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The effects of radiotherapy for the treatment of contralateral breast cancer

  • Epidemology
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Abstract

Radiotherapy following breast-conserving surgery for the treatment of first primary breast cancer is the standard of care and is widely used despite its small survival benefit. The effects of radiotherapy in metachronous contralateral breast cancer are unknown. We examined the use of radiotherapy and its effect on cause-specific and all-cause mortality among women with metachronous contralateral breast cancer treated with breast-conserving surgery in community settings. Using data from the 1985–2000 Surveillance, Epidemiology, and End Results program, we identified women with stage 0-III metachronous contralateral breast cancer that occurred at least six months after stage 0-III first primary breast cancer. Cause-specific and all-cause mortality of women age 40–69 who did and who did not receive radiotherapy following breast-conserving surgery for metachronous contralateral breast cancer were compared in proportional hazard models using propensity scores to balance covariates by radiotherapy use. We adjusted for misclassification of radiotherapy use. Based on misclassification-corrected analyses, 43.2 percent of 1,083 women with metachronous contralateral breast cancer did not receive radiotherapy after BCS. After adjustment for propensity scores and radiotherapy misclassification, women who did not receive radiotherapy had 2.2 times greater risk of cause-specific and 1.7 times greater risk of all-cause mortality. In community settings, a high percentage of women with stage 0-III metachronous contralateral breast cancer did not receive radiotherapy following breast-conserving surgery. Unlike the small survival benefit of radiotherapy after first primary breast cancer, omission of radiotherapy after metachronous contralateral breast cancer significantly increased the risk of cause-specific and all-cause mortality.

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Acknowledgment

We thank James Struthers, for data management and selected statistical services provided through the Health Behavior and Outreach Core of the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri. This research was supported in part by grants from the National Cancer Institute (CA91842; CA91734; CA98594; CA100760; CA10712) and the Agency for Health Research and Quality (HS 14095).

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Authors and Affiliations

  1. Departments of Medicine and Pediatrics, Division of Health Behavior Research, Washington University School of Medicine , 4444 Forest Park Blvd, Box 8504, Saint Louis, MO, 63108, U.S.A

    Mario Schootman & Donna B. Jeffe

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, 63110, U.S.A

    Mario Schootman, Donna B. Jeffe, William E. Gillanders, Yan Yan & Rebecca Aft

  3. Department of Surgery, Washington University School of Medicine, Saint Louis, MO, 63110, U.S.A

    William E. Gillanders, Yan Yan & Rebecca Aft

  4. John Cochran VA Medical Center, Saint Louis, MO, U.S.A

    Rebecca Aft

Authors
  1. Mario Schootman
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  2. Donna B. Jeffe
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  3. William E. Gillanders
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  4. Yan Yan
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  5. Rebecca Aft
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Correspondence to Mario Schootman.

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Schootman, M., Jeffe, D.B., Gillanders, W.E. et al. The effects of radiotherapy for the treatment of contralateral breast cancer. Breast Cancer Res Treat 103, 77–83 (2007). https://doi.org/10.1007/s10549-006-9354-1

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  • DOI: https://doi.org/10.1007/s10549-006-9354-1

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