Radiation treatment for breast cancer may increase incidence of nonkeratinocyte skin cancer

1.  Amongst a cohort of breast cancer survivors, those that were treated with radiation had a higher risk of developing nonkeratinocyte skin cancer.

Evidence Rating Level: 2 (Good) 

Cancer remains the second leading cause of death in the United States (US), even though incidence rates have declined. In the US, there are over 4 million breast cancer survivors that deal with mental and physical health challenges after the end of their treatment. Of the 875 880 patients with a new diagnosis of breast cancer, 51.6% were 60 years of age or older and 50.3% underwent radiation therapy. Further, Of the participants, 11.2% identified as Hispanic, 10.1% identified as non-Hispanic Black, and 69.5% identified as non-Hispanic White. Standardized incidence ratios (SIRs) for subsequent nonkeratinocyte skin cancer development based on treatment type, skin cancer location, and skin cancer subtype, were the primary outcomes of the study. Between 2000 and 2019, a total of 3839 patients who were finished with treatment developed nonkeratinocyte cancer, which includes melanoma (3419 [89.1%]), Merkel cell carcinoma (121 [3.2%]), hemangiosarcoma (104 [2.7]) and 32 others (195 [5.1%]). When compared to the general population, the risk of getting diagnosed with nonkeratinocyte skin cancer was 57% higher (SIR, 1.57 [95% CI, 1.45-1.7]) in those who received breast cancer treatment. When compared to the general population, the incidence of melanoma increased by 1.37-fold (SIR, 1.37 [95% CI, 1.25-1.49]) and the incidence of hemangiosarcoma increased by 27.11-fold (SIR, 27.11 [95% CI, 21.6-33.61]) when localized to the skin of the breast or trunk. Different cancer treatments had differing risks of nonkeratinocyte skin cancer, with radiation having a much greater risk than chemotherapy and surgery. The increased risk of developing nonkeratinocyte skin cancer in breast cancer survivors was statistically significant, with an even greater risk in those that received radiation as their treatment. Consistent with previous data, the findings of the study showed the role of radiation as a risk for secondary malignant neoplasms. Overall, breast cancer survivors had a greater risk of developing melanoma and hemangiosarcoma after treatment with radiation. Although nonkeratinocyte cancers are rare, it is important for physicians to understand their elevated risk of occurrence in breast cancer survivors previously treated with radiation.

Click to read the study in JAMA Network Open

Image: PD

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