Lisa R Diller2, Smita Bhatia2, Lisa B Kenney2, Joseph P Neglia2, Colin B Begg2, Leslie L Robison2, Kevin C Oeffinger2. 1. Chaya S. Moskowitz, Joanne F. Chou, Suzanne L. Wolden, Jonine L. Bernstein, Danielle Novetsky Friedman, Nidha Z. Mubdi, Colin B. Begg, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Jyoti Malhotra, Mount Sinai Medical Center, New York, NY; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Marilyn Stovall and Susan A. Smith, University of Texas MD Anderson Cancer Center, Houston, TX; Sue Hammond, Nationwide Children's Hospital, Columbus, OH; Tara O. Henderson, University of Chicago Medicine Comer Children's Hospital, Chicago, IL; John D. Boice, Vanderbilt-Ingram Cancer Center, Nashville; Melissa M. Hudson and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; Lisa R. Diller and Lisa B. Kenney, Dana-Farber Cancer Institute, Boston, MA; Smita Bhatia, City of Hope National Medical Center, Duarte, CA; and Joseph P. Neglia, University of Minnesota Masonic Cancer Center, Minneapolis, MN. moskowc1@mskcc.org. 2. Chaya S. Moskowitz, Joanne F. Chou, Suzanne L. Wolden, Jonine L. Bernstein, Danielle Novetsky Friedman, Nidha Z. Mubdi, Colin B. Begg, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Jyoti Malhotra, Mount Sinai Medical Center, New York, NY; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Marilyn Stovall and Susan A. Smith, University of Texas MD Anderson Cancer Center, Houston, TX; Sue Hammond, Nationwide Children's Hospital, Columbus, OH; Tara O. Henderson, University of Chicago Medicine Comer Children's Hospital, Chicago, IL; John D. Boice, Vanderbilt-Ingram Cancer Center, Nashville; Melissa M. Hudson and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; Lisa R. Diller and Lisa B. Kenney, Dana-Farber Cancer Institute, Boston, MA; Smita Bhatia, City of Hope National Medical Center, Duarte, CA; and Joseph P. Neglia, University of Minnesota Masonic Cancer Center, Minneapolis, MN.
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.
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.
Authors: Lois B Travis; Deirdre Hill; Graça M Dores; Mary Gospodarowicz; Flora E van Leeuwen; Eric Holowaty; Bengt Glimelius; Michael Andersson; Eero Pukkala; Charles F Lynch; David Pee; Susan A Smith; Mars B Van't Veer; Timo Joensuu; Hans Storm; Marilyn Stovall; John D Boice; Ethel Gilbert; Mitchell H Gail Journal: J Natl Cancer Inst Date: 2005-10-05 Impact factor: 13.506
Authors: C Metayer; C F Lynch; E A Clarke; B Glimelius; H Storm; E Pukkala; T Joensuu; F E van Leeuwen; M B van't Veer; R E Curtis; E J Holowaty; M Andersson; T Wiklund; M Gospodarowicz; L B Travis Journal: J Clin Oncol Date: 2000-06 Impact factor: 44.544
Authors: Andrea K Ng; M V Patricia Bernardo; Edie Weller; Kendall Backstrand; Barbara Silver; Karen C Marcus; Nancy J Tarbell; Mary Ann Stevenson; Jonathan W Friedberg; Peter M Mauch Journal: Blood Date: 2002-09-15 Impact factor: 22.113
Authors: Lois B Travis; Deirdre A Hill; Graça M Dores; Mary Gospodarowicz; Flora E van Leeuwen; Eric Holowaty; Bengt Glimelius; Michael Andersson; Tom Wiklund; Charles F Lynch; Mars B Van't Veer; Ingrid Glimelius; Hans Storm; Eero Pukkala; Marilyn Stovall; Rochelle Curtis; John D Boice; Ethel Gilbert Journal: JAMA Date: 2003-07-23 Impact factor: 56.272
