BACKGROUND. Patients with breast cancer have a threefold increase in the risk that a second breast cancer will develop. Radiation treatment for the initial cancer can result in moderately high doses to the contralateral breast, possibly contributing to this heightened risk. METHODS. We conducted a case-control study in a cohort of 41,109 women diagnosed with breast cancer between 1935 and 1982 in Connecticut. We reviewed the medical records of 655 women in whom a second breast cancer developed five or more years after the initial tumor and compared their radiation exposure with that of 1189 matched controls from the cohort who did not have a second cancer. The dose of radiation to the contralateral breast was estimated from the original radiotherapy records. Among the exposed women, the average radiation dose to the contralateral breast was 2.82 Gy (maximum, 7.10). RESULTS. Overall, 23 percent of the women who had a second breast cancer and 20 percent of the controls had received radiotherapy (relative risk of a second breast cancer associated with radiotherapy, 1.19). Among women who survived for at least 10 years, radiation treatment was associated with a small but marginally significant elevation in the risk of a second breast cancer (relative risk, 1.33); the risk increased significantly with the dose of radiation. An increase in risk in association with radiotherapy was evident only among women who were under 45 years of age when they were treated (relative risk, 1.59) and not among older women (relative risk, 1.01). CONCLUSIONS. Radiotherapy for breast cancer contributes little to the already high risk of a second cancer in the opposite breast. Fewer than 3 percent of all second breast cancers in this study could be attributed to previous radiation treatment; the risk, however, was significantly increased among women who underwent irradiation at a relatively young age (less than 45 years). Radiation exposure after the age of 45 entails little, if any, risk of radiation-induced breast cancer.
Source Information
Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Md.
This article has been cited by other articles:
Hooning, M. J., Aleman, B. M.P., Hauptmann, M., Baaijens, M. H.A., Klijn, J. G.M., Noyon, R., Stovall, M., van Leeuwen, F. E.
(2008). Roles of Radiotherapy and Chemotherapy in the Development of Contralateral Breast Cancer. JCO
26: 5561-5568
[Abstract][Full Text]
Brenner, D. J., Shuryak, I., Russo, S., Sachs, R. K.
(2007). Reducing Second Breast Cancers: A Potential Role for Prophylactic Mammary Irradiation. JCO
25: 4868-4872
[Full Text]
Largent, J. A., Capanu, M., Bernstein, L., Langholz, B., Mellemkjaer, L., Malone, K. E., Begg, C. B., Haile, R. W., Lynch, C. F., Anton-Culver, H., Wolitzer, A., Bernstein, J. L.
(2007). Reproductive History and Risk of Second Primary Breast Cancer: The WECARE Study. Cancer Epidemiol. Biomarkers Prev.
16: 906-911
[Abstract][Full Text]
Armstrong, K., Moye, E., Williams, S., Berlin, J. A., Reynolds, E. E.
(2007). Screening Mammography in Women 40 to 49 Years of Age: A Systematic Review for the American College of Physicians. ANN INTERN MED
146: 516-526
[Abstract][Full Text]
Schmidt, M. K., Tollenaar, R. A.E.M., de Kemp, S. R., Broeks, A., Cornelisse, C. J., Smit, V. T.H.B.M., Peterse, J. L., van Leeuwen, F. E., Van 't Veer, L. J.
(2007). Breast Cancer Survival and Tumor Characteristics in Premenopausal Women Carrying the CHEK2*1100delC Germline Mutation. JCO
25: 64-69
[Abstract][Full Text]
Hill, D. A., Gilbert, E., Dores, G. M., Gospodarowicz, M., van Leeuwen, F. E., Holowaty, E., Glimelius, B., Andersson, M., Wiklund, T., Lynch, C. F., van't Veer, M., Storm, H., Pukkala, E., Stovall, M., Curtis, R. E., Allan, J. M., Boice, J. D., Travis, L. B.
(2005). Breast cancer risk following radiotherapy for Hodgkin lymphoma: modification by other risk factors. Blood
106: 3358-3365
[Abstract][Full Text]
Longo, D. L.
(2005). Radiation Therapy in Hodgkin Disease: Why Risk a Pyrrhic Victory?. JNCI J Natl Cancer Inst
97: 1394-1395
[Full Text]
Zablotska, L. B., Chak, A., Das, A., Neugut, A. I.
