Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease
Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease
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DOI：
10.1001/jama.290.4.465
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发表时间：
2003-07-23
影响因子：
120.7
通讯作者：
Gilbert, E
中科院分区：
文献类型：
--
作者：
Travis, LB;Hill, DA;Gilbert, E
背景第二种癌症是霍奇金病 (HD) 长期幸存者死亡的主要原因，在年轻时接受治疗的女性患乳腺癌的风险极高。迄今为止，尚未进行大规模系列报道，报道了乳房放疗剂量与化疗之间的定量关联，也没有卵巢暴露对随后风险的影响。目的量化与使用放疗和化疗治疗患有 HD 的年轻女性相关的乳腺癌长期风险。设计、设置和受试者在 1 月 1 日至 1 月 1 日期间，在 3817 名 30 岁或以下的 HD 女性 1 年幸存者队列中进行乳腺癌匹配病例对照研究。 1965 年和 1994 年 12 月 31 日，以及 6 个基于人群的癌症登记处。该研究于1996年3月1日至1998年9月30日进行。 主要结果测量乳腺癌的相对风险（RR）与乳腺癌部位或卵巢的辐射剂量以及烷化剂的累积剂量相关。 结果 105名HD患者发生乳腺癌，与266名HD但无乳腺癌患者相匹配。与接受较低剂量且未使用烷化剂的患者相比，乳房接受 4 Gy 或以上辐射剂量的风险增加 3.2 倍（95% 置信区间 [CI]，1.4-8.2）。剂量超过 40 Gy 时，风险增加至 9 倍（95% CI，2.6-26.4）（P
Context Second cancer is the leading cause of death in long-term survivors of Hodgkin disease (HD), with exceptionally high risks of breast cancer among women treated at a young age. Quantitative associations between radiotherapy dose delivered to the breast and administered chemotherapy have not been reported to date in large series, nor has the influence of ovarian exposures on subsequent risk.Objective To quantify the long-term risk of breast cancer associated with use of radiotherapy and chemotherapy to treat young women with HD.Design, Setting, and Subjects Matched case-control study of breast cancer within a cohort of 3817 female 1-year survivors of HD diagnosed at age 30 years or younger, between January 1, 1965, and December 31, 1994, and within 6 population-based cancer registries. The study was conducted March 1, 1996, through September 30, 1998.Main Outcome Measures Relative risk (RR) of breast cancer associated with radiation dose delivered to site of breast cancer or to ovaries and with cumulative dose of alkylating agents.Results Breast cancer occurred in 105 patients with HD who were matched to 266 patients with HD but without breast cancer. A radiation dose of 4 Gy or more delivered to the breast was associated with a 3.2-fold (95% confidence interval [CI], 1.4-8.2) increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 9-fold (95% CI, 2.6-26.4) with a dose of more than 40 Gy (P