title: Malignant breast tumors after radiotherapy for a first cancer during childhood.
abstract: OBJECTIVE
  To assess the specific role of treatment and type of first cancer (FC) in the risk of long-term subsequent breast cancer (BC) among childhood cancer survivors.
  
  
  METHODS
  In a cohort of 1,814 3-year female survivors treated between 1946 and 1986 in eight French and English centers, data on chemotherapy and radiotherapy were collected. Individual estimation of radiation dose to each breast was performed for the 1,258 patients treated by external radiotherapy; mean dose to breast was 5.06 Gy (range, 0.0 to 88.0 Gy) delivered in 20 fractions (mean).
  
  
  RESULTS
  Mean follow-up was 16 years; 16 patients developed a clinical BC, 13 after radiotherapy. The cumulative incidence of BC was 2.8% (95% CI, 1.0% to 4.5%) 30 years after the FC and 5.1% (95% CI, 2.1% to 8.2%) at the age of 40 years. The annual excess incidence increased as age increased, whereas the standardized incidence ratio decreased. On average, each Gray unit received by any breast increased the excess relative risk of BC by 0.13 (< 0.0 to 0.75). After stratification on castration and attained age, and adjusting for radiation dose, FC type, and chemotherapy, a higher risk of a subsequent BC was associated with Hodgkin's disease (relative risk, 7.0; 95% CI, 1.4 to 30.9).
  
  
  CONCLUSIONS
  The reported high risk of BC after childhood Hodgkin's disease treatment seems to be due not only to a higher radiation dose to the breasts, but also to a specific susceptibility.
authors.affiliation: National Institute of Health and Medical Research, Cancer Epidemiology Research Unit (U605 INSERM), Physics Department, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Guibout
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Adjadj
authors.forename: Carole
authors.initials: C
authors.lastname: Rubino
authors.forename: Akthar
authors.initials: A
authors.lastname: Shamsaldin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Grimaud
authors.forename: Mike
authors.initials: M
authors.lastname: Hawkins
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Mathieu
authors.forename: Odile
authors.initials: O
authors.lastname: Oberlin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Zucker
authors.forename: Xavier
authors.initials: X
authors.lastname: Panis
authors.forename: Jean-Léon
authors.initials: JL
authors.lastname: Lagrange
authors.forename: Nicolas
authors.initials: N
authors.lastname: Daly-Schveitzer
authors.forename: Jean
authors.initials: J
authors.lastname: Chavaudra
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011879:Radiotherapy Dosage; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents