Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK).
Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK).
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DOI：
10.1136/bmj.e5660
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发表时间：
2012-09-06
期刊：
影响因子：
--
通讯作者：
HEBON
中科院分区：
文献类型：
--
作者：
Pijpe A;Andrieu N;Easton DF;Kesminiene A;Cardis E;Noguès C;Gauthier-Villars M;Lasset C;Fricker JP;Peock S;Frost D;Evans DG;Eeles RA;Paterson J;Manders P;van Asperen CJ;Ausems MG;Meijers-Heijboer H;Thierry-Chef I;Hauptmann M;Goldgar D;Rookus MA;van Leeuwen FE;GENEPSO;EMBRACE;HEBON
目的评估BRCA1/2基因突变携带者与放射治疗相关的乳腺癌风险。设计回顾性队列研究（GENE-RAD-RISK）。在法国、英国和荷兰进行的三项全国性研究（GENEPSO、EMBRACE、HEBON），参与者为2006 - 09年招募的1993名BRCA 1/2突变女性携带者。主要结局指标：根据器官剂量的标称估计值和自我报告的诊断程序频率，采用加权考克斯比例风险模型和时间依赖性个体估计累积乳腺剂量估计乳腺癌风险。为了纠正潜在的生存偏差，分析排除了在完成研究问卷前被诊断超过五年的携带者。结果BRCA1/2突变携带者在30岁之前接受任何诊断性辐射都与乳腺癌风险增加相关（风险比1.90，95%置信区间1.20 - 3.00），具有剂量反应模式。估计累积剂量<0.0020戈伊、≥ 0.0020 - 0.0065戈伊、≥ 0.0066 - 0.0173戈伊和≥ 0.0174戈伊的风险为1.63（0.96至2.77）、1.78（0.88至3.58）、1.75（0.72至4.25）和3.84（1.67至8.79）。对不同类型的诊断程序的分析显示，与没有暴露相比，随着20岁之前和30岁之前的X光片数量的增加，风险增加。30岁以前的乳房X线摄影史也与乳腺癌风险增加相关（风险比1.43，0.85至2.40）。敏感性分析表明，这一结果不是由家族史的混杂引起的。结论：在这项针对BRCA 1/2突变携带者的大型欧洲研究中，30岁之前暴露于诊断辐射与乳腺癌风险增加相关，剂量水平远低于暴露于辐射的其他队列中发现的增加。这项研究的结果支持使用非电离辐射成像技术（如磁共振成像）作为监测BRCA1/2突变的年轻女性的主要工具。
Objective To estimate the risk of breast cancer associated with diagnostic radiation in carriers of BRCA1/2 mutations. Design Retrospective cohort study (GENE-RAD-RISK). Setting Three nationwide studies (GENEPSO, EMBRACE, HEBON) in France, United Kingdom, and the Netherlands, Participants 1993 female carriers of BRCA1/2 mutations recruited in 2006-09. Main outcome measure Risk of breast cancer estimated with a weighted Cox proportional hazards model with a time dependent individually estimated cumulative breast dose, based on nominal estimates of organ dose and frequency of self reported diagnostic procedures. To correct for potential survival bias, the analysis excluded carriers who were diagnosed more than five years before completion of the study questionnaire. Results In carriers of BRCA1/2 mutations any exposure to diagnostic radiation before the age of 30 was associated with an increased risk of breast cancer (hazard ratio 1.90, 95% confidence interval 1.20 to 3.00), with a dose-response pattern. The risks by quarter of estimated cumulative dose <0.0020 Gy, ≥0.0020-0.0065 Gy, ≥0.0066-0.0173 Gy, and ≥0.0174 Gy were 1.63 (0.96 to 2.77), 1.78 (0.88 to 3.58), 1.75 (0.72 to 4.25), and 3.84 (1.67 to 8.79), respectively. Analyses on the different types of diagnostic procedures showed a pattern of increasing risk with increasing number of radiographs before age 20 and before age 30 compared with no exposure. A history of mammography before age 30 was also associated with an increased risk of breast cancer (hazard ratio 1.43, 0.85 to 2.40). Sensitivity analysis showed that this finding was not caused by confounding by indication of family history. Conclusion In this large European study among carriers of BRCA1/2 mutations, exposure to diagnostic radiation before age 30 was associated with an increased risk of breast cancer at dose levels considerably lower than those at which increases have been found in other cohorts exposed to radiation. The results of this study support the use of non-ionising radiation imaging techniques (such as magnetic resonance imaging) as the main tool for surveillance in young women with BRCA1/2 mutations.
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DOI：
10.1016/j.ijrobp.2009.09.004
发表时间：
2010-02-01
影响因子：
7
作者：
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影响因子：
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