Childhood Cancer Treatment Raises Breast Cancer Risk in Later Life

Breast cancer risk is higher in female patients who underwent specific types of chemotherapy and cancer drug therapy for childhood cancer, according to a large-scale international study led by scientists from the Princess Máxima Center for Pediatric Oncology, and the findings are published in the journal Nature Medicine.

Three out of four children with cancer are successfully treated and survive the disease. However, the treatment, which often consists of a combination of surgery, chemotherapy, and radiation, can cause serious side effects and late effects in some survivors. One of those late effects is developing a second cancer in adulthood.

Quiz on Breast Cancer
Breast cancer is one of the leading causes of cancer deaths among women. It is often said that a woman who breast-feeds is at a lower risk of developing cancer compared to another who does not .Are these mere old wives tales or is there some truth ...

‘Earlier breast cancer screening in women who have previously been treated with chemotherapy for childhood cancer, can cut down the risk of breast cancer in later years. #cancersurvivors #childhoodcancer #breastcancer’

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In a new study, scientists from the Princess Máxima Center investigated the risk of breast cancer in women who were treated for childhood cancer with so-called anthracycline chemotherapy, including doxorubicin (). They looked at the medical records of nearly 18,000 childhood cancer survivors treated between 1946 and 2012 in the Netherlands, France, the United States, and Switzerland.

Childhood Cancer Treatment - An Underlying Risk Factor for Recurrence of Breast Cancer

An international team of researchers, led by group leader Prof. Dr. Leontien Kremer and Dr. Jop Teepen, found that 782 of all 17,903 survivors in the study were later diagnosed with breast cancer. The scientists analyzed which forms of treatment were linked to the later occurrence of breast cancer.

Women treated with high-dose doxorubicin, without radiation to the chest, had an almost six-fold greater risk of breast cancer before the age of 40 (3.4%) than women in the general population (0.6%).

The small group of women who had both radiation to the chest and a high dose of the chemotherapy doxorubicin as a child had the highest risk of breast cancer. In that group, the estimated risk of breast cancer before the age of 40 was 8.1%.

Need for Early Screening and Diagnosis for Breast Cancer in Childhood Cancer Survivors

From five years after diagnosis, children and adults who have been treated for childhood cancer visit the LATER outpatient clinic of the Princess Máxima Center. There, they are monitored for possible late effects of treatment, including developing a second cancer. Based on the new results, the researchers are calling for broadening the guidelines for breast cancer screening in childhood cancer survivors.

Childhood Cancer
Childhood or pediatric cancers occur in children less than 15 years of age. They are rare and differ from adult tumors in their location and behaviour.

Yuehan Wang, a member of the Kremer group at the Princess Máxima Center for pediatric oncology, worked on the study as part of her PhD research. She says:

Anthracyclines are still an important part of the treatment for more than half of children with cancer. The dose that is now prescribed is on average much lower than in the past, but there are still children who need a high dose of these drugs in their treatment.

Chest Radiation to Treat Childhood Cancer Increases Breast Cancer Risk
Patients who received chest radiation for Wilms tumor, a rare childhood cancer, face an increased risk of developing breast cancer later in life due to their radiation exposure, finds a new study.

‘We have known for some time that anthracyclines can be harmful to the heart, so the importance of keeping the dose of this type of chemotherapy low was already clear. Developing a second cancer is a rare but serious late effect of childhood cancer treatment. Our results underline the need to reduce the dose of doxorubicin in children whenever possible.’

Prof. Dr. Leontien Kremer, research group leader at the Princess Máxima Center for Pediatric Oncology, who led the study, says:

Breast Cancer: Early Screening Prevents Death
Women exposed to chest radiation for treatment of childhood cancer, should be screened for breast cancer using a combined approach of breast MRI and mammography starting at age 30 years. Compared with no screening, all annual screening strategies ...

We work hard to make treatment for children with cancer more effective, and to improve the quality of life during and after treatment. In our research, we saw that the majority of survivors fortunately do not get breast cancer at a young age. But a number of patient groups have a higher risk of developing breast cancer.

‘Women who received chest radiotherapy as a child are screened for breast cancer from the age of 25 because it was already known that they are at an increased risk. Based on these new results, we aim to expand international guidelines for breast cancer screening, so that women who received a high dose of doxorubicin are also screened early.’

Reference:

Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer - (https://www.nature.com/articles/s41591-023-02514-1)

Source: Eurekalert