1. Total Body Irradiation and Risk of Breast Cancer After Blood or Marrow Transplantation: A Blood or Marrow Transplantation Survivor Study Report.
- Author
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McDonald AM, Chen Y, Wu J, Hageman L, Francisco L, Kung M, Wong FL, Ness E, Landier W, Battles K, Salzman D, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, and Bhatia S
- Subjects
- Adult, Alabama epidemiology, Bone Marrow Transplantation adverse effects, Bone Marrow Transplantation methods, Breast Neoplasms mortality, Cohort Studies, Female, Hematologic Neoplasms epidemiology, Hematologic Neoplasms radiotherapy, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Humans, Middle Aged, Minnesota epidemiology, Neoplasms, Radiation-Induced etiology, Proportional Hazards Models, Retrospective Studies, Risk, Whole-Body Irradiation adverse effects, Whole-Body Irradiation methods, Bone Marrow Transplantation statistics & numerical data, Breast Neoplasms epidemiology, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation statistics & numerical data, Neoplasms, Radiation-Induced epidemiology, Whole-Body Irradiation statistics & numerical data
- Abstract
Purpose: To examine the association between total body irradiation (TBI) and subsequent breast cancer in women treated with blood or marrow transplantation (BMT) for hematologic malignancies., Patients and Methods: Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived for ≥ 2 years after BMT. Patients with pre-BMT chest radiation or a history of breast cancer were excluded. Participants completed the BMTSS survey, which included details regarding breast cancer diagnosis. Subsequent breast cancer was confirmed by pathology report review or physician notes. Cox proportional hazards models assessed the association between TBI and subsequent breast cancer. Standardized incidence ratios were calculated to determine the excess risk of subsequent breast cancer compared with that in the general population., Results: A total of 1,464 female BMT survivors (allogeneic: n = 788; autologous: n = 676) participated, with a median follow-up of 9.3 years from BMT. TBI was used in 660 patients (46%). Thirty-seven women developed subsequent breast cancer (allogeneic: n = 19; autologous: n = 18). Multivariable analysis revealed that exposure to TBI was associated with an increased risk of subsequent breast cancer among allogeneic BMT survivors (hazard ratio [HR], 3.7 [95% CI, 1.2 to 11.8]; P = .03) and autologous BMT survivors (HR, 2.6 [95% CI, 1.0 to 6.8]; P = .048). Pre-BMT exposure to alkylating agents was associated with an increased risk of subsequent breast cancer among autologous BMT survivors (HR, 3.3 [95% CI, 1.0 to 9.0]; P = .05). Compared with that in the general population, exposure to TBI at age < 30 years was associated with a 4.4-fold higher risk of subsequent breast cancer in allogeneic BMT survivors and a 4.6-fold higher risk in autologous BMT survivors., Conclusion: The association between TBI and subsequent breast cancer, especially among those exposed at a young age, as well as pre-BMT exposure to alkylating agents, should inform breast cancer screening for early detection.
- Published
- 2020
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