Breast cancer after childhood irradiation
Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30 years of life: A French multicentre cohort study

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Abstract

Purpose

Irradiation (>3 Gy) to the breast or axillae before 30 years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer.

Patients and methods

This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3 Gy) on part or all of the breast before 30 years of age, for any type of tumour except BC.

Results

A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up.

Conclusion

Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient’s age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.

Section snippets

Selection of patients and data collection

Patients were recruited from eight French centres, who were able to do an exhaustive research in medical files and from the French patients of the Euro2K database, which is a cohort of childhood solid cancer survivor [19], [24]. To be included, women should have all these inclusion criteria: a personal past history of treatment for cancer before 30 years of age, and, who had received radiotherapy at a dose of ≥3 Gy over all or part of the breast, and, who developed SBC at ≤50 years of age. This

Characteristics of the initial cancer

One hundred and four women (≤50-year of age) with 121 breast tumours were included in the study (67 from the eight centres and 37 from the Euro2k cohort). Mean age at diagnosis of the initial cancer was 16.3 years (range: 0.6–30.6); this was HL in 71% of cases. The initial cancer was treated between 1950 and 1995 with a total dose of ≥3 Gy over at least part of the breast, in 6–27 sessions spread over 3 days to 6 weeks. The majority of patients received radiotherapy to the mediastinum at a dose of

Discussion

In our cohort of 104 women, only 17.5% were previously followed up for this risk, although they had received radiotherapy for a cancer during their childhood or young adulthood. In contrast to the North American patients described by Elkin [26], SBCs in our patients were rarely diagnosed during screening, but usually at a symptomatic stage (88.3%) and no patient benefited from MRI screening.

SBC presented in women as young as 25 years (except one at 16 years) with a mean age at SBC diagnosis of 37 

Funding

This work was funded by the Association pour la Recherche sur le Cancer (ARC Fundation), the Agence Nationale pour la Recherche Scientifique (ANR, Hope-Epi).

Conflicts of interest

All authors declare no conflict of interest.

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