Taylor Aliki J, Winter David L, Stiller Charles A, Murphy Mike, Hawkins Mike M
Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Int J Cancer. 2007 Jan 15;120(2):384-91. doi: 10.1002/ijc.22261.
There is now widespread evidence that female survivors of Hodgkin's disease who have been treated with supradiaphragmatic radiotherapy are at an increased risk of breast cancer. Mantle irradiation, which includes irradiation of the mediastinum, conveys a particularly high risk. Previously published studies have found a wide variation in risk. To provide British estimates of risk to inform surveillance programmes, we carried out the first British population-based cohort study of breast cancer in female survivors of childhood Hodgkin's disease. From the underlying cohort of the British Childhood Cancer Survivor Study, a cohort of 18,123 British 5-year survivors of childhood cancer diagnosed between 1940 and 1991, there were in total 383 female 5-year survivors of childhood Hodgkin's disease. Sixteen of these 383 survivors went on to develop invasive breast cancer subsequent to 5-year survival (standardised incidence ratio, 11.5; 95% confidence interval (95% CI), 6.6-18.6) and all of these 16 survivors had been treated with supradiaphragmatic irradiation as treatment for childhood Hodgkin's disease. The cumulative risk of breast cancer by 25 years of follow up was 9.9% (95% CI, 3.3-16.6) for all patients and 12.2% (95% CI, 4.3-20.1) for those treated with supradiaphragmatic radiotherapy. The cumulative risk of breast cancer in female survivors of childhood Hodgkin's disease in Britain is at the lower end of previous estimates. We hope that our data may provide a basis for future surveillance and for counselling survivors as to their likely risk of breast cancer.
目前有广泛证据表明，接受膈上放疗的霍奇金淋巴瘤女性幸存者患乳腺癌的风险增加。包括纵隔照射的斗篷野照射带来的风险尤其高。此前发表的研究发现风险存在很大差异。为了提供英国的风险估计以指导监测计划，我们开展了英国第一项基于人群的儿童霍奇金淋巴瘤女性幸存者乳腺癌队列研究。在英国儿童癌症幸存者研究的基础队列中，有18123名在1940年至1991年期间被诊断为儿童癌症的5年幸存者，其中共有383名儿童霍奇金淋巴瘤女性5年幸存者。这383名幸存者中有16人在5年生存后患上浸润性乳腺癌（标准化发病比为11.5；95%置信区间（95%CI）为6.6 - 18.6），并且这16名幸存者都接受过膈上照射作为儿童霍奇金淋巴瘤的治疗。所有患者在随访25年时乳腺癌的累积风险为9.9%（95%CI为3.3 - 16.6），接受膈上放疗的患者为12.2%（95%CI为4.3 - 20.1）。英国儿童霍奇金淋巴瘤女性幸存者中乳腺癌的累积风险处于先前估计范围的下限。我们希望我们的数据可为未来的监测以及为幸存者提供关于其患乳腺癌可能风险的咨询提供依据。
