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Study Estimates Risks of Radiation Treatment for Breast Cancer in Women With Scleroderma

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Scleroderma is a group of autoimmune diseases that cause the skin and connective tissues to become hard and tighten. Scleroderma is caused by the body producing too much collagen, which then builds up in the tissues. Collagen is a type of protein that makes up your body’s connective tissue, including your skin.

For some people, scleroderma affects only the skin, causing a hardening and tightening of patches of skin. Still, in many people scleroderma also affects the blood vessels, internal organs, such as the heart, lungs or kidneys, and the digestive tract.

Scleroderma affects women more often than men.

People diagnosed with scleroderma have a higher risk of several types of cancer. Breast cancer is the most common type of cancer diagnosed in people with scleroderma.

Lumpectomy and radiation therapy are common treatments for early-stage breast cancer.

Many doctors believe that people diagnosed with scleroderma should not receive radiation therapy because the radiation can cause more hardening and tightening of the skin, lungs, and other organs in the treatment area. It is thought that radiation also may cause a flare-up of scleroderma symptoms. Still, little research has been done in this area and not much is known about how scleroderma affects breast cancer outcomes.

A study done to help fill in this information gap suggests that some women diagnosed with scleroderma and breast cancer treated with radiation had long-term skin tightening or thickening in the treatment area, but no disease flare-up.

The research was published online on Jan. 5, 2018 by the journal Arthritis Care & Research. Read the abstract of “Impact of Radiation Therapy on Scleroderma and Cancer Outcomes in Scleroderma Patients with Breast Cancer.”

The study included 116 women diagnosed with scleroderma and breast cancer who were treated at the Johns Hopkins University Scleroderma Center from 1982 to 2013 and 67 women diagnosed with both diseases who were treated at the University of Pittsburgh Medical Center Scleroderma Center from 1990 to 2014:

  • 43 of the 116 women treated at Johns Hopkins were treated with radiation therapy for breast cancer
  • information on radiation treatment was available for 37 women treated at the University of Pittsburgh; 26 of the 37 women were treated with radiation therapy for breast cancer

Because the way information was collected was different at the two medical centers, the researchers analyzed the two groups separately.

In the Johns Hopkins group, the rate of severe skin side effects in women treated with radiation was low:

  • 13.3% of the women had reddening of the skin
  • 3.3% had skin ulceration
  • 48.4% had skin thickening in the treatment area
  • 0% had blistering

Additionally, 10% of the women had hardening of lung tissue that was in the treatment area, called pulmonary fibrosis.

In the University of Pittsburgh group, the rate of severe skin side effects also was low:

  • 63.6% had reddening of the skin
  • 18.2% had blistering
  • 54.6% had skin thickening in the radiation port
  • 0% had skin ulceration

There was no information on pulmonary fibrosis for this group.

One year after breast cancer was diagnosed, there was no evidence of a scleroderma flare-up in either group. There also was no real difference in Rodnan skin scores between women who were treated with radiation therapy and women who didn’t receive radiation. The Rodnan skin score is a tool that doctors use to assess the thickening of the skin in people with scleroderma.

In both groups, similar numbers of women had no evidence of breast cancer 1, 2, and 5 years after diagnosis.

"In our clinical experience, many scleroderma patients are denied breast conserving surgery and radiation as a treatment option," the researchers wrote. "These data suggest that radiation injury causing local tissue fibrosis is not inevitable in scleroderma patients with breast cancer, occurring in approximately 50% of cases without evidence of lung or generalized skin disease flare. These data suggest to us that the decision about whether to proceed with radiation therapy should involve a multidisciplinary discussion between the treating rheumatologist, medical and radiation oncologists, breast surgeon, and patient, factoring in each patient's preferences and tolerance for risk."

If you have been diagnosed with scleroderma and now breast cancer and are planning your treatment for breast cancer, you might want to talk to both your scleroderma doctor and your oncologist about this study. You and your doctors will consider a number of factors when deciding on breast cancer treatments. In addition to any other conditions you’ve been diagnosed with, you’ll also consider:

  • the characteristics of the cancer
  • any treatments you’ve already had
  • the results of any genetic testing you’ve had
  • your general health
  • your personal preferences

For more information on radiation to treat breast cancer, visit the Radiation Therapy section.

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