Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL.
J Clin Oncol. 2020 Sep 1;38(25):2872-2882. doi: 10.1200/JCO.20.00231. Epub 2020 Jul 16.
To examine the association between total body irradiation (TBI) and subsequent breast cancer in women treated with blood or marrow transplantation (BMT) for hematologic malignancies.
Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived for ≥ 2 years after BMT. Patients with pre-BMT chest radiation or a history of breast cancer were excluded. Participants completed the BMTSS survey, which included details regarding breast cancer diagnosis. Subsequent breast cancer was confirmed by pathology report review or physician notes. Cox proportional hazards models assessed the association between TBI and subsequent breast cancer. Standardized incidence ratios were calculated to determine the excess risk of subsequent breast cancer compared with that in the general population.
A total of 1,464 female BMT survivors (allogeneic: n = 788; autologous: n = 676) participated, with a median follow-up of 9.3 years from BMT. TBI was used in 660 patients (46%). Thirty-seven women developed subsequent breast cancer (allogeneic: n = 19; autologous: n = 18). Multivariable analysis revealed that exposure to TBI was associated with an increased risk of subsequent breast cancer among allogeneic BMT survivors (hazard ratio [HR], 3.7 [95% CI, 1.2 to 11.8]; = .03) and autologous BMT survivors (HR, 2.6 [95% CI, 1.0 to 6.8]; = .048). Pre-BMT exposure to alkylating agents was associated with an increased risk of subsequent breast cancer among autologous BMT survivors (HR, 3.3 [95% CI, 1.0 to 9.0]; = .05). Compared with that in the general population, exposure to TBI at age < 30 years was associated with a 4.4-fold higher risk of subsequent breast cancer in allogeneic BMT survivors and a 4.6-fold higher risk in autologous BMT survivors.
The association between TBI and subsequent breast cancer, especially among those exposed at a young age, as well as pre-BMT exposure to alkylating agents, should inform breast cancer screening for early detection.
研究全身放疗（TBI）与血液或骨髓移植（BMT）治疗血液系统恶性肿瘤后女性乳腺癌之间的关联。
参与者来自 BMT 幸存者研究（BMTSS），这是一项回顾性队列研究，包括 1974 年至 2014 年期间接受移植且 BMT 后存活时间≥2 年的患者。排除了 Pre-BMT 胸部放疗或乳腺癌病史的患者。参与者完成了 BMTSS 调查，其中包括乳腺癌诊断的详细信息。随后的乳腺癌通过病理报告回顾或医生笔记确认。Cox 比例风险模型评估了 TBI 与随后乳腺癌之间的关联。标准化发病率比用于确定与一般人群相比随后乳腺癌的超额风险。
共有 1464 名女性 BMT 幸存者（异体：n=788；自体：n=676）参与，从 BMT 开始中位随访 9.3 年。在 660 名患者（46%）中使用了 TBI。37 名女性发生了随后的乳腺癌（异体：n=19；自体：n=18）。多变量分析显示，异体 BMT 幸存者（风险比 [HR]，3.7 [95%CI，1.2 至 11.8]；.03）和自体 BMT 幸存者（HR，2.6 [95%CI，1.0 至 6.8]；.048）暴露于 TBI 与随后乳腺癌风险增加相关。自体 BMT 幸存者中，Pre-BMT 接触烷化剂与随后乳腺癌风险增加相关（HR，3.3 [95%CI，1.0 至 9.0]；.05）。与普通人群相比，在<30 岁时暴露于 TBI 与异体 BMT 幸存者随后乳腺癌的风险增加 4.4 倍，与自体 BMT 幸存者随后乳腺癌的风险增加 4.6 倍。
TBI 与随后乳腺癌之间的关联，特别是在年轻患者中以及 Pre-BMT 接触烷化剂的情况下，应告知早期发现的乳腺癌筛查。
