Advertisement

Breast Cancer Research and Treatment

, Volume 61, Issue 3, pp 183–195 | Cite as

Increased risk of second cancers following breast cancer: Role of the initial treatment

  • Carole Rubino
  • Florent de Vathaire
  • Ibrahima Diallo
  • Akhtar Shamsaldin
  • Monique G Lê
Article

Abstract

Objectives and methods.The risk of second primary malignancies (SMN) was studied in a cohort of 4,416 one-year survivors of a breast cancer. The role of the menopausal status and of the initial treatment modalities (surgery, radiotherapy, and chemotherapy) was investigated.

Results.Excluding second primary breast cancer and non-melanoma skin cancer, a total of 193 (4.4%) patients developed a SMN between 1973 and 1992, compared with 136 expected (Standardised Incidence Ratio, SIR = 1.4, 95% CI (1.2–1.6)). No trend towards either an increase or a decrease was noted in the SIR with time after treatment (p = 0.2). The greatest increase in the relative risk concerned soft tissue cancers (SIR = 13.0, 95% CI: 6.8–22.3), followed by leukaemia (SIR = 3.1, 95% CI: 1.7–5.0), melanoma (SIR  =  2.7, 95% CI: 1.4–4.8), kidney (SIR = 2.5, 95% CI: 1.2–4.5), ovary (SIR = 2.0, 95% CI: 1.2–3.1) and uterine tumours (SIR = 1.9, 95% CI: 1.4–2.5). The SIR was 3.0 (95% CI 1.8–4.7) in women under 40 at the time of the breast cancer, 1.9 (95% CI : 1.4 – 2.4) in those aged 40–49 and 1.2 (95% CI 1.0–1.4) in those aged 50 or more. In the 2,514 women who had received radiotherapy as initial treatment without chemotherapy, the SIR for all SMN was 1.6 (95% CI: 1.1–2.3) fold higher than in those who had not received radiotherapy as initial treatment.

Conclusion.In conclusion, this study confirms the increased risk of second malignancies in women treated for a breast cancer, and particularly in those who were younger at the time of treatment for breast cancer. Our results also suggest that radiotherapy may play a role in the onset of these second lesions.

