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Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer.

Abstract

PURPOSE

Prior studies have found that postmastectomy radiotherapy (PMRT) for breast cancer (BC) increases the risk of lung cancer (LC). We explored the joint effects of cigarette smoking and PMRT on LC risk.

METHODS

We conducted a population-based nested case-control study among women registered in the Connecticut Tumor Registry diagnosed with nonmetastatic BC between January 1, 1965 and December 31, 1989. Patient cases developed a LC >or= 10 years after BC diagnosis. Controls were matched to patient cases on age, year of BC diagnosis, and length of survival. Medical records were reviewed for pathology, BC therapy, and smoking history. We used conditional logistic regression to estimate odds ratios for the independent and joint effects of smoking and PMRT on risk of overall, ipsilateral, and contralateral LC.

RESULTS

Among 113 second primary LC patient cases and 364 controls, compared with nonsmoking women who did not receive PMRT, nonsmoking women who received PMRT had no higher risk of LC; adjusted odds ratios were 5.9 (95% CI, 2.7 to 12.8) for ever-smokers who did not receive PMRT and 18.9 (95% CI, 7.9 to 45.4) for ever-smokers who received PMRT. Adjusted odds ratios for the joint effects of smoking and PMRT were 10.5 (95% CI, 2.9 to 37.8) for the contralateral lung and 37.6 (95% CI, 10.2 to 139.0) for the ipsilateral lung. Smoking and PMRT were associated with increased risk for all histologic types of LC.

CONCLUSION

PMRT after a diagnosis of BC sharply increased the risk of second primary LC, especially in the ipsilateral lung, among ever-smokers. Clinicians should consider including smoking history in their discussions with patients about the risks and benefits of PMRT.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.

    , , ,

    Source

    MeSH

    Adenocarcinoma
    Adult
    Age Distribution
    Aged
    Aged, 80 and over
    Breast Neoplasms
    Carcinoma, Ductal, Breast
    Case-Control Studies
    Cocarcinogenesis
    Female
    Humans
    Lung Neoplasms
    Middle Aged
    Neoplasms, Radiation-Induced
    Neoplasms, Second Primary
    Odds Ratio
    Radiotherapy
    Radiotherapy Dosage
    Risk Factors
    Smoking
    Time Factors

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    18202415

    Citation

    Kaufman, Elizabeth L., et al. "Effect of Breast Cancer Radiotherapy and Cigarette Smoking On Risk of Second Primary Lung Cancer." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 26, no. 3, 2008, pp. 392-8.
    Kaufman EL, Jacobson JS, Hershman DL, et al. Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. J Clin Oncol. 2008;26(3):392-8.
    Kaufman, E. L., Jacobson, J. S., Hershman, D. L., Desai, M., & Neugut, A. I. (2008). Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 26(3), pp. 392-8. doi:10.1200/JCO.2007.13.3033.
    Kaufman EL, et al. Effect of Breast Cancer Radiotherapy and Cigarette Smoking On Risk of Second Primary Lung Cancer. J Clin Oncol. 2008 Jan 20;26(3):392-8. PubMed PMID: 18202415.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. AU - Kaufman,Elizabeth L, AU - Jacobson,Judith S, AU - Hershman,Dawn L, AU - Desai,Manisha, AU - Neugut,Alfred I, PY - 2008/1/19/pubmed PY - 2008/2/15/medline PY - 2008/1/19/entrez SP - 392 EP - 8 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 26 IS - 3 N2 - PURPOSE: Prior studies have found that postmastectomy radiotherapy (PMRT) for breast cancer (BC) increases the risk of lung cancer (LC). We explored the joint effects of cigarette smoking and PMRT on LC risk. METHODS: We conducted a population-based nested case-control study among women registered in the Connecticut Tumor Registry diagnosed with nonmetastatic BC between January 1, 1965 and December 31, 1989. Patient cases developed a LC >or= 10 years after BC diagnosis. Controls were matched to patient cases on age, year of BC diagnosis, and length of survival. Medical records were reviewed for pathology, BC therapy, and smoking history. We used conditional logistic regression to estimate odds ratios for the independent and joint effects of smoking and PMRT on risk of overall, ipsilateral, and contralateral LC. RESULTS: Among 113 second primary LC patient cases and 364 controls, compared with nonsmoking women who did not receive PMRT, nonsmoking women who received PMRT had no higher risk of LC; adjusted odds ratios were 5.9 (95% CI, 2.7 to 12.8) for ever-smokers who did not receive PMRT and 18.9 (95% CI, 7.9 to 45.4) for ever-smokers who received PMRT. Adjusted odds ratios for the joint effects of smoking and PMRT were 10.5 (95% CI, 2.9 to 37.8) for the contralateral lung and 37.6 (95% CI, 10.2 to 139.0) for the ipsilateral lung. Smoking and PMRT were associated with increased risk for all histologic types of LC. CONCLUSION: PMRT after a diagnosis of BC sharply increased the risk of second primary LC, especially in the ipsilateral lung, among ever-smokers. Clinicians should consider including smoking history in their discussions with patients about the risks and benefits of PMRT. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/18202415/full_citation L2 - http://ascopubs.org/doi/full/10.1200/JCO.2007.13.3033?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -