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Treatment, toxicity, and mortality after subsequent breast cancer in female survivors of childhood cancer

Author

Listed:
  • Cindy Im

    (University of Minnesota)

  • Hasibul Hasan

    (University of Minnesota)

  • Emily Stene

    (University of Minnesota)

  • Sarah Monick

    (Mayo Clinic Arizona)

  • Ryan K. Rader

    (University of Kansas)

  • Jori Sheade

    (Lurie Cancer Center Affiliate Network)

  • Heather Wolfe

    (University of Texas Southwestern Medical Center)

  • Zhanni Lu

    (University of Minnesota)

  • Logan G. Spector

    (University of Minnesota)

  • Aaron J. McDonald

    (St. Jude Children’s Research Hospital)

  • Vikki Nolan

    (St. Jude Children’s Research Hospital)

  • Michael A. Arnold

    (Anschutz Medical Campus)

  • Miriam R. Conces

    (Nationwide Children’s Hospital)

  • Chaya S. Moskowitz

    (Memorial Sloan Kettering Cancer Center)

  • Tara O. Henderson

    (University of Chicago)

  • Leslie L. Robison

    (St. Jude Children’s Research Hospital)

  • Gregory T. Armstrong

    (St. Jude Children’s Research Hospital)

  • Yutaka Yasui

    (St. Jude Children’s Research Hospital)

  • Rita Nanda

    (University of Chicago)

  • Kevin C. Oeffinger

    (Duke University)

  • Joseph P. Neglia

    (University of Minnesota)

  • Anne Blaes

    (University of Minnesota)

  • Lucie M. Turcotte

    (University of Minnesota)

Abstract

Childhood cancer survivors, particularly those who received chest radiotherapy, are at high risk for developing subsequent breast cancer. Minimizing long-term toxicity risks associated with additional radiotherapy and chemotherapy is a priority, but therapeutic tradeoffs have not been comprehensively characterized and their impact on survival is unknown. In this study, 431 female childhood cancer survivors with subsequent breast cancer from a multicenter retrospective cohort study were evaluated. Compared with one-to-one matched females with first primary breast cancer, survivors are as likely to be prescribed guideline-concordant treatment (N = 344 pairs; survivors: 94%, controls: 93%), but more frequently undergo mastectomy (survivors: 81%, controls: 60%) and are less likely to be treated with anthracyclines (survivors: 47%, controls: 66%) or radiotherapy (survivors: 18%, controls: 61%). Despite this, survivors have nearly 3.5-fold (95% CI = 2.17-5.57) greater mortality risk. Here, we show survivors with subsequent breast cancer face excess mortality despite therapeutic tradeoffs and require specialized treatment guidelines.

Suggested Citation

  • Cindy Im & Hasibul Hasan & Emily Stene & Sarah Monick & Ryan K. Rader & Jori Sheade & Heather Wolfe & Zhanni Lu & Logan G. Spector & Aaron J. McDonald & Vikki Nolan & Michael A. Arnold & Miriam R. Con, 2025. "Treatment, toxicity, and mortality after subsequent breast cancer in female survivors of childhood cancer," Nature Communications, Nature, vol. 16(1), pages 1-11, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-58434-w
    DOI: 10.1038/s41467-025-58434-w
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