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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Breast Oncology

Management and Prevention of Breast Cancer After Radiation to the Chest for Childhood, Adolescent, and Young Adulthood Malignancy

Authors: Eva Koo, MBBS, FRACS, Michael A. Henderson, MBBS, MD, FRACS, Mary Dwyer, MBBS, FRANZCR, Anita R. Skandarajah, MBBS, MD, FRACS

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Background

Women treated with chest irradiation for childhood, adolescent, and young adulthood (CAYA) malignancies, in particular Hodgkin’s lymphoma, have an increased risk of developing second cancers of the breast (SCB). However, there are few uniform guidelines regarding surveillance and prevention for this high-risk group.

Methods

A systematic search using PUBMED and OVID MEDLINE was performed. Publications listed under the terms “breast neoplasm”, “neoplasm, radiation-induced”, “therapeutic radiation-induced breast cancer”, “screening”, “surveillance”, “prevention”, and “prophylaxis” between January 1992 and January 2015 were assessed.

Results

A total of 138 publications were reviewed. Factors associated with increased SCB risk include young age at irradiation, prolong duration since irradiation (peak relative risk 13.87 at 15–19 years postradiation), and increased radiation dose and field. Early menopause reduces SCB risk. Annual screening mammography and breast MRI is recommended from age 25 or 8 years posttreatment for women treated with ≥20 Gy chest radiation before age 30 years. Compared with sporadic primary breast cancers (PBC), SCB more often are bilateral (6–34 %), managed with mastectomy (56–100 %), hormone receptor-negative (27–49 %), and high-grade (35 %). Women with SCB have a similar breast cancer event-free survival and breast cancer-specific survival compared to women with PBC. However, their overall survival is worse due to comorbid conditions. There is paucity of information regarding secondary prevention of SCB.

Conclusions

Survivors of CAYA malignancy are at risk of many late effects, including iatrogenic breast cancer from chest irradiation. They are best managed in a multidisciplinary late-effects setting where tailored risk management can be provided.
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Metadata
Title
Management and Prevention of Breast Cancer After Radiation to the Chest for Childhood, Adolescent, and Young Adulthood Malignancy
Authors
Eva Koo, MBBS, FRACS
Michael A. Henderson, MBBS, MD, FRACS
Mary Dwyer, MBBS, FRANZCR
Anita R. Skandarajah, MBBS, MD, FRACS
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4596-y

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