Breast Cancer: Survivor, Are You at Risk?

Breast Cancer: survivor, are you at risk?

Risk for developing a secondary breast cancer after treatment for a childhood, adolescent, or young adult cancer depends on the type of treatment one received for their original diagnosis. While secondary breast cancers affect primarily females, males are also at risk as they, too, have breast tissue.

Known Risk Factors:

  • Chest radiation (>/= 20 Gy)
  • TOTAL dose of chest radiation received
  • Early menstruation (before the age of 12)
  • Late Menopause (after age 55)
  • Never having a baby OR having a baby after the age of 30
  • Having a close relative with breast cancer
  • Leading an inactive lifestyle

Note: TBI should be factored into the total dose of chest radiation

Breast Cancer after Chest Radiation Therapy for Childhood Cancer

Possible Risk Factors:

  • High in fat diet
  • Drinking too much alcohol
  • Never having breastfed
  • Smoking
  • Birth control pills
  • Hormone replacement therapy taken for long periods of time

This risk for secondary breast cancer begins to rise between 5-9 years after the radiation therapy ends and continues to rise, thus breast cancer occurs in much younger women and the risk does not plateau.

Prevention:

There is no way to prevent the development of a secondary breast cancer; one must, therefore, be committed to surveillance in the name of early detection.

Early Detection:

If you receive 20 Gy or greater of radiation to your chest during you cancer treatment, then the monitoring recommendations are as follows:

  • Be Breast Aware: report any lumps, bumps, pain, discharge, or any other change to your healthcare provider immediately
  • Clinical Breast Exam [CBE] performed once a year until you are 25 years old, then every 6 months thereafter
  • Have a yearly mammogram and breast MRI starting at age 25 or 8 years after you received the radiation; ideally, alternating at 6 month intervals

What if I received less than 20 GY?

You may still be at increased risk; therefore, it is important for you to discuss this risk and devise a plan for monitoring with your primary care provider that is appropriate and acceptable to you.

Children’s Oncology Group Survivorship Guidelines

What if you didn’t received any chest radiation whatsoever?

You may still be at risk if you received akylators [i. e. cytoxan], anthracyclines [i. e. doxorubicin], DTIC, or carmustine as part of your therapy. In particular, survivors of sarcoma and leukemia seem to carry an increased risk for the subsequent development of breast cancer.

Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy

LifeStyle Changes you may want to consider:

  • Eat more fruits and veggies
  • 30 minutes of exercise on most days of the week
  • Lose weight
  • Stop smoking
  • Limit alcohol intake
  • If you have a baby, try to breastfeed 3-4 months
  • If you need hormone replacement therapy or birth control pills, discuss the risks and benefits within the context of your cancer treatment history

Disclaimer: This content is intended for survivors of childhood cancers and is provided for educational purposes only. This is not medical advice; please consult your healthcare providers with questions and/or concerns.

Finally, there are a few specific diagnoses that are associated with an increased risk of secondary breast cancer: the sarcomas, the leukemias, and Hodgkin’s lymphoma.

Further Reading and Resources:

Guidelines on Survivorship Care from ASCO

American Cancer Society on MRI Screening

American Cancer Society on Breast Screening in Women of Average Risk

Advertisements

Primary Care Provider: Essential

Fact: primary care providers  are essential in the life of the cancer survivor.

Fact: medical education does not speak to the potential late effects of cancer treatment and appropriate screenings across time.

Fact: we, survivors, have a tendency to feel safe [and] secure under the umbrella of our oncologists; however, our oncologists have a tendency to focus solely on our cancer at the expense of our primary healthcare needs as we age.

If your cancer treatment summary is the little black dress of your survivorship wardrobe, then a primary care provider is the string of pearls around your neck.

Truth: I have not seen an oncologist in 35 years which was 2 years after I was given my last dose of chemotherapy. I grew up as [a well child, a well teenager, a well young adult, a well individual], and I believe, I am ALL the better for it as I never viewed myself as chronically ill.

Truth: I find myself reluctant to step out from under my PCP’s care unless it is absolutely necessary which, to be quite candid it, usually isn’t. I will admit to you that my internist is second to none.

She is the head coach of my healthcare team [and] we utilize our special teams [if/when] we need to do so. Forgive the football analogy, but I LOVE football (Gator Nation; Steelers Nation).

She knows me.

She knows my history.

She knows my risk factors.

She respects that I know my body.

She not only cares for me, but she also cares about me.

She approaches my care with an attitude of humility and grace that allows her to know the limits of her expertise.

She is my advocate [and] we are  truly partners with regard to my health and wellbeing.

Like I said, she is second to none.

Survivors, we need PCP’s who are focused on prevention with a healthy respect of the potential late effects we are at risk for across our lives.

Again, you want a PCP who will partner with you on the screening for late effects; a PCP who will be responsible without being overly vigilant; a PCP who cares for you [and] about you. A PCP who knows the limits of his/her expertise. A PCP who is invested in your wellness.

I live a life-full [and] I am hope-full with a vision for my future.

I fully intend to watch my grandchildren grow up: BOOM!

It is possible to find such doctors and nurse practitioners; they are out there though it may take some time in interviewing.

Persevere.

Further Reading: Creating a Multidisciplinary Healthcare Dream Team.