title: Management and Prevention of Breast Cancer After Radiation to the Chest for Childhood, Adolescent, and Young Adulthood Malignancy.
abstract: BACKGROUND
  Women treated with chest irradiation for childhood, adolescent, and young adulthood (CAYA) malignancies, in particular Hodgkin's lymphoma, have an increased risk of developing second cancers of the breast (SCB). However, there are few uniform guidelines regarding surveillance and prevention for this high-risk group.
  
  
  METHODS
  A systematic search using PUBMED and OVID MEDLINE was performed. Publications listed under the terms "breast neoplasm", "neoplasm, radiation-induced", "therapeutic radiation-induced breast cancer", "screening", "surveillance", "prevention", and "prophylaxis" between January 1992 and January 2015 were assessed.
  
  
  RESULTS
  A total of 138 publications were reviewed. Factors associated with increased SCB risk include young age at irradiation, prolong duration since irradiation (peak relative risk 13.87 at 15-19 years postradiation), and increased radiation dose and field. Early menopause reduces SCB risk. Annual screening mammography and breast MRI is recommended from age 25 or 8 years posttreatment for women treated with ≥20 Gy chest radiation before age 30 years. Compared with sporadic primary breast cancers (PBC), SCB more often are bilateral (6-34 %), managed with mastectomy (56-100 %), hormone receptor-negative (27-49 %), and high-grade (35 %). Women with SCB have a similar breast cancer event-free survival and breast cancer-specific survival compared to women with PBC. However, their overall survival is worse due to comorbid conditions. There is paucity of information regarding secondary prevention of SCB.
  
  
  CONCLUSIONS
  Survivors of CAYA malignancy are at risk of many late effects, including iatrogenic breast cancer from chest irradiation. They are best managed in a multidisciplinary late-effects setting where tailored risk management can be provided.
authors.affiliation: Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia. kooeva@hotmail.com.|Department of Surgery, University of Melbourne, Parkville, VIC, Australia. kooeva@hotmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Koo
authors.affiliation: Department of Surgery, University of Melbourne, Parkville, VIC, Australia.|Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
authors.affiliation: Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Dwyer
authors.affiliation: Department of Surgery, University of Melbourne, Parkville, VIC, Australia.|Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Skandarajah
mesh_terms: D000293:Adolescent; D001943:Breast Neoplasms / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D015201:Meta-Analysis as Topic; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D015996:Survival Rate; D055815:Young Adult