Occurrence of breast cancer after chest wall irradiation for pediatric cancer, as detected by a multimodal screening program.
OBJECTIVE
To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program.


METHODS
We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment.


RESULTS
Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%.


CONCLUSIONS
Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.
Pediatric Oncology Unit, Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
Monica
M
Terenziani
Patrizia
P
Casalini
Gianfranco
G
Scaperrotta
Lorenza
L
Gandola
Giovanna
G
Trecate
Serena
S
Catania
Graziella
G
Cefalo
Alberto
A
Conti
Maura
M
Massimino
Cristina
C
Meazza
Marta
M
Podda
Filippo
F
Spreafico
Laura
L
Suman
Massimiliano
M
Gennaro
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008572:Menarche; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis*; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000209:etiology; D010173:Palpation; D012680:Sensitivity and Specificity; D013909:Thorax / Q000528:radiation effects; D016217:Ultrasonography, Mammary; D055815:Young Adult