Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results |
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| Affiliation: | 1. University of Utah Huntsman Cancer Hospital, Department of Radiation Oncology, USA;2. University of Utah School of Medicine, Department of Internal Medicine, USA;3. Duke University, Department of Radiation Oncology, USA;1. Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;4. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland;6. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas;3. Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;5. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;1. Icahn School of Medicine, Mount Sinai Health System, New York, New York;2. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California;3. Breast Oncology Program, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;1. Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France Gustave-Roussy, Villejuif, France;2. Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France;3. University of Hong Kong – Shenzhen Hospital, University of Hong-Kong, China;4. Service de Biostatistique et d’Epidémiologie, Gustave Roussy, Villejuif, France;5. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China;6. State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, China;7. National Taiwan University Hospital, Taipei, Taiwan;8. Sun Yat-sen University Cancer Center, Guangzhou, China;9. Department of Clinical Oncology, University of Hong Kong, Hong Kong, China;10. National Cancer Center, Singapore;11. Aristotle University of Thessaloniki School of Medicine, Thessaloniki, and Hellenic Cooperative Oncology Group, Athens, Greece and German Oncology Center, Limassol, Cyprus;12. Department of Radiotherapy, Centre hospitalier universitaire vaudois, Lausanne, Switzerland;1. Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California;2. University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, and Case Western Reserve University School of Medicine, Cleveland, Ohio;2. School of Advanced Sciences, VIT University, Vellore, India;3. Department of Medical Physics and Human Oncology, University of Wisconsin-Madison, WI and Aspirus UW Cancer Center, Wisconsin Rapids, WI;1. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;2. Banbury, United Kingdom;3. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan |
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| Abstract: | GoalsTo assess risks of secondary malignancies in breast cancer patients who received radiation therapy compared to patients who did not.MethodsThe SEER database was used to identify females with a primary diagnosis of breast cancer as their first malignancy, during 1973–2008. We excluded patients with metastatic disease, age <18 years, no definitive surgical intervention, ipsilateral breast cancer recurrence, or who developed a secondary malignancy within 1 year of diagnosis. Standardized incidence ratios and absolute excess risk were calculated using SEER*Stat, version 8.2.1 and SAS, version 9.4.Principle resultsThere were 374,993 patients meeting the inclusion criteria, with 154,697 who received radiation therapy. With a median follow-up of 8.9 years, 13% of patients (49,867) developed a secondary malignancy. The rate of secondary malignancies was significantly greater than the endemic rate in breast cancer patients treated without radiation therapy, (O/E 1.2, 95% CI 1.19–1.22) and with radiation therapy (O/E 1.33, 95% CI 1.31–1.35). Approximately 3.4% of secondary malignancies were attributable to radiation therapy. The increased risk of secondary malignancies in breast cancer patients treated with radiation therapy compared to those without was significant regardless of age at breast cancer diagnosis (p < 0.01) and more pronounced with longer latency periods.ConclusionThere was an increased risk of secondary malignancies for breast cancer patients both with and without radiation therapy compared to the general population. There was an increased risk in specific sites for patients treated with radiation therapy. This risk was most evident in young patients and who had longer latency periods. |
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| Keywords: | Breast cancer Radiation therapy Secondary malignancies Breast cancer treatment |
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