Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer

Abstract

Women treated with chest radiation for a pediatric malignancy face a significantly increased risk of breast cancer at a young age.^1-6 The risk of breast cancer begins to increase as early as 8 years after radiation and the median age of breast cancer diagnosis ranges from 32 to 35 years.^1,2,4 Risk of breast cancer is greatest among women who were treated for Hodgkin lymphoma with high-dose mantle radiation.² By age 45 years, it is estimated that from 12% to 20% of women treated with moderate- to high-dose chest radiation will be diagnosed with breast cancer.^1,2,4 For perspective, among women with a BRCA gene mutation, the estimated cumulative incidence of breast cancer ranges from 1% to 5% at age 30 years and from 10% to 19% at age 40 years.^7-11 As in the general population, breast cancer outcomes among childhood cancer survivors are strongly associated with stage at diagnosis.^12-14 Notably, treatment options for these women are often limited due to previous chest radiation and possible exposure to anthracycline chemotherapy.