Risk of secondary cancers in women with breast cancer and the influence of radiotherapy

Abstract

Breast cancer is the most common cancer in women worldwide; thus, the prolongation of survival, and the incidence and risk factors, including radiotherapy, for developing secondary malignancies are important. We compared the incidence of secondary and new primary cancers in women with breast cancer (CAPos) and well-matched for age, geographic region, and monthly income cancer-free controls (CANeg). The risk for secondary cancers with and without radiotherapy was also compared in CAPos women. We enrolled 2422 CAPos patients and CANeg 12,110 controls. In a 4-year follow-up, the secondary cancers risk was significant in the CAPos group (adjusted hazard ratio [AHR]: 1.59; 95% confidence interval [CI]: 1.17–2.18). Only the risk of uterine cancer was significant compared with the controls (AHR: 6.30; 95% CI: 2.28–17.38). CAPos patients and <50 years old had a higher risk for secondary cancers. Developing secondary cancers was significant in the first follow-up year (AHR: 1.51; 95% CI: 1.11–2.06). Radiotherapy had no significant effect on the CAPos group, but it was significant (P = 0.0298) in women ≥60 years old (elderly). We recommend monitoring secondary cancers in CAPos women, especially those <50 years old, and during the first year of follow-up. Radiotherapy should be used more carefully in elderly CAPos women.

Dosimetric comparison of different planning techniques in left-sided whole-breast irradiation: A planning study

“…Although inverse planning provides a superior dose coverage to tumor and spare OARs, low-dose spillage in normal tissue which increases the risk of secondary malignancies is also a concern. [ 7 19 20 ]…”

“…Many studies have demonstrated that IMRT plans better scored as compared to VMAT plans with respect to mean heart dose, low-dose parameter V 5Gy , high-dose parameter V 25Gy , and LAD dose. [ 5 6 7 ] Some studies have shown a linear increase in complications such as myocardial infarction and ischemic heart disease by approximately 7%/Gy increase in the mean heart dose. [ 23 27 28 ] Adverse impact of radiation to the heart is manifested mainly in first three decades after radiation therapy.…”

“…Many authors have investigated the effect of number and orientation of beams in treatment planning of left-sided breast cancer. [ 5 6 7 8 ] VMAT technique was introduced to combine the advantage of optimization of treatment plan and to reduce the treatment time. Many authors have reported variable outcomes by comparing IMRT and VMAT treatment plans with different beam orientation.…”

“…Many authors have reported variable outcomes by comparing IMRT and VMAT treatment plans with different beam orientation. [ 5 6 7 8 ]…”

Ensemble Feature Learning to Identify Risk Factors for Predicting Secondary Cancer

“…Compared to people with the same age and gender who have never had cancer, cancer survivors have an increased chance of developing secondary cancer. It is important for cancer survivors to be aware of the risk factors for secondary cancers and maintain good follow-up health care 9-11. Furthermore, the literature shows that secondary cancer should be predicted with regard to their personal risk factors and clinical symptoms 12-15.…”