Women diagnosed with breast cancer before menopause were more likely to die from breast cancer if they were previously diagnosed with a childhood or young adult cancer that was treated with radiation therapy, according to a study.
The research was published online on Aug. 26, 2020, by the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of “Characteristics and Outcomes for Secondary Breast Cancer in Childhood, Adolescent, and Young Adult Cancer Survivors Treated with Radiation.”
About the study
Earlier research has shown that women diagnosed with cancer as children or young adults have a higher risk of being diagnosed with breast cancer as adults. This higher risk is due to a number of factors, including treatments they received for childhood cancer, such as chest radiation therapy and chemotherapy.
For this study, the researchers wanted to know how radiation therapy for childhood or young adult cancer affected the breast cancer survival rates of women who were diagnosed with breast cancer before menopause.
To do the study, the researchers used information from the California Cancer Registry, a database that includes information on nearly all invasive cancers diagnosed in the state of California. The registry is maintained by the California Department of Public Health Chronic Disease Surveillance and Research Branch.
The researchers analyzed information for two groups of women:
- 107,751 women were diagnosed with breast cancer between the ages of 12 to 50; this was the women’s first cancer diagnosis
- 1,147 women were diagnosed with a first cancer that was treated with radiation between the ages of 12 and 39 and then diagnosed with breast cancer before age 50
The researchers compared a number of factors between the two groups of women. Compared to women diagnosed with breast cancer as a first cancer at age 50 or younger, women who had been treated with radiation for a first cancer at a young age and then diagnosed with breast cancer at age 50 or younger were more likely to:
- be Hispanic or Black
- be age 35 to 45
- have earlier-stage breast cancer
- have higher-grade breast cancer
- have cancer that had not spread to the lymph nodes
- be diagnosed with hormone-receptor-negative breast cancer
- be nearly twice as likely to die from breast cancer
Specifically, women who had been previously treated with radiation for childhood/young adult cancer had:
- more than twice the risk of dying from breast cancer if they were diagnosed with stage I disease
- nearly twice the risk of dying from breast cancer if they were diagnosed with stage II or stage III disease
- about 2.4 times the risk of dying from breast cancer if no breast cancer was found in the lymph nodes
- about 1.7 times the risk of dying from breast cancer if breast cancer was found in the lymph nodes
“Our results suggest that breast cancer-related survival is significantly decreased among all survivors of childhood, adolescent, and young adult cancer who were treated with radiation therapy and then develop breast cancer, even in the setting of early-stage breast cancer and other characteristics that are considered good prognostic factors,” said lead researcher Candice Sauder, M.D., surgical oncologist at the University of California Davis Comprehensive Cancer Center, in a statement. “As such, we may need to tailor our treatment strategy for women with a second primary breast cancer.
“We found that the negative impact of second primary breast cancer among women previously treated with radiation was particularly strong in subgroups of patients that have superior survival after primary breast cancer,” Sauder continued. “It will be important to prospectively evaluate how certain treatments, such as specific radiation fields or chemotherapeutic agents, can affect second primary breast cancer outcomes.”
The researchers pointed out that the study did have some limitations. They didn’t know if any of the women had a BRCA1 or BRCA2 mutation, which can affect breast cancer treatment choices. They also didn’t know if any of the women had other conditions that could affect breast cancer outcomes, such as obesity, high blood pressure, liver disease, or diabetes.
What this means for you
This study offers more evidence that being treated for childhood/young adult cancer can affect breast cancer survival later in life.
If you were treated with radiation for cancer as a child or young adult and then developed breast cancer before you went through menopause, it’s particularly important that you tell your oncologist about all your earlier treatments, as well as any other medical issues that you have.
You may want to discuss this study with your doctor and ask whether you need to consider a more aggressive treatment plan, even if you’ve been diagnosed with early-stage breast cancer that hasn’t spread to the lymph nodes. By considering all the aspects of your unique situation, you and your doctor can come up with a treatment plan that is right for you.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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