Breast cancer risk in childhood cancer survivors without a history of chest radiotherapy: A report from the childhood cancer survivor study

Tara O. Henderson, Chaya S. Moskowitz, Joanne F. Chou, Angela R. Bradbury, Joseph Phillip Neglia, Chau T. Dang, Kenan Onel, Danielle Novetsky Friedman, Smita Bhatia, Louise C. Strong, Marilyn Stovall, Lisa B. Kenney, Dana Barnea, Elena Lorenzi, Sue Hammond, Wendy M. Leisenring, Leslie L. Robison, Gregory T. Armstrong, Lisa R. Diller, Kevin C. Oeffinger

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Purpose: Little is known about the breast cancer risk among childhood cancer survivors who did not receive chest radiotherapy. We sought to determine the magnitude of risk and associated risk factors for breast cancer among these women. Patients and Methods: We evaluated cumulative breast cancer risk in 3,768 female childhood cancer survivors without a history of chest radiotherapy who were participants in the Childhood Cancer Survivor Study. Results: With median follow up of 25.5 years (range, 8 to 39 years), 47 women developed breast cancer at a median age of 38.0 years (range, 22 to 47 years) and median of 24.0 years (range, 10 to 34 years) from primary cancer to breast cancer. A four-fold increased breast cancer risk (standardized incidence ratio [SIR] = 4.0; 95% CI, 3.0 to 5.3) was observed when compared with the general population. Risk was highest among sarcoma and leukemia survivors (SIR = 5.3; 95% CI, 3.6 to 7.8 and SIR = 4.1; 95% CI, 2.4 to 6.9, respectively). By the age of 45 years, the cumulative incidence of breast cancer in sarcoma and leukemia survivors was 5.8% (95% CI, 3.7 to 8.4) and 6.3% (95% CI, 3.0 to 11.3), respectively. No other primary cancer diagnosis was associated with an elevated risk. Alkylators and anthracyclines were associated with an increased breast cancer risk in a dose-dependent manner (P values from test for trend were both < .01). Conclusions: Women not exposed to chest radiotherapy who survive childhood sarcoma or leukemia have an increased risk of breast cancer at a young age. The data suggest high-dose alkylator and anthra-cycline chemotherapy increase the risk of breast cancer. This may suggest a possible underlying gene-environment interaction that warrants further study.

Original languageEnglish (US)
Pages (from-to)910-918
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number9
DOIs
StatePublished - Mar 20 2016

Bibliographical note

Funding Information:
Supported by grants from the National Cancer Institute (U24CA55727 [G.T.A.], K07CA134935 [T.O.H.], R01CA136783 [C.S.M.], K05CA160724, and R01CA134722 [K.C.O.]) and the Meg Berté Owen Foundation. Support to St Jude Children's Research Hospital was also provided by the American Lebanese-Syrian Associated Charities. Support to Memorial Sloan Kettering was provided by the core grant P30 CA008748.

Funding Information:
Supported by grants from the National Cancer Institute (U24CA55727 [G.T.A.], K07CA134935 [T.O.H.], R01CA136783 [C.S.M.], K05CA160724, and R01CA134722 [K.C.O.]) and the Meg Bert? Owen Foundation. Support to St Jude Children's Research Hospital was also provided by the American Lebanese-Syrian Associated Charities. Support to Memorial Sloan Kettering was provided by the core grant P30 CA008748.

Publisher Copyright:
© 2015 by American Society of Clinical Oncology.

Fingerprint

Dive into the research topics of 'Breast cancer risk in childhood cancer survivors without a history of chest radiotherapy: A report from the childhood cancer survivor study'. Together they form a unique fingerprint.

Cite this