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2014 ; 120
(23
): 3722-30
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Breast cancer in female survivors of Wilms tumor: a report from the national
Wilms tumor late effects study
#MMPMID25348097
Lange JM
; Takashima JR
; Peterson SM
; Kalapurakal JA
; Green DM
; Breslow NE
Cancer
2014[Dec]; 120
(23
): 3722-30
PMID25348097
show ga
BACKGROUND: The standard treatment of pulmonary metastases in patients with Wilms
tumor (WT) includes 12-gray radiotherapy (RT) to the entire chest. To the
authors' knowledge, the risk of breast cancer (BC) in a large cohort of female
survivors of WT has not previously been reported. METHODS: A total of 2492 female
participants in National Wilms Tumor Studies 1 through 4 (1969-1995) were
followed from age 15 years through the middle of 2013 for incident BC. The median
age at the time of last contact was 27.3 years. The authors calculated cumulative
risk at age 40 years (CR40), hazard ratios (HR) by Cox regression, standardized
incidence ratios (SIRs) relative to US population rates, and 95% confidence
intervals (95% CIs). RESULTS: The numbers of survivors with invasive BC divided
by the numbers at risk were 16 of 369 (CR40, 14.8% [95% CI, 8.7-24.5]) for women
who received chest RT for metastatic WT, 10 of 894 (CR40, 3.1% [95% CI,
1.3-7.41]) for those who received only abdominal RT, and 2 of 1229 (CR40, 0.3%
[95% CI, 0.0-2.3]) for those who received no RT. The SIRs for these 3 groups were
27.6 (95% CI, 16.1-44.2) based on 5010 person-years (PY) of follow-up, 6.0 (95%
CI, 2.9-11.0) based on 13,185 PY of follow-up, and 2.2 (95% CI, 0.3-7.8) based on
13,560 PY of follow-up, respectively. The risk was high regardless of the use of
chest RT among women diagnosed with WT at age ?10 years, with 9 of 90 women
developing BC (CR40, 13.5% [95% CI, 5.6-30.6]; SIR, 23.6 [95% CI, 10.8-44.8] [PY,
1463]). CONCLUSIONS: Female survivors of WT who were treated with chest RT had a
high risk of developing early BC, with nearly 15% developing invasive disease by
age 40 years. Current guidelines that recommend screening only those survivors
who received ?20 Gy of RT to the chest might be reevaluated.
|Adolescent
[MESH]
|Adult
[MESH]
|Antibiotics, Antineoplastic/therapeutic use
[MESH]