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Increased Breast Cancer Risk in Female Survivors of Wilms Tumor | Breast Cancer Arabia
  • Increased Breast Cancer Risk in Female Survivors of Wilms Tumor

    NEW YORK (Reuters Health) – Women who had radiotherapy for Wilms tumor face an increased risk of early breast cancer, according to results from National Wilms Tumor Late Effects Study.

    “While we had expected to observe an increase in risk based on our own and others’ data specific for Wilms tumor, the large magnitude of the excess was not anticipated,” Dr. Norman E. Breslow from the University of Washington in Seattle told Reuters Health by email.

    Survivors of childhood cancers have an estimated 24.7-fold increased risk after chest radiotherapy and an estimated 4.8-fold increased risk without chest radiotherapy, but information regarding breast cancer in survivors of Wilms tumor is scarce.

    Dr. Breslow and colleagues used data from 2492 female participants in National Wilms Tumor Studies 1 through 4 to calculate their risk of breast cancer in comparison with the general population.

    They identified 29 cases of invasive breast cancer among 28 participants, all but four of them before age 40, according to the October 27 Cancer online report.

    Based on the incidence in the general population, they should have diagnosed only 3.20 cases. So these women experienced a 9.1-fold increased risk and an estimated cumulative risk of invasive breast cancer at age 40 years of 4.5%.

    The risk relative to the general population was even higher for women who had chest radiotherapy; they had a 27.6-fold increase, and their cumulative risk of breast cancer by age 40 was 14.8%.

    Among the women who developed breast cancer after chest radiotherapy, nine received 12 Gy, three received 14 Gy, and one each received 15 Gy and 21 Gy to the bilateral chest. One other patient received 12 Gy bilaterally plus a boost of 26 Gy to the left lung, and the remaining patient received 12.3 Gy to the right lung only.

    Breast cancer rates did not differ significantly between women who had abdominal irradiation and those who did not.

    The percentage of women whose cancers were estrogen receptor- and/or progesterone receptor-positive resembled that of women diagnosed with postmenopausal breast cancer, which the researchers say “is compatible with the theory that radiogenic cancers are typical of those that occur in the general population, but are induced to appear earlier.”

    “Patients with Wilms tumor who were treated for pulmonary metastases with 12 Gy of whole-chest radiotherapy are strong candidates for breast cancer surveillance before age 40 years, after which routine mammographic surveillance for women in the general population is recommended,” the investigators say

    They continue: “Current guidelines, which suggest yearly mammography and breast magnetic resonance imaging starting at age 25 years or eight years after treatment culmination only for those who received at least 20 Gy of radiotherapy to the chest or mantle, would need to be revised to facilitate the early diagnosis and prompt treatment of breast cancer among survivors of Wilms tumor

    Dr. James Yu from Yale School of Medicine, New Haven, Connecticut told Reuters Health by email, “I agree completely with the authors on this conclusion given the well performed nature of this study, the long follow up, the large size of the cohort, and the very clean radiation data (all patients treated on protocol).”

    “The implications for male survivors are unclear,” Dr. Breslow said. “To date we have not observed any cases of breast cancer in male survivors. In the general population, the rates for females are roughly 100 times those for males, and male breast cancer under age 40 is extremely rare. Even if (crudely extrapolating from our data) the rates were 28 times background, the risk of an early breast cancer in a male survivor who had received chest radiation would be negligible.”

    Dr. Breslow pointed out that “cure of childhood cancer is not without cost. Patients, parents, and physicians all need to consider the risks of ‘late effects’ of cancer and its treatment when making treatment decisions.”

    Dr. Yu added, “This study emphasizes what we as a discipline are learning more and more – that long-term cancer survivorship is critical. Furthermore, the fact that these patients are at increased risk for breast cancer is bittersweet – it means that they are living longer and cured of cancer due to the radiation treatment itself.”

    “Radiation remains an important and critical part of childhood cancer treatment,” Dr. Yu said. “It also means that innovation and research in radiation therapy treatment is needed, and federal funding for radiation research impacts all patients – young and old.”

    Cancer 2014.

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