Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer

A population-based study

Amer M. Zeidan, Jessica B. Long, Rong Wang, Xin Hu, James B. Yu, Scott F. Huntington, Gregory A. Abel, Sarah S. Mougalian, Nikolai A. Podoltsev, Steven D. Gore, Cary P. Gross, Xiaomei Ma, Amy J. Davidoff

Research output: Contribution to journalArticle

Abstract

Background There are inconsistent and limited data regarding the risk of myeloid neoplasms (MN) among breast cancer survivors who received radiotherapy (RT) in the absence of chemotherapy. Concern about subsequent MN might influence the decision to use adjuvant RT for women with localized disease. As patients with therapy-related MN have generally poor outcomes, the presumption of subsequent MN being therapy-related could affect treatment recommendations. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to study older women with in-situ or stage 1-3 breast cancer diagnosed 2001-2009 who received surgery. Chemotherapy and RT were ascertained using Medicare claims, and new MN diagnoses were captured using both SEER registry and Medicare claims. We excluded women who received chemotherapy for initial treatment, and censored at receipt of subsequent chemotherapy. Competing-risk survival analysis was used to assess the association between RT and risk of subsequent MN adjusting for relevant characteristics. Results Median follow-up for 60,426 eligible patients was 68 months (interquartile range, 46 to 92 months), with 47.6% receiving RT. In total, 316 patients (0.52%) were diagnosed with MN; the cumulative incidence per 10,000 person-years was 10.6 vs 9.0 among RT-treated vs non-RT-treated women, respectively (p = .004); the increased risk of subsequent MN persisted in the adjusted analysis (hazard ratio = 1.36, 95% confidence interval: 1.03-1.80). The results were consistent in multiple sensitivity analyses. Conclusions Our data suggest that RT is associated with a significant risk of subsequent MN among older breast cancer survivors, though the absolute risk increase is very small. These findings suggest the benefits of RT outweigh the risks of development of subsequent MN.

Original languageEnglish (US)
Article numbere0184747
JournalPLoS One
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2017

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Radiotherapy
radiotherapy
breast neoplasms
Breast Neoplasms
neoplasms
Chemotherapy
Population
Neoplasms
Medicare
drug therapy
Drug Therapy
Epidemiology
Second Primary Neoplasms
Survivors
epidemiology
Adjuvant Radiotherapy
Risk analysis
Survival Analysis
hazard characterization
therapeutics

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Zeidan, A. M., Long, J. B., Wang, R., Hu, X., Yu, J. B., Huntington, S. F., ... Davidoff, A. J. (2017). Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer: A population-based study. PLoS One, 12(9), [e0184747]. https://doi.org/10.1371/journal.pone.0184747

Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer : A population-based study. / Zeidan, Amer M.; Long, Jessica B.; Wang, Rong; Hu, Xin; Yu, James B.; Huntington, Scott F.; Abel, Gregory A.; Mougalian, Sarah S.; Podoltsev, Nikolai A.; Gore, Steven D.; Gross, Cary P.; Ma, Xiaomei; Davidoff, Amy J.

In: PLoS One, Vol. 12, No. 9, e0184747, 01.09.2017.

Research output: Contribution to journalArticle

Zeidan, AM, Long, JB, Wang, R, Hu, X, Yu, JB, Huntington, SF, Abel, GA, Mougalian, SS, Podoltsev, NA, Gore, SD, Gross, CP, Ma, X & Davidoff, AJ 2017, 'Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer: A population-based study', PLoS One, vol. 12, no. 9, e0184747. https://doi.org/10.1371/journal.pone.0184747
Zeidan, Amer M. ; Long, Jessica B. ; Wang, Rong ; Hu, Xin ; Yu, James B. ; Huntington, Scott F. ; Abel, Gregory A. ; Mougalian, Sarah S. ; Podoltsev, Nikolai A. ; Gore, Steven D. ; Gross, Cary P. ; Ma, Xiaomei ; Davidoff, Amy J. / Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer : A population-based study. In: PLoS One. 2017 ; Vol. 12, No. 9.
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abstract = "Background There are inconsistent and limited data regarding the risk of myeloid neoplasms (MN) among breast cancer survivors who received radiotherapy (RT) in the absence of chemotherapy. Concern about subsequent MN might influence the decision to use adjuvant RT for women with localized disease. As patients with therapy-related MN have generally poor outcomes, the presumption of subsequent MN being therapy-related could affect treatment recommendations. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to study older women with in-situ or stage 1-3 breast cancer diagnosed 2001-2009 who received surgery. Chemotherapy and RT were ascertained using Medicare claims, and new MN diagnoses were captured using both SEER registry and Medicare claims. We excluded women who received chemotherapy for initial treatment, and censored at receipt of subsequent chemotherapy. Competing-risk survival analysis was used to assess the association between RT and risk of subsequent MN adjusting for relevant characteristics. Results Median follow-up for 60,426 eligible patients was 68 months (interquartile range, 46 to 92 months), with 47.6{\%} receiving RT. In total, 316 patients (0.52{\%}) were diagnosed with MN; the cumulative incidence per 10,000 person-years was 10.6 vs 9.0 among RT-treated vs non-RT-treated women, respectively (p = .004); the increased risk of subsequent MN persisted in the adjusted analysis (hazard ratio = 1.36, 95{\%} confidence interval: 1.03-1.80). The results were consistent in multiple sensitivity analyses. Conclusions Our data suggest that RT is associated with a significant risk of subsequent MN among older breast cancer survivors, though the absolute risk increase is very small. These findings suggest the benefits of RT outweigh the risks of development of subsequent MN.",
author = "Zeidan, {Amer M.} and Long, {Jessica B.} and Rong Wang and Xin Hu and Yu, {James B.} and Huntington, {Scott F.} and Abel, {Gregory A.} and Mougalian, {Sarah S.} and Podoltsev, {Nikolai A.} and Gore, {Steven D.} and Gross, {Cary P.} and Xiaomei Ma and Davidoff, {Amy J.}",
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T1 - Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer

