Radiation-associated breast cancers in a late-effects cohort: Long-term surveillance is essential
Eva Koo
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Search for more papers by this authorMichael A. Henderson
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Search for more papers by this authorMary Dwyer
Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Anita R. Skandarajah
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Correspondence
Anita R. Skandarajah, University of Melbourne, Parkville, VIC 3052, Australia.
Email: [email protected]
Search for more papers by this authorEva Koo
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Search for more papers by this authorMichael A. Henderson
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Search for more papers by this authorMary Dwyer
Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Anita R. Skandarajah
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Correspondence
Anita R. Skandarajah, University of Melbourne, Parkville, VIC 3052, Australia.
Email: [email protected]
Search for more papers by this authorAbstract
Aims
Survivors of childhood, adolescent, and young adulthood malignancies have an increased risk of subsequent primary malignancies, particularly after exposure to therapeutic radiation. This study aims to evaluate the mode of surveillance and surveillance compliance, incidence and mode of detection of breast cancer, breast cancer phenotype, and outcomes after radiation-associated breast cancer (RBC) in a late-effects cohort.
Methods
Women exposed to therapeutic radiation attending the late effects service from 1st January 2000 to 20th February 2013. All invasive and in-situ cancers, benign tumors, and deaths were evaluated. The incidence of breast cancer was compared to the Australian general population. Compliance with breast surveillance recommendations, clinicopathological features, and management of breast cancers were examined.
Results
The prevalence of RBC was 17.1%. Twenty-eight cases of RBC occurred in 24 women, out of 140 women exposed to chest radiation. Patients whose first attendance was ≥15 years after radiation exposure experienced the highest incidence of RBC at 23%. The incidence of breast cancer was 11.2 times the general population (P < .001). Compliance with surveillance mammography was observed in 18.4%. Breast cancers diagnosed after the first attendance to the service were more likely screen-detected (P = .002). Most were hormone receptor positive (84.0%), invasive ductal carcinomas (82.1%), and managed with mastectomy (89.3%).
Conclusions
Patients attending a dedicated late effects service have a high burden of subsequent malignancies generally occurring after long latency. Judicious management with adherence to long-term surveillance guidelines is advocated.
CONFLICT OF INTEREST
None of the authors have any conflict of interest.
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