Radiation and future cancer risk

[Lorel]

I had a rare presentation of what was decided upon as breast cancer, where I had a poorly differentiated adenocarcinoma located in my left axillary node(s), but no cancer was detected in either breast upon various diagnostic tests, including breast MRI.  I was treated with an initial axillary lymph node lesion excision for diagnosis, then with induction chemotherapy x 6 months, left axillary lymph node dissection, and then radiation to my entire chest, from supraclavicular nodes down to lower rib cage area, from sternum  to axillary region, with a boost in the axilla, x 5.5 weeks.  I am almost five years from dx apparently cancer-free.  
I live with a lot of discomfort in the treated area.  The tissues hurt all the time and throb, etc,in the breast and all the surrounding tissue. I was 38 y/o when this occured and so after regaining ovarian function, I deal with even more painful side effects from radiation and surgery during my cycle.  
The frustration I've had is that I have been uneducated as to the side effects of radiation to my skin and muscle tissues and mostly, to my left lung, of which a top portion has been scarred/damaged, dare I say, killed off, by the radiation. I know that solid tumors are a risk of radiation therapy.  My question is...what is the true risk to my lung for developing cancer in that injured tissue area? I work in the medical field and read that one of several main risks besides smoking for lung cancer is ionizing radiation that scars lung tissue.  I'm afraid of getting lung cancer in my scarred tissue. But I like answers and I like knowing what I'm dealing with. Can you please tell me what studies have shown about secondary cancers in younger women who have had lung damage and other tissue damage from large-area radiation for breast cancer?   If there are no such studies out there, could you please educate me from information you do have? And could you please consider how this subject could receive research. Though my case is rare, there are others out there who experience this type of cancer presentation and must decide to withstand the intense treatment it requires to "cover all the bases" regarding source. Thank you very very much. Lorel

[Andrew Gorden]

Oncology:effective and secure devices of the help.
http://gorden-infomed.blogspot.com/

[docboston]

1. What is the risk of developing lung cancer after receiving extensive chest wall radiation as therapy for early stage breast cancer?

A: In the NSABP B4 trial, 1665 women treated for early stage breast cancer were followed for 25 years for lung cancer.  1019 of these women were treated with surgery alone and 646 were treated with surgery plus radiation. Of these 1665, 23 developed lung cancer, ie 1.4% at 25 years.
Of the 646 who received radiation, 14 developed braest cancer. (2.16%)
Of the 1019 who did not receive radiation, 9 developed lung cancer (0.88%)

So you can see that radiation does increase the risk of lung cancer, but the risk is low (2.16%). Also, this trial was done in 1970s when huge doses of radiation were used. A more recent study, NSABP B6 found no increase in risk with or without radiation.

The more important risk for women who have received chest wall radiation is from cariacc toxicity. WOmen who have received radiation are 30% more likely to develop heart problems than those who havent been irraidated. However, it is also important to note that women who have received radiation have better survival rates, despite increased cardiac risk because their cancers are less likely to recur.

Here is the journal article from which the above numbers are quopted:

Cancer. 2003 Oct 1;98(7):1362-8.


I hope this is useful. Please remember, these are statatistics and do not necessarily apply to individual cases.

[Carol 1]

Hi Lorel,

I'm a 9 year survivor and still have extreme tenderness in the area of the axillary lymph node dissection.  

As for your question about Lung CA after RT, you might want to post your question in the Breast CA Forum here on MedHelp.  The Cleveland Clinic answers questions for free over there and their answers are really excellent!

Carol