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Systematic Review: Surveillance for Breast Cancer in Women Treated With Chest Radiation for Childhood, Adolescent, or Young Adult Cancer

Tara O. Henderson, MD, MPH; Alison Amsterdam, MD; Smita Bhatia, MD, MPH; Melissa M. Hudson, MD; Anna T. Meadows, MD; Joseph P. Neglia, MD, MPH; Lisa R. Diller, MD; Louis S. Constine, MD; Robert A. Smith, PhD; Martin C. Mahoney, MD, PhD; Elizabeth A. Morris, MD; Leslie L. Montgomery, MD; Wendy Landier, MSN, CPNP; Stephanie M. Smith, MPH; Leslie L. Robison, PhD; and Kevin C. Oeffinger, MD
[+] Article and Author Information

From University of Chicago Pritzker School of Medicine, Chicago, Illinois; City of Hope National Medical Center, Duarte, California; St. Jude Children's Research Hospital, Memphis, Tennessee; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; Dana-Farber Cancer Institute, Boston, Massachusetts; American Cancer Society, Atlanta, Georgia; and Memorial Sloan-Kettering Cancer Center, Mount Sinai Medical Center, New York, Montefiore-Einstein Center for Cancer Care, Bronx, University of Rochester Medical Center, Rochester, and Roswell Park Cancer Institute, Buffalo, New York.


Grant Support: By the National Cancer Institute (grant U10 CA098543).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-0980.

Requests for Single Reprints: Kevin C. Oeffinger, MD, Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 396, New York, NY 10065; e-mail, oeffingk@mskcc.org.

Current Author Addresses: Dr. Henderson: University of Chicago, 5841 South Maryland Avenue, MC 4060, Chicago, IL 60637.

Dr. Amsterdam: Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029.

Dr. Bhatia and Ms. Landier: City of Hope Comprehensive Cancer Center, 1500 Duarte Avenue, Duarte, CA 91010.

Drs. Hudson and Robison: St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105.

Dr. Meadows: Children's Hospital of Philadelphia, Division of Oncology, 34th and Civic Center Boulevard, Philadelphia, PA 19104.

Dr. Neglia: University of Minnesota Cancer Center, Division of Pediatric Hematology/Oncology, Room D557 Mayo Building, Mayo Mail Code #484, 420 Delaware Street Southeast, Minneapolis, MN 55455.

Dr. Diller: Dana-Farber Cancer Institute, Pediatric Oncology, 44 Binney Street, Boston, MA 02115.

Dr. Constine: University of Rochester Medical Center, Radiation Oncology, 601 Elmwood Avenue, Box 647, Rochester, NY 14642.

Dr. Smith: American Cancer Society, 250 Williams Street, 6th Floor, Atlanta, GA 30303.

Dr. Mahoney: Cancer Prevention and Population Sciences, Department of Educational Affairs, Roswell Park Cancer Institute, Buffalo, NY 14263.

Dr. Morris: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1114 1st Avenue, New York, NY 10065.

Dr. Montgomery: Department of Surgery, Montefiore-Einstein Center for Cancer Care, Montefiore Medical Park, 1575 Blondell Avenue, Bronx, NY 10461.

Ms. Smith: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.

Dr. Oeffinger: Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 396, New York, NY 10065.

Author Contributions: Conception and design: T.O. Henderson, S. Bhatia, M.M. Hudson, A.T. Meadows, L.R. Diller, L.S. Constine, L.L. Montgomery, S.M. Smith, K.C. Oeffinger.

Analysis and interpretation of the data: T.O. Henderson, S. Bhatia, M.M. Hudson, L.R. Diller, L.S. Constine, R.A. Smith, M.C. Mahoney, W. Landier, K.C. Oeffinger.

Drafting of the article: T.O. Henderson, A. Amsterdam, S. Bhatia, M.M. Hudson, J.P. Neglia, L.R. Diller, K.C. Oeffinger.

Critical revision of the article for important intellectual content: T.O. Henderson, A. Amsterdam, S. Bhatia, A.T. Meadows, J.P. Neglia, L.R. Diller, L.S. Constine, R.A. Smith, M.C. Mahoney, E.A. Morris, L.L. Montgomery, W. Landier, S.M. Smith, L.L. Robison, K.C. Oeffinger.

Final approval of the article: T.O. Henderson, A. Amsterdam, S. Bhatia, M.M. Hudson, A.T. Meadows, J.P. Neglia, L.R. Diller, L.S. Constine, R.A. Smith, M.C. Mahoney, E.A. Morris, L.L. Montgomery, W. Landier, S.M. Smith, L.L. Robison, K.C. Oeffinger.

Provision of study materials or patients: T.O. Henderson.

Administrative, technical, or logistic support: T.O. Henderson, A. Amsterdam, M.M. Hudson, S.M. Smith.

Collection and assembly of data: T.O. Henderson, A. Amsterdam, S. Bhatia, S.M. Smith.


Ann Intern Med. 2010;152(7):444-455. doi:10.7326/0003-4819-152-7-201004060-00009
Text Size: A A A

Background: Women treated with therapeutic chest radiation may develop breast cancer.

Purpose: To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.

Data Sources: Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).

Study Selection: Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation?

Data Extraction: Three investigators independently extracted data and assessed study quality.

Data Synthesis: Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited.

Limitation: The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.

Conclusion: Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.

Primary Funding Source: National Cancer Institute.

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