Childhood Cancer Linked to Worse Mortality After Breast Cancer

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Women diagnosed with a childhood cancer who developed breast cancer as an adult were more likely to die after being diagnosed with breast cancer compared to women who did not have childhood cancer, according to a study.

While childhood cancer survivors were a bit more likely to die from breast cancer, they were much more likely to die because of other health issues, suggesting that childhood cancer survivors need follow-up care that includes regular screenings for possible complications of the earlier care.

The research was published online on July 1, 2019, by the Journal of Clinical Oncology. Read the abstract of “Mortality After Breast Cancer Among Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

How the study was done

Earlier research has shown that women diagnosed with cancer as children have a higher risk of being diagnosed with breast cancer as adults. This higher risk is due to a number of factors, including treatments for childhood cancer, such as chest radiation therapy and chemotherapy.

For this study, researchers wanted information on survival after a breast cancer diagnosis in women who had been treated for childhood cancer.

The Childhood Cancer Survivor Study was started in 1994 to better understand the health problems that may develop years after childhood cancer treatment. Originally, childhood cancer survivors diagnosed between 1970 and 1986 and their siblings were included in the study. Because of advances in the treatment of childhood cancer, a second group of childhood cancer survivors diagnosed between 1987 and 1999 and their siblings also were included in the study.

This study included 277 people who had been treated for childhood cancer between 1970 and 1986 and were later diagnosed with breast cancer as an adult. Three of these people were men, and they were not included in the analysis.

Among the 274 women:

  • 71% had been treated with chest radiation for childhood cancer
  • 61% had been treated with chemotherapy for childhood cancer
  • 64% had been diagnosed with Hodgkin lymphoma as children
  • 336 breast cancers were diagnosed; 62 women had two breast cancers diagnosed
  • half were younger than 38 when diagnosed with breast cancer and half were older; age at breast cancer diagnosis ranged from 20 to 58

Of the 336 breast cancers diagnosed:

  • 74% were invasive
  • 24% were DCIS
  • 68% of the invasive cancers were stage I or stage II when diagnosed

Survival statistics

The researchers compared the outcomes after being diagnosed with breast cancer in the women with a history of childhood cancer to outcomes in a similar group of women who had been diagnosed with breast cancer but had not been diagnosed with childhood cancer.

Overall, 92 women who developed breast cancer as an adult after a childhood cancer diagnosis had died. The risk of dying from any cause after a breast cancer diagnosis was more than twice as high among women who were childhood cancer survivors compared to women who did not have childhood cancer.

Of the women with a history of childhood cancer who died, 49 died as a result of breast cancer. The risk of dying from breast cancer was a bit higher among women who had been diagnosed with childhood cancer than among women who did not have childhood cancer. Still, the researchers pointed out that the childhood cancer survivors were more than five times as likely to die of other health issues, including other cancers and heart/lung problems compared to women with no history of childhood cancer.

“Although [breast cancer] specific mortality was modestly higher in childhood cancer survivors, deaths attributable to health conditions other than [breast cancer] seem to be the driving force in the elevated all-cause mortality,” the researchers wrote.

Among the 43 women with a history of childhood cancer who died from causes other than breast cancer:

  • 18 were due to another cancer
  • 14 were due to heart issues
  • 7 were due to lung issues

What this means for you

If you were treated for cancer as a child, it’s particularly important that you regularly see a doctor who:

  • is familiar with your medical history
  • understands the unique risks you have
  • can give you the appropriate counseling, monitoring, and screening for possible complications of your earlier cancer treatment

Still, research has shown that many childhood cancer survivors don’t get recommended follow-up care, in part because not all doctors know how to provide this care.

"Although guidelines recommend related follow-up care, many primary care physicians are unaware of these guidelines, and many childhood cancer survivors are not receiving the recommended surveillance,” the researchers wrote. "Our results emphasize the need for this population with a high risk of mortality to be followed by clinicians familiar with the health conditions faced by childhood cancer survivors."

It’s also important to know that treatment for childhood cancer increases the risk of being diagnosed with breast cancer. If you were treated for childhood cancer, you and your doctor should strongly consider a more aggressive breast cancer screening plan. This plan might include more frequent mammograms starting at an earlier age than the recommended age of 40, and possibly using different imaging techniques, such as MRI or ultrasound.

Written by: Jamie DePolo, senior editor


Reviewed by: Brian Wojciechowski, M.D., medical adviser


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