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- Title
Breast Cancer Following Radiotherapy and Chemotherapy Among Young Women With Hodgkin Disease.
- Authors
Travis, Lois B.; Hill, Deirdre A.; Dores, Graça M.; Gospodarowicz, Mary; van Leeuwen, Flora E.; Holowaty, Eric; Glimelius, Bengt; Andersson, Michael; Wiklund, Tom; Lynch, Charles F.; Van't Veer, Mars B.; Glimelius, Ingrid; Storm, Hans; Pukkala, Eero; Stovall, Marilyn; Curtis, Rochelle; Boice, Jr, John D.; Gilbert, Ethel
- Abstract
Context: Second cancer is the leading cause of death in long-term survivors of Hodgkin disease (HD), with exceptionally high risks of breast cancer among women treated at a young age. Quantitative associations between radiotherapy dose delivered to the breast and administered chemotherapy have not been reported to date in large series, nor has the influence of ovarian exposures on subsequent risk. Objective: To quantify the long-term risk of breast cancer associated with use of radiotherapy and chemotherapy to treat young women with HD. Design, Setting, and Subjects: Matched case-control study of breast cancer within a cohort of 3817 female 1-year survivors of HD diagnosed at age 30 years or younger, between January 1, 1965, and December 31, 1994, and within 6 population-based cancer registries. The study was conducted March 1, 1996, through September 30, 1998. Main Outcome Measures: Relative risk (RR) of breast cancer associated with radiation dose delivered to site of breast cancer or to ovaries and with cumulative dose of alkylating agents. Results: Breast cancer occurred in 105 patients with HD who were matched to 266 patients with HD but without breast cancer. A radiation dose of 4 Gy or more delivered to the breast was associated with a 3.2-fold (95% confidence interval [CI], 1.4-8.2) increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 8-fold (95% CI, 2.6-26.4) with a dose of more than 40 Gy (P<.001 for trend). Radiation risk did not vary appreciably by age at exposure or reproductive history. Increased risks persisted for 25 or more years following radiotherapy (RR, 2.3; 95% CI, 0.5-16.5; P = .03 for trend with dose). Treatment with alkylating agents alone resulted in a reduced risk (RR, 0.6; 95% CI, 0.2-2.0) of breast cancer, and combined alkylating agents and radiotherapy in a 1.4-fold (95% CI, 0.6-3.5) increased risk. Risk of breast cancer decreased with increasing number of...
- Subjects
BREAST cancer risk factors; HODGKIN'S disease treatment; CANCER in women; WOMEN'S health; MEDICAL radiology; DRUG therapy; CARCINOGENS; CANCER patients
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 290, Issue 4, p465
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.290.4.465