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Diagnostic and therapeutic ionizing radiation and the risk of a first and second primary breast cancer, with special attention for BRCA1 and BRCA2 mutation carriers: A critical review of the literature

  • Jan C. Drooger
    Correspondence
    Corresponding author at: Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands. Tel.: +31 107041754; fax: +31 107041003.
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands

    Ikazia Hospital, Department of Internal Medicine, PO Box 3008 AA, Rotterdam, The Netherlands
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  • Maartje J. Hooning
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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  • Caroline M. Seynaeve
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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  • Margreet H.A. Baaijens
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Radiotherapy, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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  • Inge Marie Obdeijn
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Radiology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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  • Stefan Sleijfer
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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  • Agnes Jager
    Affiliations
    Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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Published:December 08, 2014DOI:https://doi.org/10.1016/j.ctrv.2014.12.002

      Highlights

      • Ionizing radiation is a well-known risk factor for primary breast cancer.
      • Sporadic breast cancer patients >45 years can be safely treated with radiotherapy.
      • Mammography screening is not advised in BRCA1/2 mutation carriers <30 years.
      • There are no hard data against adjuvant radiotherapy in BRCA1/2 mutation carriers.
      • Caution with adjuvant radiotherapy seems warranted in young BRCA1/2 mutation carriers.

      Abstract

      Occurrence of breast cancer is a well-known long-term side effect of ionizing radiation (both diagnostic and therapeutic). The radiation-induced breast cancer risk increases with longer follow-up, higher radiation dose and younger age of exposure. The risk for breast cancer following irradiation for lymphomas is well known. Although data regarding the carcinogenic risk of adjuvant radiotherapy for a primary breast cancer are sparse, an increased risk is suggested with longer follow-up mainly when exposed at younger age. Particularly, patients with a BRCA1/2 mutation might be more sensitive for the deleterious effects of ionizing radiation due to an impaired capacity of repairing double strand DNA breaks. This might have consequences for the use of mammography in breast cancer screening, as well as the choice between breast conserving therapy including radiotherapy and mastectomy at primary breast cancer diagnosis in young BRCA1/2 mutation carriers. Good data regarding this topic, however, are scarce, mainly due to constraints in the design of performed studies. In this review, we will discuss the current literature on the association between ionizing radiation and developing breast cancer, with particular attention to patients with a BRCA1/2 mutation.

      Keywords

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