A study finds that female survivors of childhood cancer treated with radiation to the chest had a high risk of developing breast cancer at a young age, comparable to that of BRCA1/2 mutation carriers. The findings also suggest that more survivors may be affected than previously thought. The results were presented at the 48th Annual Meeting of the American Society of Clinical Oncology (ASCO).

Currently, screening guidelines for childhood cancer survivors recommend annual breast cancer screening for women who received moderate to high radiation doses of 20 Gray (Gy) or more to the chest as children, adolescents, or young adults. The researchers found that women treated with lower doses of chest radiation (10 to 19 Gy) also have an elevated risk of breast cancer at a young age, and may warrant screening as well.

An essential part of therapy
?While radiation doses have decreased and techniques have improved, radiation is still an essential part of therapy for many childhood cancers,? said Chaya S. Moskowitz, Ph.D., the study?s lead author and an associate member and associate attending biostatistician atMemorial Sloan-Kettering Cancer Center, New York, NY.

?The goal is to maximize the cure rates for childhood cancer while minimizing future health problems. For women treated with 20 Gy or more of chest radiation, the Children?s Oncology Group recommends breast cancer surveillance with an annual mammogram and breast MRI, starting at age 25 or 8 years after the radiation (whichever is last). Our results suggest that young women treated with lower doses of radiation who are not currently being screened also have an elevated risk of breast cancer and might benefit from a similar screening strategy.?

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Increased risk
?Previous studies have shown that women treated with radiation to the chest for childhood cancer have an increased risk for breast cancer, but ours is the first to demonstrate that their risk is comparable to women with BRCA mutations,? Moskowitz said. ?While most women are aware that hereditary mutations can increase their risk for breast cancer, few are aware that radiation to the chest can also increase this risk, including the women who themselves were treated.?

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Study design
The study analyzed data from more than 1,200 women participating in the Childhood Cancer Survivor Study(CCSS) and 4,570 female first-degree relatives of participants in the Women’s Environmental Cancer and Radiation Epidemiology (WECARE) Study. WECARE enrolled women who had been diagnosed with breast cancer and survived at least one year after their diagnosis.

For the childhood cancer survivors overall, breast cancer incidence by age 50 was 24%. Among those who survived Hodgkin?s lymphoma, the incidence was 30%. Among women who were carriers of a BRCA1 mutation, the incidence of breast cancer by age 50 was 31%.

It’s not just survivors of Hodgkin lymphoma who are at risk of developing breast cancer but survivors of other childhood cancers typically treated with more-moderate doses of radiation,? Moskowitz added. ?The issue is not just the dose of radiation. It?s also the volume of breast tissue that is exposed to radiation that?s a factor here.?

Women treated with the lower doses of chest radiation ranging from 10 to 19 Gy had a breast cancer incidence of 7% by age 40 compared with 12% for those women treated with 20 Gy or higher. There are currently about 50,000 women in the U.S. who were treated with >20 Gy who should be receiving annual breast cancer screening, as recommended by Children?s Oncology Group.

The authors estimate that there are another 7,000-9,000 women in the U.S who were treated with 10-19 Gy for childhood cancer and might benefit from annual screening as well. To follow up on this study, Moskowitz has received a grant from the National Cancer Institute to build a model to predict the risk of breast cancer in childhood cancer survivors treated with chest radiation.

Presentation: Monday, June 4, 2012, 9:15 ? 9:30 AM CDT
Abstract: #CRA9513
Title: New insights into the risk of breast cancer in childhood cancer survivors treated with chest radiation: A report from the Childhood Cancer Survivor Study (CCSS) and the Women’s Environmental Cancer and Radiation Epidemiology (WECARE) Study.
Authors: Moskowitz CS, Chou JF, Wolden SL, Bernstein JL, Malhotra J, Friedman DN, Mubdi NZ, et al.

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