Authors: Smita Bhatia; Yutaka Yasui; Leslie L Robison; Jillian M Birch; Monica K Bogue; Lisa Diller; Cyndi DeLaat; Franca Fossati-Bellani; Elaine Morgan; Odile Oberlin; Gregory Reaman; Frederick B Ruymann; Jean Tersak; Anna T Meadows Journal: J Clin Oncol Date: 2003-12-01 Impact factor: 44.544
Authors: Lisa B Kenney; Yutaka Yasui; Peter D Inskip; Sue Hammond; Joseph P Neglia; Ann C Mertens; Anna T Meadows; Debra Friedman; Leslie L Robison; Lisa Diller Journal: Ann Intern Med Date: 2004-10-19 Impact factor: 51.598
Authors: Leslie L Robison; Ann C Mertens; John D Boice; Norman E Breslow; Sarah S Donaldson; Daniel M Green; Frederic P Li; Anna T Meadows; John J Mulvihill; Joseph P Neglia; Mark E Nesbit; Roger J Packer; John D Potter; Charles A Sklar; Malcolm A Smith; Marilyn Stovall; Louise C Strong; Yutaka Yasui; Lonnie K Zeltzer Journal: Med Pediatr Oncol Date: 2002-04
Authors: Jonine L Bernstein; Bryan Langholz; Robert W Haile; Leslie Bernstein; Duncan C Thomas; Marilyn Stovall; Kathleen E Malone; Charles F Lynch; Jørgen H Olsen; Hoda Anton-Culver; Roy E Shore; John D Boice; Gertrud S Berkowitz; Richard A Gatti; Susan L Teitelbaum; Susan A Smith; Barry S Rosenstein; Anne-Lise Børresen-Dale; Patrick Concannon; W Douglas Thompson Journal: Breast Cancer Res Date: 2004-03-09 Impact factor: 6.466
Authors: Smita Bhatia; Saro H Armenian; Gregory T Armstrong; Eline van Dulmen-den Broeder; Michael M Hawkins; Leontien C M Kremer; Claudia E Kuehni; Jørgen H Olsen; Leslie L Robison; Melissa M Hudson Journal: J Clin Oncol Date: 2015-08-24 Impact factor: 44.544
Authors: Chaya S Moskowitz; Joanne F Chou; Joseph P Neglia; Ann H Partridge; Rebecca M Howell; Lisa R Diller; Danielle Novetsky Friedman; Dana Barnea; Lindsay M Morton; Lucie M Turcotte; Michael A Arnold; Wendy M Leisenring; Gregory T Armstrong; Leslie L Robison; Kevin C Oeffinger; Tara O Henderson Journal: J Clin Oncol Date: 2019-07-01 Impact factor: 44.544
Authors: Jennifer M Yeh; Kathryn P Lowry; Clyde B Schechter; Lisa R Diller; Oguzhan Alagoz; Gregory T Armstrong; John M Hampton; Wendy Leisenring; Qi Liu; Jeanne S Mandelblatt; Diana L Miglioretti; Chaya S Moskowitz; Kevin C Oeffinger; Amy Trentham-Dietz; Natasha K Stout Journal: Ann Intern Med Date: 2020-07-07 Impact factor: 25.391
Authors: Sharyl J Nass; Lynda K Beaupin; Wendy Demark-Wahnefried; Karen Fasciano; Patricia A Ganz; Brandon Hayes-Lattin; Melissa M Hudson; Brenda Nevidjon; Kevin C Oeffinger; Ruth Rechis; Lisa C Richardson; Nita L Seibel; Ashley W Smith Journal: Oncologist Date: 2015-01-07
Authors: Heidi D Nelson; Ellen S O'Meara; Karla Kerlikowske; Steven Balch; Diana Miglioretti Journal: Ann Intern Med Date: 2016-01-12 Impact factor: 25.391
Authors: Renée L Mulder; Melissa M Hudson; Smita Bhatia; Wendy Landier; Gill Levitt; Louis S Constine; W Hamish Wallace; Flora E van Leeuwen; Cécile M Ronckers; Tara O Henderson; Chaya S Moskowitz; Danielle N Friedman; Andrea K Ng; Helen C Jenkinson; Charlotte Demoor-Goldschmidt; Roderick Skinner; Leontien C M Kremer; Kevin C Oeffinger Journal: J Clin Oncol Date: 2020-09-29 Impact factor: 44.544
Authors: Stephanie R McKeown; Paul Hatfield; Robin J D Prestwich; Richard E Shaffer; Roger E Taylor Journal: Br J Radiol Date: 2015-10-14 Impact factor: 3.039