Premenopausal women previously treated with radiation have poor breast cancer-specific survival

Conclusion:

Before menopause Women with breast cancer, Patients previously treated with radiation for primary childhood, adolescent, or young adult cancer had poor breast cancer-specific survival.

Journal in which the study was published:

Cancer epidemiology, biomarkers, prevention, Journal of the American Cancer Research Association

Author:

Candace A. Sauder, MD, Surgical Oncologist at the University of California (UC) Davis Comprehensive Cancer Center

Background:

We traditionally use similar treatments for primary and secondary breast cancers, and we base treatment approaches on specific prognostic factors. Our results show that breast cancer-related survival rates can be determined in early survivors of breast cancer and other cancers when treated with radiation therapy and subsequently develop breast cancer in all survivors of breast cancer, adolescent, and young adult cancers. It is considered to be a good prognostic factor, suggesting that it is significantly reduced even in characteristic situations. “

Candice A. Sauder, MD, Surgical Oncologist, University of California (UC) Davis Comprehensive Cancer Center

“Therefore, treatment strategies for women with a second primary breast cancer may need to be adjusted.”

According to the National Cancer Institute, secondary primary cancers are defined as new cancers that occur in people who have had cancer in the past.

Many common pediatric and adolescent/young adult (AYA) cancer treatments include radiation therapy, a second risk factor for primary breast cancer.

Sauder notes that the second primary breast cancer in young women previously receiving radiation therapy has unique clinical features. However, it is unclear whether such features are associated with previous radiation therapy or premenopausal status, she said.

Survey method:

To better understand how radiation therapy used in the primary setting affects the clinical features of secondary breast cancer in young women, Sauder et al. reported that almost all invasiveness diagnosed in California We contacted the California Cancer Registry, including

They are women aged 12 to 50 years (menarche and menstruation) diagnosed with primary breast cancer (107,751 women) or secondary primary breast cancer (1,147 women) between January 1 and December 31, 1988. Data to understand premenopausal breast cancer based on an estimate of age at menopause, 2014.

The second primary breast cancer patient was limited to the first primary cancer patient who was treated with radiation between the ages of 12 and 39 years.

The researchers compared demographic and clinical factors between women with secondary breast cancer and women with primary breast cancer.

In addition, we compared breast cancer-specific survival rates among these groups, including population and age, race/ethnicity, lymph node involvement, hormone receptor status, and HER2 status.

result:

Overall, women with second primary breast cancer who had previously received radiation treatment were more likely to be Hispanic or black compared to premenopausal women with primary breast cancer, with earlier tumors, higher grade There was a tumor, cancer without lymph node metastases, and a tumor that was hormone receptor negative.

Women with secondary primary breast cancer in this cohort had approximately twice the risk of breast cancer-specific mortality compared to women with primary breast cancer.

The researchers also found that breast cancer-specific survival in women with secondary breast cancer who had previously received radiation was significantly worse in all subgroups examined.

A subgroup of women with a usually good prognosis in the primary setting of breast cancer, including hormone receptor-positive tumors, tumors without lymph node metastases, stage I disease, and women of Asian or Pacific island ethnicity, was particularly experienced. There is worse survival after secondary breast cancer.

For example, women with secondary breast cancer who have been previously treated with radiation have more than doubled the risk of breast cancer-specific death for stage I disease and the risk of breast cancer-specific death for stage II or stage III. Has almost doubled. Illness compared to women who had the same stage of primary breast cancer.

Similarly, women with secondary breast cancer in this cohort have approximately 2.4 times the risk of breast cancer-specific death for tumors without lymph node metastases and approximately 1.7 times the risk of breast cancer-specific death for lymphoma tumors. The comparison was with women with primary breast cancer who had the same lymph node metastasis status.

Author’s comment:

“We found that the adverse effects of secondary primary breast cancer in women who had been previously treated with radiation were particularly strong in a subgroup of patients who had good survival rates after primary breast cancer,” Sauder said. ..

“It is important to positively evaluate how a particular treatment modality, such as a particular radiation field or chemotherapeutic agent, will affect the outcome of secondary breast cancer.”

Study limitations: Study limitations include lack of co-morbidity data and genetic information, including BRCA mutation status, which can influence treatment decisions and potentially affect secondary breast cancer risk. ..