Pediatric Oncology Unit, Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):35-9. doi: 10.1016/j.ijrobp.2012.03.043. Epub 2012 Jun 5.
To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program.
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.
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%.
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.
通过多模式筛查计划，评估儿童癌症患者接受电离辐射后乳腺癌（BC）的发生情况。
我们确定了 86 名因儿童癌症接受胸壁放射治疗的患者。每年进行临床乳房检查（CBE）、超声（US）和乳房 X 线照相术（MX）。自 2007 年 10 月起，增加了磁共振成像（MRI）。我们根据放射治疗剂量、患者年龄以及原发性治疗前后的初潮，计算发生 BC 的风险。
11 名女性于 2002 年 7 月至 2010 年 2 月间发生了 BC。筛查方法的敏感性分别为 CBE 的 36%、MX 的 73%、US 的 55%和 MRI 的 100%；特异性分别为 CBE 的 91%、MX 的 99%、US 的 95%和 MRI 的 80%。每年 BC 的检出率为 2.9%。BC 诊断的中位年龄为 33 岁。尽管年龄没有影响，但与放射治疗前相比，放射治疗后初潮与 BC 显著相关（P=.027）：前一组的每年 BC 检出率为 5.3%。
在我们的年轻女性队列中，与 CBE 或 US 相比，乳房 X 线照相术显示出更高的敏感性和特异性。磁共振成像显示出 100%的敏感性（但这一初步发现需要进一步证实）。我们的患者队列在比一般人群年轻 20 岁以上的年龄发生 BC 的风险增加了 10 倍。
