Roles of Radiotherapy and Chemotherapy in the Development of Contralateral Breast Cancer

Hooning, Maartje J.; Aleman, Berthe M.P.; Hauptmann, Michael; Baaijens, Margreet H.A.; Klijn, Jan G.M.; Noyon, R.; Stovall, Marilyn; Leeuwen, Flora E. van

doi:10.1200/jco.2007.16.0192

Cited by 99 publications

(77 citation statements)

References 37 publications

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“…Three earlier studies with individual dosimetry have reported an increased risk of contralateral breast cancer after radiotherapy in the youngest patients (oage 45) (Boice et al, 1992;Hooning et al, 2008;Stovall et al, 2008). This is consistent with the wellestablished modifying effects of age at radiation exposure; risk decreases with increasing age at exposure and is particularly low in post-menopausal women (Preston et al, 2002).…”

Section: Discussionsupporting

confidence: 68%

“…Although we found no difference in contralateral breast cancer risk in women who had radiotherapy after mastectomy compared with those who underwent breast-conserving surgery, a recent Dutch study reported lower risks after mastectomy (Hooning et al, 2008). However, the majority of women in the Dutch study who had mastectomy were treated with electrons rather than with photons, which should result in a lower radiation dose to the contralateral breast and is the most likely explanation for the difference in findings.…”

Section: Discussioncontrasting

confidence: 54%

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Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

et al. 2009

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BACKGROUND: Radiotherapy for breast cancer reduces disease recurrence and breast cancer mortality. However, it has also been associated with increased second cancer risks in exposed sites. METHODS: We evaluated long-term second cancer risks among 182 057 5-year survivors of locoregional invasive breast cancer diagnosed between 1973 and 2000 and reported to US NCI-SEER Program cancer registries. Multivariate Poisson regression was used to estimate the relative risk (RR) and excess cases of second cancer in women who had surgery and radiotherapy, compared with those who had surgery alone. Second cancer sites were grouped according to doses received from typical tangential breast fields. RESULTS: By the end of 2005 (median follow-up ¼ 13.0 years), 15 498 second solid cancers had occurred, including 6491 contralateral breast cancers. The RRs for radiotherapy were 1.45 (95% confidence interval (CI) ¼ 1.33 -1.58) for high-dose second cancer sites (1 þ Gy: lung, oesophagus, pleura, bone and soft tissue) and 1.09 (1.04 -1.15) for contralateral breast cancer (E1 Gy). These risks decreased with increasing age and year of treatment. There was no evidence of elevated risks for sites receiving medium (0.5 -0.99 Gy, RR ¼ 0.89 (0.74 -1.06)) or low doses (o0.5 Gy, RR ¼ 1.01 (0.95 -1.07)). The estimated excess cases of cancer in women treated with radiotherapy were as follows: 176 (95% CI ¼ 69 -284) contralateral breast cancers or 5% (2 -8%) of the total in all 1 þ year survivors, and 292 (222 -362) other solid cancers or 6% (4 -7%) of the total. CONCLUSIONS: Most second solid cancers in breast cancer survivors are not related to radiotherapy.

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Section: Discussionsupporting

confidence: 68%

Section: Discussioncontrasting

confidence: 54%

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

et al. 2009

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“…However, variations in CBC risk according to the length of follow-up after the initial BC have not been clearly documented (Hankey et al, 1983;Brenner et al, 1993;Soerjomataram et al, 2005;Hooning et al, 2008). One study assessed variations in CBC risk by 5-year periods, but not by further details during the first 5 years (Hankey et al, 1983).…”

mentioning

confidence: 99%

“…Indeed, the cutoff time separating them was arbitrarily chosen, varying widely between 0 and 12 months (Hislop et al, 1984;Basco et al, 1985;Bernstein et al, 1992;Broët et al, 1996;Chen et al, 2001;Gao et al, 2003;Hartman et al, 2005;Howe et al, 2005). The samples studied also varied because some studies selected only operable BC (Hankey et al, 1983;Broët et al, 1996), whereas others analysed populations selected using many criteria (Chen et al, 2001;Hartman et al, 2005;Hooning et al, 2008). It is probably for these reasons that the factors associated with the risk of asynchronous CBC differed between these studies.…”

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confidence: 99%

Relation of risk of contralateral breast cancer to the interval since the first primary tumour

et al. 2009

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BACKGROUND: There is no consensus on how to separate contralateral breast cancer (CBC) occurring as distant spread of the primary breast cancer (BC) from an independent CBC. METHODS: We used standardised incidence ratios (SIRs) to analyse the variations in the risk of CBC over time among 6629 women with BC diagnosed between 1954 and 1983. To explore the most appropriate cutoff to separate the two types of CBC, we analysed the deviance between models including different cutoff points as compared with the basal model with no cutoff date. We also performed a prognostic study through a Cox model. RESULTS: The SIR was much higher during the first 2 years of follow-up than afterwards. The best cutoff appeared to be 2 years. The risk of early CBC was linked to tumour spread and the risk of late CBC was linked to age and to the size of the tumour. Radiotherapy was not selected by the model either for early or late CBC risk. CONCLUSION: A clearer pattern of CBC risk might appear if studies used a similar cutoff time after the initial BC.

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“…Increased breast cancer risk has been shown following acute radiation exposure from the atomic bombings in Japan (37) and following high cumulative doses associated with the treatment of some diseases and multiple diagnostic radiographic examinations (38,39). Radiotherapy for breast cancer contributed to the development of contralateral breast cancer among women who underwent irradiation at a relatively young age (<35 years) and especially among those with a family history of breast cancer (40).…”

Section: Ionizing Radiationmentioning

confidence: 99%

Environmental factors and breast cancer

2010

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Roles of Radiotherapy and Chemotherapy in the Development of Contralateral Breast Cancer

Cited by 99 publications

References 37 publications

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

Relation of risk of contralateral breast cancer to the interval since the first primary tumour

Environmental factors and breast cancer

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