Increased incidence of myelodysplastic syndrome and acute myeloid leukemia following breast cancer treatment with radiation alone or combined with chemotherapy: a registry cohort analysis 1990-2005

Autor: Judith A. Malmgren, MK Atwood, Henry G. Kaplan
Jazyk: angličtina
Předmět:
Oncology
Adult
medicine.medical_specialty
Cancer Research
Time Factors
medicine.medical_treatment
Population
Breast Neoplasms
Kaplan-Meier Estimate
Rate ratio
lcsh:RC254-282
Young Adult
Breast cancer
Postoperative Complications
Internal medicine
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
medicine
Genetics
Humans
Registries
education
Mastectomy
Aged
Aged
80 and over
Leukemia
Radiation-Induced
education.field_of_study
Radiotherapy
business.industry
Incidence (epidemiology)
Myelodysplastic syndromes
Incidence
Cancer
Neoplasms
Second Primary
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
Combined Modality Therapy
Radiation therapy
Transplantation
Leukemia
Myeloid
Acute
Myelodysplastic Syndromes
Female
business
Research Article
Follow-Up Studies
Zdroj: BMC Cancer
BMC Cancer, Vol 11, Iss 1, p 260 (2011)
ISSN: 1471-2407
DOI: 10.1186/1471-2407-11-260
Popis: Background Our objective was to measure myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML) risk associated with radiation and/or chemotherapy breast cancer (BC) treatment. Methods Our study cohort was composed of BC patients diagnosed from 1990 to 2005 and followed up for blood disorders, mean length of follow up = 7.17 years, range 2-18 years. 5790 TNM stage 0-III patients treated with surgery alone, radiation and/or chemotherapy were included. Patients without surgery (n = 111), with stem cell transplantation (n = 98), unknown or non-standard chemotherapy regimens (n = 94), lost to follow up (n = 66) or 'cancer status unknown' (n = 67) were excluded. Rates observed at our community based cancer care institution were compared to SEER incidence data for rate ratio (RR) calculations. Results 17 cases of MDS/AML (10 MDS/7 AML) occurred during the follow up period, crude rate .29% (95% CI = .17, .47), SEER comparison RR = 3.94 (95% CI = 2.34, 6.15). The RR of MDS in patients age < 65 comparing our cohort incidence to SEER incidence data was 10.88 (95% CI = 3.84, 24.03) and the RR of AML in patients age < 65 was 5.32 (95% CI = 1.31, 14.04). No significant increased risk of MDS or AML was observed in women ≥ 65 or the surgery/chemotherapy-only group. A RR of 3.32 (95% CI = 1.42, 6.45) was observed in the surgery/radiation-only group and a RR of 6.32 (95% CI = 3.03, 11.45) in the surgery/radiation/chemotherapy group. 3 out of 10 MDS cases died of disease at an average 3.8 months post diagnosis and five of seven AML cases died at an average 9 months post diagnosis. Conclusions An elevated rate of MDS and AML was observed among breast cancer patients < 65, those treated with radiation and those treated with radiation and chemotherapy compared to available population incidence data. Although a small number of patients are affected, leukemia risk associated with treatment and younger age is significant.
Databáze: OpenAIRE
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