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In Reply

Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

We appreciate the comments by De Giorgi et al regarding our recent publication in Journal of Clinical Oncology.¹ We do not disagree with their fundamental point. By nature, reports of the long-term sequelae of an intervention, whether based on randomized trials or observational studies, are often outdated by the time of publication due to advances or changes in technology. The patients in our study were diagnosed between the years 1965 and 1985 and had a minimum follow-up of 10 years. We undertook our study with the understanding that changes in radiotherapy techniques occurring in the intervening decades might lead to changes in treatment-related risks.

We do have some minor corrections. Our study was not a pilot study. We had previously conducted a pilot study² using more crude data and methods, but with similar findings. We consider the current study to be complete.

Regarding screening, we are aware that a randomized trial for proof of efficacy of computed tomography scanning for lung cancer has not yet been completed, but allowances are often made in high-risk situations. Given the risks described in our article, smokers who have received radiotherapy for breast cancer more than 10 years ago may qualify for such allowances.

Finally, we concur that an adverse effect should not be considered a reason to avoid a beneficial treatment. However, as we stated in the article, the benefit of postmastectomy radiotherapy (PMRT) in borderline settings may need to be weighed against such risks. Yu et al³ showed that even with large tumors, patients with node-negative disease may not benefit from PMRT, and other studies show that significant numbers of patients with small node-negative tumors receive PMRT despite the probable absence of benefit.⁴ In settings where the use of PMRT is questionable, particularly when the patient is a smoker, the physician and patient need to weigh more carefully the relative risks and benefits of its use.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Kaufman EL, Jacobson JS, Hershman DL, et al. Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. J Clin Oncol 26:392-398, 2008[Abstract/Free Full Text]

2. Neugut AI, Murray T, Santos J, et al: Increased risk of lung cancer after breast cancer radiation therapy in cigarette smokers. Cancer 73:1615-1620, 1994[CrossRef][Medline]

3. Yu JB, Wilson LD, Dasgupta T, et al: Postmastectomy radiation therapy for lymph node-negative, locally advanced breast cancer after modified radical mastectomy: Analysis of the NCI Surveillance, Epidemiology, and End Results database. Cancer 113:38-47, 2008[CrossRef][Medline]

4. Smith BD, Haffty BG, Hurria A, et al: Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol 24:4901-4907, 2006[Abstract/Free Full Text]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Neugut, A. I. Articles by Hershman, D. Search for Related Content PubMed Articles by Neugut, A. I. Articles by Hershman, D. Social Bookmarking                            What's this?