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; Kevin C. Oeffinger, MD
Women treated with therapeutic chest radiation may develop breast cancer.
To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.
Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).
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?
Three investigators independently extracted data and assessed study quality.
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.
The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.
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.
National Cancer Institute.
Henderson TO, Amsterdam A, Bhatia S, Hudson MM, Meadows AT, Neglia JP, et al. Systematic Review: Surveillance for Breast Cancer in Women Treated With Chest Radiation for Childhood, Adolescent, or Young Adult Cancer. Ann Intern Med. 2010;152:444–455. doi: 10.7326/0003-4819-152-7-201004060-00009
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Published: Ann Intern Med. 2010;152(7):444-455.
Breast Cancer, Hematology/Oncology.
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