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Radiation dose and breast cancer risk in the Childhood Cancer Survivor Study
Journal of Clinical Oncology, 07/23/09

Inskip PD et al. - In a trial to quantify the risk of breast cancer in relation to radiation dose and chemotherapy among survivors of childhood cancer, results confirm the radiation sensitivity of the breast in girls age 10 to 20 yrs but do not demonstrate a strong effect of age at exposure within this range. Irradiation of the ovaries at doses >5 Gy seems to lessen carcinogenic effects of breast irradiation, most likely by reducing exposure of radiation-damaged breast cells to stimulating effects of ovarian hormones.

• A study of breast cancer was conducted in a cohort of 6647 women who were 5-yr survivors of childhood cancer and who were treated during 1970 through 1986.
• 120 pts with histologically confirmed breast cancer were identified and were individually matched to 4 selected controls on age at initial cancer and time since initial cancer.
• Medical physicists estimated radiation dose to the breast tumor site and ovaries on the basis of medical records.

• The odds ratio for breast cancer increased linearly with radiation dose, and it reached 11-fold for local breast doses of approximately 40 Gy relative to no radiation.
• Risk associated with breast irradiation was sharply reduced among women who received ≥5 Gy to the ovaries.
• Excess odds ratio per Gy was 0.36 for those who received ovarian doses <5 Gy and was 0.06 for those who received higher doses.
• Radiation-related risk did not vary significantly by age at exposure.
• Borderline significantly elevated risks were seen for doxorubicin, dactinomycin, dacarbazine, and carmustine.

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