https://immattersacp.org/weekly/archives/2010/04/06/5.htm

Survivors of childhood cancer treated with chest radiation may benefit from early breast cancer surveillance

Nearly one-third of older adults need end-of-life decisions made but lack ability


Women treated with chest radiation for cancer as children or young adults may benefit from early surveillance for breast cancer, according to a new study.

Researchers performed a meta-analysis of 11 trials to examine the incidence of and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer, as well as the clinical characteristics of their cancers and the possible benefits and harms of surveillance in this group. The study results were published in the April 6 Annals of Internal Medicine.

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After chest radiation for cancer early in life, women have a substantially elevated risk for breast cancer, the study found (standardized incidence ratio, 13.3 to 55.5; cumulative breast cancer incidence by age 40 to 45, 13% to 20%). Higher doses of radiation were associated with higher cancer risk. Although evidence on the characteristics and outcomes of breast cancer in this group was limited, both seemed similar to the general population.

The authors acknowledged that their results were limited by study heterogeneity, varied study design, and small sample size. However, they concluded that women who receive chest radiation for childhood or young adult cancer are at substantially elevated risk for early breast cancer and that the risk does not seem to plateau with age. Early detection appeared to have benefit in this group because those who received diagnoses of early-stage breast cancer were likely to have favorable outcomes. The authors pointed out that more research is needed to weigh the potential benefits and harms of the additional radiation exposure involved when mammograms are started early.

In related news, a study published online March 29 by the Journal of Clinical Oncology found that in women with early-stage breast cancer, those who had mastectomies were less likely to receive subsequent radiation than those who had breast-conserving surgery, even when radiation was strongly indicated. The researchers found that patients' willingness to receive radiation and surgeon involvement in the decision heavily influenced treatment.