(2005). Increased Risk of Squamous Cell Esophageal Cancer after Adjuvant Radiation Therapy for Primary Breast Cancer. Am J Epidemiol
161: 330-337
[Abstract][Full Text]
Violet, J A, Harmer, C
(2004). Breast cancer: improving outcome following adjuvant radiotherapy. Br. J. Radiol.
77: 811-820
[Abstract][Full Text]
Truong, P. T., Olivotto, I. A., Whelan, T. J., Levine, M.
(2004). Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ
170: 1263-1273
[Abstract][Full Text]
Punglia, R. S., Kuntz, K. M., Lee, J. H., Recht, A.
(2003). Radiation Therapy Plus Tamoxifen Versus Tamoxifen Alone After Breast-Conserving Surgery in Postmenopausal Women With Stage I Breast Cancer: A Decision Analysis. JCO
21: 2260-2267
[Abstract][Full Text]
Smith, R. A., Saslow, D., Andrews Sawyer, K., Burke, W., Costanza, M. E., Evans, W. P. III, Foster, R. S. Jr., Hendrick, E., Eyre, H. J., Sener, S.
(2003). American Cancer Society Guidelines for Breast Cancer Screening: Update 2003. CA Cancer J Clin
53: 141-169
[Abstract][Full Text]
Pierce, L. J.
(2001). Treatment Guidelines and Techniques in Delivery of Postmastectomy Radiotherapy in Management of Operable Breast Cancer. J Natl Cancer Inst Monogr
2001: 117-124
[Abstract][Full Text]
Shapiro, C. L., Recht, A.
(2001). Side Effects of Adjuvant Treatment of Breast Cancer. NEJM
344: 1997-2008
[Full Text]
Wärnberg, F., Bergh, J., Zack, M., Holmberg, L.
(2001). Risk Factors for Subsequent Invasive Breast Cancer and Breast Cancer Death after Ductal Carcinoma in Situ: A Population-based Case-Control Study in Sweden. Cancer Epidemiol. Biomarkers Prev.
10: 495-499
[Abstract][Full Text]
Recht, A., Edge, S. B., Solin, L. J., Robinson, D. S., Estabrook, A., Fine, R. E., Fleming, G. F., Formenti, S., Hudis, C., Kirshner, J. J., Krause, D. A., Kuske, R. R., Langer, A. S., Sledge, G. W. Jr, Whelan, T. J., Pfister, D. G.
(2001). Postmastectomy Radiotherapy: Clinical Practice Guidelines of the American Society of Clinical Oncology. JCO
19: 1539-1569
[Abstract][Full Text]
Unnithian, J., Macklis, R., Haffty, B. G.
(2000). Breast Cancer Radiotherapy: Safe for All?. JCO
18: 4000-4001
[Full Text]
Pierce, L. J., Strawderman, M., Narod, S. A., Oliviotto, I., Eisen, A., Dawson, L., Gaffney, D., Solin, L. J., Nixon, A., Garber, J., Berg, C., Isaacs, C., Heimann, R., Olopade, O. I., Haffty, B., Weber, B. L.
(2000). Effect of Radiotherapy After Breast-Conserving Treatment in Women With Breast Cancer and Germline BRCA1/2 Mutations. JCO
18: 3360-3369
[Abstract][Full Text]
Burstein, H. J., Winer, E. P.
(2000). Primary Care for Survivors of Breast Cancer. NEJM
343: 1086-1094
[Full Text]
Obedian, E., Fischer, D. B., Haffty, B. G.
(2000). Second Malignancies After Treatment of Early-Stage Breast Cancer: Lumpectomy and Radiation Therapy Versus Mastectomy. JCO
18: 2406-2412
[Abstract][Full Text]
Chen, Y., Thompson, W., Semenciw, R., Mao, Y.
(1999). Epidemiology of Contralateral Breast Cancer. Cancer Epidemiol. Biomarkers Prev.
8: 855-861
[Abstract][Full Text]
Boice, J. D. Jr, Mandel, J. S., Doody, M. M.
(1995). Breast Cancer Among Radiologic Technologists. JAMA
274: 394-401
[Abstract]
(1992). DOES RADIOTHERAPY INCREASE RISK OF CANCER IN THE OPPOSITE BREAST. JWatch General
1992: 1-1
[Full Text]