breast cancer chemotherapy cohort study radiotherapy second primary cancer 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    De Vathaire F, Koscielny S, Rezvani A, Laplanche A, Estè ve J, Ferlay J: Estimation de l'incidence des cancers en France 1983- 1987. Les éditions INSERM, Paris, 1996.Google Scholar
  2. 2.
    Menegoz F, Black RJ, Arveux P, Magne V, Ferlay J, et al: Cancer incidence and mortality in France in 1975- 95. Eur J Cancer Prev6: 442–466, 1997Google Scholar
  3. 3.
    Shapiro CL, Recht A: Late effects of adjuvant therapy for breast cancer. Natl Canc Inst Monogr 16: 101–112, 1994Google Scholar
  4. 4.
    Volk N and Pompe-Kirn V: Second primary cancers in breast cancer patients in Slovenia. Canc Caus Control8: 764–770, 1997Google Scholar
  5. 5.
    Doherty MA, Rodger A, Langlands AO, Kerr GR: Multiple primary tumours in patients treated with radiotherapy for breast cancer. Radiother Oncol 26: 125–131, 1993Google Scholar
  6. 6.
    Harvey EB, Brinton LA: Second cancer following cancer of the breast in Connecticut, 1935- 1982. Natl Cancer Inst Monogr 68: 99–112, 1985Google Scholar
  7. 7.
    Boice JD: Cancer following medical irradiation. Cancer 47: 1081–1090, 1981Google Scholar
  8. 8.
    UNSCEAR: Sources, Effects and Risks of Ionizing Radiation. United Nations, New York, NY, USA, 1994Google Scholar
  9. 9.
    Benhamou E, Laplanche A, Wartelle M, Faivre J, Gignoux M, Menegoz F, Robillard J, Schaffer P, Schraub S, Flamant R: Incidence des cancers en France 1978- 1982. Les éditions INSERM, Paris, 1990Google Scholar
  10. 10.
    Sarrazin D, Lê MG, Mouriesse H, Contesso G, Fontaine F, Arriagada R, Tubiana M: Radiotherapeutic studies on breast cancer at Villejuif. Cancer Bulletin 34(6): 242–249, 1982Google Scholar
  11. 11.
    Sarrazin D, Lê MG, Rouë sse JL, Contesso G, Petit JY, Lacour J, Viguier J, Hill C: Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20mm or less. Cancer 53:1209–1213, 1984Google Scholar
  12. 12.
    Preston DL, Lubin JH Pierce DA, McConney ME: EPICURE. Generalized regression models for epidemiological data. Hirosoft International Corporation, Seattle, WA, 1991Google Scholar
  13. 13.
    Ewertz M, Mouridsen H: Second cancer following cancer of the female breast in Denmark, 1943-80. Natl Cancer Inst Monogr 68: 325–329, 1985Google Scholar
  14. 14.
    Karlson P, Holmberg E, Johansson K-A, Kindblom L-G, Carstensen J, Wallgren A: Soft tissue sarcoma after treatment for breast cancer. Radiother Oncol 38: 25–31, 1996Google Scholar
  15. 15.
    Lavey RS, Eby NL, Prosnitz LR: Impact of radiation therapy and/or chemotherapy on the risk for a second malignancy after breast cancer. Cancer 66: 874–881, 1990Google Scholar
  16. 16.
    Schottenfeld D and Berg J: Incidence of multiple primary cancers. IV. Cancers of the female breast and genital organs. J Natl Cancer Inst 46: 161–170, 1971Google Scholar
  17. 17.
    Taghian A, De Vathaire F, Terrier P, Lê M, Auquier A, Mouriesse H, Grimaud E, Sarrazin D, Tubiana M: Long-term risk of sarcoma following radiation treatment for breast cancer. Int J Rad Oncol 21: 361–367, 1991Google Scholar
  18. 18.
    Valagussa P, Moliterni M, Terenziani M, Zambetti M, Bonadonna G: Second malignancies following CMF-based adjuvant chemotherapy in resectable breast cancer. Ann Oncol5: 803–808, 1994Google Scholar
  19. 19.
    Zucali R, Merson M, Placucci M, Di Palma S, Veronesi U: Soft tissue sarcoma of the breast after conservative surgery and irradiation for early mammary cancer. Radiother Oncol 30: 271–273, 1994Google Scholar
  20. 20.
    Murakami R, Hiyama T, Hanai A, Fujimoto I. Second primary cancers following female breast cancer in Osaka, Japan - A population-based cohort study. Jpn J Clin Oncol 17: 293–302, 1987Google Scholar
  21. 21.
    Grossbart Schwartz A, Ragheb NE, Swanson GM, Satariano WA: Racial and age differences in multiple primary cancers after breast cancer: a population-based analysis. Breast Canc Res Treat 14: 245–254, 1989Google Scholar
  22. 22.
    Teppo L, Pukkala E, Saxen E. Multiple cancer - an epidemiologic exercise in Finland. J Natl Cancer Inst 75: 207–217, 1985Google Scholar
  23. 23.
    Hankey BF, Miller B, Curtis R, Kosary C: Trends in breast cancer in younger women in contrast to older women. Monogr Natl Cancer Inst 16: 7–14, 1994Google Scholar
  24. 24.
    Brenner H, Siegle S, Stegmaier C, Ziegler H: Second primary neoplasms following breast cancer in Saarland, Germany, 1968- 1987. Eur J Cancer 29A(10): 1410–1414, 1993Google Scholar
  25. 25.
    Adami HO, Bergkvist L, Krusemo U, Persson I: Breast cancer as a risk factor for other primary malignant diseases. A nationwide cohort study. J Natl Cancer Inst 73: 1049–1055, 1984Google Scholar
  26. 26.
    Prior P, Waterhouse JAH. Multiple primary cancers of the breast and ovary. Br J Cancer 44: 628–636, 1981Google Scholar
  27. 27.
    Fisher B, Rockette H, Fisher ER, Wickerham DL, Redmond C, Brown A: Leukemia in breast cancer patients following adjuvant chemotherapy or postoperative radiation: the NSABP Experience. J Clin Oncol 3(12): 1640–1658, 1985Google Scholar
  28. 28.
    Curtis RE, Boice JD, Stovall M, Bernstein L, Greenberg RS, Flannery JT, Schwartz AG, Weyer P, Moloney WC, Hoover RN: Risk of leukemia after chemotherapy and radiation treatment for breast cancer. N Engl J Med 326: 1745–1751, 1992Google Scholar
  29. 29.
    Hahn P, Nelson N, Baral E: Leukemia in patients with breast cancer following adjuvant chemotherapy and/or postoperative radiation therapy. Acta Oncol 33(6): 599–602, 1994Google Scholar
  30. 30.
    Laskin WB, Silverman TA, Enzinger FM: Postradiation soft tissue sarcomas. An analysis of 53 cases. Cancer 62: 2330–2340, 1988Google Scholar
  31. 31.
    Ewertz M, Storm HH: Multiple primary cancers of the breast, endometrium and ovary. Eur J Cancer Clin Oncol 25(12): 1927–1932, 1989Google Scholar
  32. 32.
    Schoenberg BS, Christine BW: Malignant melanoma associated with breast cancer. Southern Medical J 73(11): 1493–1497, 1980Google Scholar
  33. 33.
    Little NP, Nuirhead CR, Charles MW: Describing time and age variations in the risk of radiation-induced solid-tumor incidence in the Japanese Atomic Bomb Survivors using generalized relative and absolute risk nodels. Stat Ned 18(1): 17–33, 1999Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Carole Rubino
    • 1
  • Florent de Vathaire
    • 1
  • Ibrahima Diallo
    • 1
    • 2
  • Akhtar Shamsaldin
    • 1
    • 2
  • Monique G Lê
    • 1
  1. 1.Institut Gustave RoussyUnité de Recherche en Epidemiologie des Cancers de l'Institut National de la Santé et de la Recherche Médicale (U521 INSERM)VillejuifFrance
  2. 2.Service de PhysiqueInstitut Gustave RoussyVillejuifFrance

Personalised recommendations