Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study

Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1021-30. doi: 10.1016/j.ijrobp.2008.02.040. Epub 2008 Jun 14.

Abstract

Purpose: To quantify the risk of second primary breast cancer in the contralateral breast (CB) after radiotherapy (RT) for first breast cancer.

Methods and materials: The study population included participants in the Women's Environmental, Cancer, and Radiation Epidemiology study: 708 cases (women with asynchronous bilateral breast cancer) and 1399 controls (women with unilateral breast cancer) counter-matched on radiation treatment. Participants were <55 years of age at first breast cancer. Absorbed doses to quadrants of the CB were estimated. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using multivariable-adjusted conditional logistic regression models.

Results: Across all patients, the mean radiation dose to the specific quadrant of the CB tumor was 1.1 Gy. Women <40 years of age who received >1.0 Gy of absorbed dose to the specific quadrant of the CB had a 2.5-fold greater risk for CB cancer than unexposed women (RR = 2.5, 95% CI 1.4-4.5). No excess risk was observed in women >40 years of age. Women <40 years of age with follow-up periods >5 years had a RR of 3.0 (95% CI 1.1-8.1), and the dose response was significant (excess RR per Gy of 1.0, 95% CI 0.1-3.0).

Conclusions: Women <40 years of age who received a radiation dose >1.0 Gy to the CB had an elevated, long-term risk of developing a second primary CB cancer. The risk is inversely related to age at exposure and is dose dependent.

Publication types

  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Body Burden
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / radiotherapy*
  • Denmark / epidemiology
  • Female
  • Humans
  • Incidence
  • Middle Aged
  • Neoplasms, Radiation-Induced / epidemiology*
  • Neoplasms, Second Primary / epidemiology*
  • Radiotherapy / statistics & numerical data*
  • Radiotherapy Dosage
  • Relative Biological Effectiveness
  • Risk Assessment / methods*
  • Risk Factors
  • Treatment Outcome
  • United States / epidemiology
  • Women's Health