Ionizing radiation and tobacco use increases the risk of a subsequent lung carcinoma in women with breast cancer: Case-only design
Ionizing radiation and tobacco use increases the risk of a subsequent lung carcinoma in women with breast cancer: Case-only design
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DOI：
10.1200/jco.2005.01.7335
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发表时间：
2005-10-20
影响因子：
45.3
通讯作者：
Czene, K
中科院分区：
文献类型：
--
作者：
Prochazka, M;Hall, P;Czene, K
目的 分析接受乳腺癌放射治疗的女性患肺癌的风险。我们获取了与不同放射治疗技术相关的肺部剂量，提供了与放射相关的肺癌的过度相对风险 (ERR) 估计，并评估了烟草使用的影响。 患者和方法 瑞典癌症登记处用于识别 1958 年至 2000 年间斯德哥尔摩县诊断患有乳腺癌和随后肺癌的 182 名妇女。对 116 名患者进行了放射治疗。根据原始治疗图表估算辐射剂量，并在病例记录和亲属中搜索吸烟史信息。肺癌风险采用仅病例法进行评估，每位女性贡献一对肺。结果 同侧肺的平均肺剂量为 17.2 Gy（范围为 7.1 至 32.0 Gy）。在≥ 10 年的随访中观察到随后发生同侧肺癌的相对风险 (RR) 显着增加（RR = 2.04；95% CI，1.24 至 3.36）。鳞状细胞癌（RR = 4.00；95% CI，1.50至10.66）是与电离辐射最密切相关的组织病理学亚组。放疗的效果仅限于吸烟者（RR = 3.08；95% CI，1.61 至 5.91）。暴露后潜伏期≥ 10 年的女性的 ERR/Gy 为 0.11（95% CI，0.02 至 0.44）。 结论 对于在患乳腺癌时吸烟的女性，暴露后 10 年以上，乳腺癌放射治疗会显着增加患肺癌的风险。
Purpose To analyze the risk of lung cancer in women treated with radiotherapy for breast cancer. We accessed the lung dose in relation to different radiotherapy techniques, provided the excess relative risk (ERR) estimate for radiation-associated lung cancer, and evaluated the influence of tobacco use.Patients and Methods The Swedish Cancer Registry was used to identify 182 women diagnosed with breast and subsequent lung cancers in Stockholm County during 1958 to 2000. Radiotherapy was administered to 116 patients. Radiation dose was estimated from the original treatment charts, and information on smoking history was searched for in case records and among relatives. The risk of lung cancer was assessed in a case-only approach, where each woman contributed a pair of lungs.Results The average mean lung dose to the ipsilateral lung was 17.2 Gy (range, 7.1 to 32.0 Gy). A significantly increased relative risk (RR) of a subsequent ipsilateral lung cancer was observed at >= 10 years of follow-up (RR = 2.04; 95% CI, 1.24 to 3.36). Squamous cell carcinoma (RR = 4.00; 95% CI, 1.50 to 10.66) was the histopathologic subgroup most closely related to ionizing radiation. The effect of radiotherapy was restricted to smokers only (RR = 3.08; 95% CI, 1.61 to 5.91). The ERR/Gy for women with latency >= 10 years after exposure was 0.11 (95 % CI, 0.02 to 0.44).Conclusion Radiotherapy for breast cancer significantly increases the risk of lung carcinoma more than 10 years after exposure in women who smoked at time of breast cancer.