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Wang Y, Ronckers CM, van Leeuwen FE, Moskowitz CS, Leisenring W, Armstrong GT, de Vathaire F, Hudson MM, Kuehni CE, Arnold MA, Demoor-Goldschmidt C, Green DM, Henderson TO, Howell RM, Ehrhardt MJ, Neglia JP, Oeffinger KC, van der Pal HJH, Robison LL, Schaapveld M, Turcotte LM, Waespe N, Kremer LCM, Teepen JC. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer. Nat Med 2023; 29:2268-2277. [PMID: 37696934 PMCID: PMC10504074 DOI: 10.1038/s41591-023-02514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023]
Abstract
Anthracycline-based chemotherapy is associated with increased subsequent breast cancer (SBC) risk in female childhood cancer survivors, but the current evidence is insufficient to support early breast cancer screening recommendations for survivors treated with anthracyclines. In this study, we pooled individual patient data of 17,903 survivors from six well-established studies, of whom 782 (4.4%) developed a SBC, and analyzed dose-dependent effects of individual anthracycline agents on developing SBC and interactions with chest radiotherapy. A dose-dependent increased SBC risk was seen for doxorubicin (hazard ratio (HR) per 100 mg m-2: 1.24, 95% confidence interval (CI): 1.18-1.31), with more than twofold increased risk for survivors treated with ≥200 mg m-2 cumulative doxorubicin dose versus no doxorubicin (HR: 2.50 for 200-299 mg m-2, HR: 2.33 for 300-399 mg m-2 and HR: 2.78 for ≥400 mg m-2). For daunorubicin, the associations were not statistically significant. Epirubicin was associated with increased SBC risk (yes/no, HR: 3.25, 95% CI: 1.59-6.63). For patients treated with or without chest irradiation, HRs per 100 mg m-2 of doxorubicin were 1.11 (95% CI: 1.02-1.21) and 1.26 (95% CI: 1.17-1.36), respectively. Our findings support that early initiation of SBC surveillance may be reasonable for survivors who received ≥200 mg m-2 cumulative doxorubicin dose and should be considered in SBC surveillance guidelines for survivors and future treatment protocols.
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Affiliation(s)
- Yuehan Wang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Division of Childhood Cancer Epidemiology (EpiKiK), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charlotte Demoor-Goldschmidt
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Department of Pediatric Hematology and Oncology, University-Hospital of Angers, Angers, France
- Radiotherapy Department, Francois Baclesse Center, Caen, France
| | | | - Tara O Henderson
- University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA
| | - Rebecca M Howell
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | | | | | | | | | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH research platform in pediatric oncology and hematology of the University of Geneva, Geneva, Switzerland
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Wang Y, Kremer LCM, van Leeuwen FE, Armstrong GT, Leisenring W, de Vathaire F, Hudson MM, Kuehni CE, Arnold MA, Haddy N, Demoor-Goldschmidt C, Diallo I, Howell RM, Ehrhardt MJ, Moskowitz CS, Neglia JP, van der Pal HJH, Robison LL, Schaapveld M, Turcotte LM, Waespe N, Ronckers CM, Teepen JC. Cohort profile: Risk and risk factors for female breast cancer after treatment for childhood and adolescent cancer: an internationally pooled cohort. BMJ Open 2022; 12:e065910. [PMID: 36344003 PMCID: PMC9644351 DOI: 10.1136/bmjopen-2022-065910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer was established in 2018 to address gaps in knowledge of risk and risk factors for breast cancer subsequent to childhood/adolescent cancer by pooling individual patient data from seven cohorts. Initially, the pooled cohort will focus on three clinically relevant questions regarding treatment-related subsequent breast cancer risk in female survivors, which are the risk related to low-dose radiotherapy exposure to the chest, specific chemotherapy agents and attained age. PARTICIPANTS The consortium database includes pooled data on 21 892 female survivors from seven cohorts in North America and Europe with a primary cancer diagnosis at <21 years of age, and survival ≥5 years from diagnosis. FINDINGS TO DATE This is a newly established pooled study. The cohort profile summarised the data collected from each included cohort, including childhood cancer diagnosis information and treatment details (ie, radiotherapy fields and cumulative doses, and chemotherapy agents and cumulative doses for each agent). Included cohorts' follow-up started 1951-1981 and ended 2013-2021, respectively, for a median follow-up duration of 24.3 (IQR 18.0-32.8) years since primary cancer diagnosis. The median age at primary cancer diagnosis was 5.4 (IQR 2.5-11.9) years. And the median attained age at last follow-up was 32.2 (IQR 24.0-40.4) years. In all, 4240 (19.4%) survivors were treated with radiotherapy to the chest and 9308 (42.5%) with anthracyclines. At the end of the follow-up, 835 females developed a first subsequent breast cancer, including 635 invasive breast cancer only, 184 carcinomas in situ only (172 ductal carcinomas in situ and 12 lobular carcinomas in situ), and 16 with both an invasive and in situ diagnosis at the same moment. The cumulative incidences of subsequent breast cancer (both invasive and in situ) 25 and 35 years after primary cancer diagnosis were 2.2% and 6.2%, respectively. FUTURE PLANS The consortium is intended to serve as a model and robust source of childhood/adolescent cancer survivor data for elucidating other knowledge gaps on subsequent breast cancer risk, and risk of other subsequent malignancies (including data on males) in the future.
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Affiliation(s)
- Yuehan Wang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nadia Haddy
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
- Department of Pediatric Hematology and Oncology, University-Hospital of Angers, Angers, France
- Radiotherapy department, Francois Baclesse center, Caen, France
- Supportive care department, Francois Baclesse center, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Rebecca M Howell
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | | | | | | | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | - Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH research platform in pediatric oncology and hematology, University of Geneva, Geneva, Switzerland
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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