Risk of treatment-related esophageal cancer among breast cancer survivors

L. M. Morton, E. S. Gilbert, P. Hall, M. Andersson, H. Joensuu, L. Vaalavirta, G. M. Dores, M. Stovall, E. J. Holowaty, C. F. Lynch, R. E. Curtis, S. A. Smith, R. A. Kleinerman, M. Kaijser, H. H. Storm, E. Pukkala, R. E. Weathers, M. S. Linet, P. Rajaraman, J. F. FraumeniL. M. Brown, F. E. Van Leeuwen, S. D. Fossa, T. B. Johannesen, F. Langmark, S. Lamart, L. B. Travis, B. M.P. Aleman

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. Design: Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. Results: The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (Ptrend < 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). Conclusions: Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.

Original languageEnglish (US)
Article numbermds144
Pages (from-to)3081-3091
Number of pages11
JournalAnnals of Oncology
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2012

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Second Primary Neoplasms
Esophageal Neoplasms
Survivors
Breast Neoplasms
Radiotherapy
Odds Ratio
Radiation
Confidence Intervals
Radiometry
Alkylating Agents
Radiation Effects
Ionizing Radiation
Esophagus
Medical Records
Registries
Case-Control Studies
Neoplasms
Breast
Therapeutics
Smoking

Keywords

  • Breast cancer
  • Esophageal cancer
  • Radiotherapy
  • Second cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Morton, L. M., Gilbert, E. S., Hall, P., Andersson, M., Joensuu, H., Vaalavirta, L., ... Aleman, B. M. P. (2012). Risk of treatment-related esophageal cancer among breast cancer survivors. Annals of Oncology, 23(12), 3081-3091. [mds144]. https://doi.org/10.1093/annonc/mds144

Risk of treatment-related esophageal cancer among breast cancer survivors. / Morton, L. M.; Gilbert, E. S.; Hall, P.; Andersson, M.; Joensuu, H.; Vaalavirta, L.; Dores, G. M.; Stovall, M.; Holowaty, E. J.; Lynch, C. F.; Curtis, R. E.; Smith, S. A.; Kleinerman, R. A.; Kaijser, M.; Storm, H. H.; Pukkala, E.; Weathers, R. E.; Linet, M. S.; Rajaraman, P.; Fraumeni, J. F.; Brown, L. M.; Van Leeuwen, F. E.; Fossa, S. D.; Johannesen, T. B.; Langmark, F.; Lamart, S.; Travis, L. B.; Aleman, B. M.P.

In: Annals of Oncology, Vol. 23, No. 12, mds144, 01.12.2012, p. 3081-3091.

Research output: Contribution to journalArticle

Morton, LM, Gilbert, ES, Hall, P, Andersson, M, Joensuu, H, Vaalavirta, L, Dores, GM, Stovall, M, Holowaty, EJ, Lynch, CF, Curtis, RE, Smith, SA, Kleinerman, RA, Kaijser, M, Storm, HH, Pukkala, E, Weathers, RE, Linet, MS, Rajaraman, P, Fraumeni, JF, Brown, LM, Van Leeuwen, FE, Fossa, SD, Johannesen, TB, Langmark, F, Lamart, S, Travis, LB & Aleman, BMP 2012, 'Risk of treatment-related esophageal cancer among breast cancer survivors', Annals of Oncology, vol. 23, no. 12, mds144, pp. 3081-3091. https://doi.org/10.1093/annonc/mds144
Morton LM, Gilbert ES, Hall P, Andersson M, Joensuu H, Vaalavirta L et al. Risk of treatment-related esophageal cancer among breast cancer survivors. Annals of Oncology. 2012 Dec 1;23(12):3081-3091. mds144. https://doi.org/10.1093/annonc/mds144
Morton, L. M. ; Gilbert, E. S. ; Hall, P. ; Andersson, M. ; Joensuu, H. ; Vaalavirta, L. ; Dores, G. M. ; Stovall, M. ; Holowaty, E. J. ; Lynch, C. F. ; Curtis, R. E. ; Smith, S. A. ; Kleinerman, R. A. ; Kaijser, M. ; Storm, H. H. ; Pukkala, E. ; Weathers, R. E. ; Linet, M. S. ; Rajaraman, P. ; Fraumeni, J. F. ; Brown, L. M. ; Van Leeuwen, F. E. ; Fossa, S. D. ; Johannesen, T. B. ; Langmark, F. ; Lamart, S. ; Travis, L. B. ; Aleman, B. M.P. / Risk of treatment-related esophageal cancer among breast cancer survivors. In: Annals of Oncology. 2012 ; Vol. 23, No. 12. pp. 3081-3091.
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abstract = "Background: Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. Design: Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. Results: The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (Ptrend < 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95{\%} confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95{\%} CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). Conclusions: Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.",
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AU - Morton, L. M.

AU - Gilbert, E. S.

AU - Hall, P.

AU - Andersson, M.

AU - Joensuu, H.

AU - Vaalavirta, L.

AU - Dores, G. M.

AU - Stovall, M.

AU - Holowaty, E. J.

AU - Lynch, C. F.

AU - Curtis, R. E.

AU - Smith, S. A.

AU - Kleinerman, R. A.

AU - Kaijser, M.

AU - Storm, H. H.

AU - Pukkala, E.

AU - Weathers, R. E.

AU - Linet, M. S.

AU - Rajaraman, P.

AU - Fraumeni, J. F.

AU - Brown, L. M.

AU - Van Leeuwen, F. E.

AU - Fossa, S. D.

AU - Johannesen, T. B.

AU - Langmark, F.

AU - Lamart, S.

AU - Travis, L. B.

AU - Aleman, B. M.P.

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N2 - Background: Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. Design: Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. Results: The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (Ptrend < 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). Conclusions: Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.

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KW - Esophageal cancer

KW - Radiotherapy

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