Department of Dermatology, Stanford University, Stanford, California.
Center for Digital Health, Stanford University, Stanford, California.
JAMA Netw Open. 2024 Mar 4;7(3):e241632. doi: 10.1001/jamanetworkopen.2024.1632.
Previous studies have suggested that radiation therapy may contribute to an increased risk of subsequent nonkeratinocyte (ie, not squamous and basal cell) skin cancers.
To test the hypothesis that radiation therapy for breast cancer increases the risk of subsequent nonkeratinocyte skin cancers, particularly when these cancers are localized to the skin of the breast or trunk.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used longitudinal data from the Surveillance, Epidemiology, and End Results (SEER) Program for January 1, 2000, to December 31, 2019. The SEER database includes population-based cohort data from 17 registries. Patients with newly diagnosed breast cancer were identified and were evaluated for subsequent nonkeratinocyte skin cancer development. Data analysis was performed from January to August 2023.
Radiation therapy, chemotherapy, or surgery for breast cancer.
The primary outcomes were standardized incidence ratios (SIRs) for subsequent nonkeratinocyte skin cancer development from 2000 to 2019 based on treatment type (radiation therapy, chemotherapy, or surgery), skin cancer site on the body, and skin cancer subtype.
Among the 875 880 patients with newly diagnosed breast cancer included in this study, 99.3% were women, 51.6% were aged older than 60 years, and 50.3% received radiation therapy. A total of 11.2% patients identified as Hispanic, 10.1% identified as non-Hispanic Black, and 69.5% identified as non-Hispanic White. From 2000 to 2019, there were 3839 patients with nonkeratinocyte skin cancer, including melanoma (3419 [89.1%]), Merkel cell carcinoma (121 [3.2%]), hemangiosarcoma (104 [2.7%]), and 32 other nonkeratinocyte skin cancers (195 [5.1%]), documented to occur after breast cancer treatment. The risk of nonkeratinocyte skin cancer diagnosis after breast cancer treatment with radiation was 57% higher (SIR, 1.57 [95% CI, 1.45-1.7]) than that of the general population when considering the most relevant site: the skin of the breast or trunk. When risk at this site was stratified by skin cancer subtype, the SIRs for melanoma and hemangiosarcoma were both statistically significant at 1.37 (95% CI, 1.25-1.49) and 27.11 (95% CI, 21.6-33.61), respectively. Receipt of radiation therapy was associated with a greater risk of nonkeratinocyte skin cancer compared with chemotherapy and surgical interventions.
In this study of patients with breast cancer, an increased risk of melanoma and hemangiosarcoma after breast cancer treatment with radiation therapy was observed. Although occurrences of nonkeratinocyte skin cancers are rare, physicians should be aware of this elevated risk to help inform follow-up care.
先前的研究表明，放射治疗可能会增加随后发生非角质细胞（即非鳞状和基底细胞）皮肤癌的风险。
检验放射治疗乳腺癌会增加随后发生非角质细胞皮肤癌的风险的假设，特别是当这些癌症局限于乳房或躯干的皮肤时。
设计、地点和参与者：这项基于人群的队列研究使用了来自监测、流行病学和最终结果（SEER）计划的纵向数据，时间范围为 2000 年 1 月 1 日至 2019 年 12 月 31 日。SEER 数据库包括来自 17 个登记处的基于人群的队列数据。确定了新诊断为乳腺癌的患者，并评估了随后发生非角质细胞皮肤癌的情况。数据分析于 2023 年 1 月至 8 月进行。
乳腺癌的放射治疗、化疗或手术。
主要结果是根据治疗类型（放射治疗、化疗或手术）、身体皮肤癌部位和皮肤癌亚型，从 2000 年至 2019 年非角质细胞皮肤癌发展的标准化发病比（SIR）。
在这项研究中，包括 875880 例新诊断的乳腺癌患者，99.3%为女性，51.6%年龄大于 60 岁，50.3%接受了放射治疗。共有 11.2%的患者为西班牙裔，10.1%为非西班牙裔黑人，69.5%为非西班牙裔白人。从 2000 年至 2019 年，有 3839 例非角质细胞皮肤癌患者，包括黑色素瘤（3419 例[89.1%]）、默克尔细胞癌（121 例[3.2%]）、血管肉瘤（104 例[2.7%]）和 32 例其他非角质细胞皮肤癌（195 例[5.1%]），这些癌症在乳腺癌治疗后被确诊。与一般人群相比，接受放射治疗的乳腺癌患者的非角质细胞皮肤癌诊断风险高 57%（SIR，1.57[95%CI，1.45-1.7]），尤其是考虑到最相关的部位：乳房或躯干的皮肤。当按皮肤癌亚型对该部位的风险进行分层时，黑色素瘤和血管肉瘤的 SIR 均具有统计学意义，分别为 1.37（95%CI，1.25-1.49）和 27.11（95%CI，21.6-33.61）。与化疗和手术干预相比，放射治疗与非角质细胞皮肤癌风险增加相关。
在这项对乳腺癌患者的研究中，观察到放射治疗乳腺癌后黑色素瘤和血管肉瘤的风险增加。尽管非角质细胞皮肤癌的发生较为罕见，但医生应意识到这种风险增加，以帮助提供后续护理。
