ADJUVANT RADIOTHERAPY AND RISK OF CONTRALATERAL BREAST-CANCER
ADJUVANT RADIOTHERAPY AND RISK OF CONTRALATERAL BREAST-CANCER
复制标题
DOI：
10.1093/jnci/84.16.1245
复制
发表时间：
1992-08-19
期刊：
影响因子：
--
通讯作者：
PEDERSEN, M
中科院分区：
文献类型：
--
作者：
STORM, HH;ANDERSSON, M;PEDERSEN, M
背景：乳腺癌患者患对侧乳腺癌的风险增加两倍至五倍。丹麦的一项基于登记的队列研究表明，对首例乳腺癌进行放射治疗可能会增加 10 年幸存者患对侧乳腺癌的风险。目的：我们的目标是评估放射在对侧乳腺癌发展中的作用。方法：一项巢式病例对照研究对 1943 年至 1978 年间被诊断患有浸润性乳腺癌的 56 540 名丹麦女性进行了队列研究。病例患者是 529 名在首次诊断后 8 年或更长时间患上对侧乳腺癌的女性。对照组是患有乳腺癌但未患对侧乳腺癌的女性。根据年龄、乳腺癌初次诊断的日历年份和生存时间，将一名对照者与每位病例患者相匹配。根据辐射测量和提取的治疗信息估计每位患者对侧乳房的辐射剂量。每个乳腺癌的解剖位置也从医疗记录中提取。结果：82.4%的病例和对照接受了放射治疗，对侧乳房的平均放射剂量估计为2.51 Gy。放疗不会增加对侧乳腺癌的总体风险（相对风险 = 1.04；95% 置信区间 = 0.74-1.46），并且没有证据表明风险随辐射剂量、暴露后时间或暴露年龄而变化。患者中的第二个肿瘤均匀分布在乳房的内侧、外侧和中央部分，这一发现反驳了放射治疗在肿瘤发生中的因果作用。结论：我们系列中的大多数女性处于围绝经期或绝经后（总计 53%，绝经前占 38%，状态未知），并在乳腺组织对辐射致癌作用最不敏感的年龄接受放疗。根据 2.51 Gy 的剂量和其他研究对辐射风险的估计，平均年龄为 51 岁的女性群体的相对风险预计仅为 1.18。因此，我们的数据提供了额外的证据，表明在以后的生活中，与乳腺组织暴露于低剂量辐射（例如乳房X射线照相或辅助放射治疗）相关的辐射诱发乳腺癌的风险几乎没有。
Background: The risk of contralateral breast cancer is increased twofold to fivefold for breast cancer patients. A registry-based cohort study in Denmark suggested that radiation treatment of the first breast cancer might increase the risk for contralateral breast cancer among 10-year survivors. Purpose: Our goal was to assess the role of radiation in the development of contralateral breast cancer. Methods: A nested case-control study was conducted in a cohort of 56 540 women in Denmark diagnosed with invasive breast cancer from 1943 through 1978. Case patients were 529 women who developed contralateral breast cancer 8 or more years after first diagnosis. Controls were women with breast cancer who did not develop contralateral breast cancer. One control was matched to each case patient on the basis of age, calendar year of initial breast cancer diagnosis, and survival time. Radiation dose to the contralateral breast was estimated for each patient on the basis of radiation measurements and abstracted treatment information. The anatomical position of each breast cancer was also abstracted from medical records. Results: Radiotherapy had been administered to 82.4% of case patients and controls, and the mean radiation dose to the contralateral breast was estimated to be 2.51 Gy. Radiotherapy did not increase the overall risk of contralateral breast cancer (relative risk = 1.04; 95% confidence interval = 0.74-1.46), and there was no evidence that risk varied with radiation dose, time since exposure, or age at exposure. The second tumors in case patients were evenly distributed in the medial, lateral, and central portions of the breast, a finding that argues against a causal role of radiotherapy in tumorigenesis. Conclusions: The majority of women in our series were perimenopausal or postmenopausal (53% total versus 38% premenopausal and 9% of unknown status) and received radiotherapy at an age when the breast tissue appears least susceptible to the carcinogenic effects of radiation. Based on a dose of 2.51 Gy and estimates of radiation risk from other studies, a relative risk of only 1.18 would have been expected for a population of women exposed at an average age of 51 years. Thus, our data provide additional evidence that there is little if any risk of radiation-induced breast cancer associated with exposure of breast tissue to low-dose radiation (e.g., from mammographic x rays or adjuvant radiotherapy) in later life.