T2 - A population-based study

AU - Zeidan, Amer M.

AU - Long, Jessica B.

AU - Wang, Rong

AU - Hu, Xin

AU - Yu, James B.

AU - Huntington, Scott F.

AU - Abel, Gregory A.

AU - Mougalian, Sarah S.

AU - Podoltsev, Nikolai A.

AU - Gore, Steven D.

AU - Gross, Cary P.

AU - Ma, Xiaomei

AU - Davidoff, Amy J.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background There are inconsistent and limited data regarding the risk of myeloid neoplasms (MN) among breast cancer survivors who received radiotherapy (RT) in the absence of chemotherapy. Concern about subsequent MN might influence the decision to use adjuvant RT for women with localized disease. As patients with therapy-related MN have generally poor outcomes, the presumption of subsequent MN being therapy-related could affect treatment recommendations. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to study older women with in-situ or stage 1-3 breast cancer diagnosed 2001-2009 who received surgery. Chemotherapy and RT were ascertained using Medicare claims, and new MN diagnoses were captured using both SEER registry and Medicare claims. We excluded women who received chemotherapy for initial treatment, and censored at receipt of subsequent chemotherapy. Competing-risk survival analysis was used to assess the association between RT and risk of subsequent MN adjusting for relevant characteristics. Results Median follow-up for 60,426 eligible patients was 68 months (interquartile range, 46 to 92 months), with 47.6% receiving RT. In total, 316 patients (0.52%) were diagnosed with MN; the cumulative incidence per 10,000 person-years was 10.6 vs 9.0 among RT-treated vs non-RT-treated women, respectively (p = .004); the increased risk of subsequent MN persisted in the adjusted analysis (hazard ratio = 1.36, 95% confidence interval: 1.03-1.80). The results were consistent in multiple sensitivity analyses. Conclusions Our data suggest that RT is associated with a significant risk of subsequent MN among older breast cancer survivors, though the absolute risk increase is very small. These findings suggest the benefits of RT outweigh the risks of development of subsequent MN.

AB - Background There are inconsistent and limited data regarding the risk of myeloid neoplasms (MN) among breast cancer survivors who received radiotherapy (RT) in the absence of chemotherapy. Concern about subsequent MN might influence the decision to use adjuvant RT for women with localized disease. As patients with therapy-related MN have generally poor outcomes, the presumption of subsequent MN being therapy-related could affect treatment recommendations. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to study older women with in-situ or stage 1-3 breast cancer diagnosed 2001-2009 who received surgery. Chemotherapy and RT were ascertained using Medicare claims, and new MN diagnoses were captured using both SEER registry and Medicare claims. We excluded women who received chemotherapy for initial treatment, and censored at receipt of subsequent chemotherapy. Competing-risk survival analysis was used to assess the association between RT and risk of subsequent MN adjusting for relevant characteristics. Results Median follow-up for 60,426 eligible patients was 68 months (interquartile range, 46 to 92 months), with 47.6% receiving RT. In total, 316 patients (0.52%) were diagnosed with MN; the cumulative incidence per 10,000 person-years was 10.6 vs 9.0 among RT-treated vs non-RT-treated women, respectively (p = .004); the increased risk of subsequent MN persisted in the adjusted analysis (hazard ratio = 1.36, 95% confidence interval: 1.03-1.80). The results were consistent in multiple sensitivity analyses. Conclusions Our data suggest that RT is associated with a significant risk of subsequent MN among older breast cancer survivors, though the absolute risk increase is very small. These findings suggest the benefits of RT outweigh the risks of development of subsequent MN.

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U2 - 10.1371/journal.pone.0184747

DO - 10.1371/journal.pone.0184747

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JO - PLoS One

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