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Chest Radiation to Treat Childhood Cancer Increases Patients’ Risk of Developing Breast Cancer

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Key Points

  • Over 20% of female Wilms tumor survivors who received chest radiation developed breast cancer by age 40 years vs 0.3% in female survivors who did not receive radiation.
  • The breast cancer rates for females receiving chest irradiation, abdominal radiation, and no radiation are nearly 30, 6, and 2 times those expected among women in the general population.
  • The findings suggest that risk of early breast cancer among Wilms tumor survivors is sufficiently high that they should be candidates for early screening.

A new study has found that patients who received chest radiation for Wilms tumor, a rare childhood cancer, face an increased risk of developing breast cancer later in life due to their radiation exposure. Reported by Lange et al in Cancer, the findings suggest that cancer screening guidelines might be reevaluated to facilitate the early diagnosis and prompt treatment of breast cancer among Wilms tumor survivors.

Study Details

Wilms tumor is a rare childhood kidney cancer that can spread to the lungs. When this spread occurs, patients receive a relatively low dose (12–14 Gy) of radiation therapy to the entire chest. To see if such exposure to radiation affects patients’ risk of developing breast cancer, Norman Breslow, PhD, of the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle, led a team that studied nearly 2,500 young women who had been treated for Wilms tumor during childhood and who had survived until at least 15 years of age.

Of female Wilms tumor survivors who received radiation to the chest, over 20% developed breast cancer by age 40 years (three-quarters of which were invasive and one-quarter noninvasive), in contrast to only 0.3% in female Wilms tumor survivors who did not receive radiation. The researchers also found an intermediate risk (4%) of breast cancer among female Wilms tumor patients who had received abdominal but no chest radiation as part of their treatment for Wilms tumor.

The rates for females receiving chest irradiation, abdominal radiation, and no radiation are nearly 30, 6, and 2 times those expected among women of comparable age in the general population. This high incidence of breast cancer, including invasive cancer, was an unexpected finding.

Early Breast Cancer Screening for Wilms Tumor Survivors

“Current guidelines call for early screening for breast cancer among survivors of childhood cancer if they have received 20 or more Gray of radiation therapy to breast tissue. This would exclude a large majority of patients who had received whole-chest radiation for Wilms tumor,” said Dr. Breslow. “Our results suggest that the risk of early breast cancer among Wilms tumor survivors is sufficiently high that early screening might be considered an option for them also.”

In an accompanying editorial, Jennifer Dean, MD, and Jeffrey Dome, MD, PhD, of Children’s National Health System in Washington, DC, noted that Wilms tumor survivors at high risk should undergo breast cancer surveillance with mammogram, breast MRI, or both starting at age 25 years. However, they pointed to research indicating that less than half of childhood cancer survivors considered to have a high risk for breast cancer follow through with surveillance guidelines. “Because compliance with breast cancer surveillance is low in adult survivors of childhood cancer, barriers such as education of both survivors and providers should be addressed and mitigated,” they wrote.

Dr. Breslow is the corresponding author for the Cancer article.

The study was supported by the National Institutes of Health. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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