Breast cancer in young women survivors of pediatric cancer

Abstract

Background: Patients cured of a pediatric cancer have shown increased risk of second tumors. Women long-term survivors have a significantly increased risk of developing breast cancer (BC) at a young age. Screening programs for early detection of BC are well-established in healthy women. On the contrary, there is a scarcity of guidelines for young women cured of a pediatric cancer. We try to develop a multidisciplinary screening program for our survivors at risk. Methods: Patients were identified from Pediatric Oncology Department at the University Hospital La Fe. The cohort consists of young women with a prior diagnosis of a pediatric tumor, if treatment had included chest RT and/or high dose of alkylating chemotherapy before bone marrow transplantation. Imaging studies were performed according to age. If any suspicious lesion was detected, the patient was transferred to the Breast Unit in Oncology. Results: 17 women (10 Hodgkin Lymphoma, 4 Non Hodgkin Lymphoma and 3 Ewing's Sarcoma) were contacted. 4 women refused to be included (2 due to psychological reasons, 1 pregnancy, 1 just-diagnosed with BC). Median age was 27 years and median time since end-of-treatment was 14.5 years. The initial treatment was chemotherapy (CT) alone in 6 patients (46.2%) and combined CT and radiotherapy (RT) in 7 (53.8%). 7 cases were irradiated (5 Hodgkińs Lymphoma, 1 Non Hodgkińs Lymphoma, 1 Ewing). The median dose of mediastinal RT was 22.6 Gy (range 15-25.2 Gy). Breast exams were normal. The MRI were performed in 8 of 13 patients. It revealed a suspicious lesion in 1 patient (BI-RADS 4) and benign lesions in 3 patients (BI-RADS 2). MRI studies of the remaining 4 patients were normal, without findings. Benign lesions were fibroids. The patient with the malignant lesion was an invasive ductal carcinoma with positive hormonal receptors and negative Her-2 neu (pT1b N1a(sn) M0, grade II, ki67 15%). Conclusions: We have developed a complete early-detection-BC program for our population, that did not exist previously. Although a small number of women were involved, two BC were detected. We have shown the potential benefit of screening BC program, but the challenge to increase the attracting high-risk patients to these programs.