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Malignant Breast Tumors After Radiotherapy for a First Cancer During Childhood

From the National Institute of Health and Medical Research, Cancer Epidemiology Research Unit (U605 INSERM), Physics Department, Department of Paediatrics, and Department of Pathology, Institut Gustave Roussy, Villejuif; Department of Paediatrics, Institut Curie, Paris; Department of Radiotherapy, Institut Jean Godinot, Reims; Department of Radiotherapy, Centre Lacassagne, Nice; Department of Radiotherapy, Centre Claudius-Regaud, Toulouse, France; and Childhood Cancer Research Group, Radcliffe Infirmary, Oxford, United Kingdom

Address reprint requests to Florent de Vathaire, PhD, Unité 605 INSERM, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif, France; e-mail: fdv{at}igr.fr

PURPOSE: To assess the specific role of treatment and type of first cancer (FC) in the risk of long-term subsequent breast cancer (BC) among childhood cancer survivors.

RESULTS: Mean follow-up was 16 years; 16 patients developed a clinical BC, 13 after radiotherapy. The cumulative incidence of BC was 2.8% (95% CI, 1.0% to 4.5%) 30 years after the FC and 5.1% (95% CI, 2.1% to 8.2%) at the age of 40 years. The annual excess incidence increased as age increased, whereas the standardized incidence ratio decreased. On average, each Gray unit received by any breast increased the excess relative risk of BC by 0.13 (< 0.0 to 0.75). After stratification on castration and attained age, and adjusting for radiation dose, FC type, and chemotherapy, a higher risk of a subsequent BC was associated with Hodgkin’s disease (relative risk, 7.0; 95% CI, 1.4 to 30.9).

CONCLUSION: The reported high risk of BC after childhood Hodgkin’s disease treatment seems to be due not only to a higher radiation dose to the breasts, but also to a specific susceptibility.

Supported by grants from Europe Against Cancer (Contract 91CV01090-0) and Radiation Protection (Contracts F13P-CT92-0064 and F14P-CT95-0009) programs of the EEC, Institut Gustave Roussy, INSERM, CNAMTS, EDF, SNECMA, FRAMATOME, ARC, and the committees Champagne Ardennes, Essonne, and Val d’Oise of the Ligue Nationale Contre le Cancer.

Presented at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Web Tables 1 to 3 are included in the full-text version of this article, available online only at www.jco.org. They are not included in the PDF (via Adobe® Acrobat Reader®) version.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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