COLUMBIA-PRESBYTERIAN MEDICAL CENTER
Contact: Ruth Flaherty 212/305-5587
RADIATION TREATMENT FOR BREAST CANCER RAISES RISK FOR ESOPHAGEAL CANCER
NEW YORK, NY, JANUARY 14, 1998 -- Radiation treatment for breast cancer slightly raises a woman's long-term risk for esophageal cancer, according to a study conducted by epidemiologists at Columbia-Presbyterian Medical Center.
The findings, published in the January 15 issue of the Annals of Internal Medicine, do not imply that patients should avoid lumpectomy and radiation, the standard therapy for early-stage breast cancer. Rather, physicians should be especially alert to symptoms suggestive of esophageal cancer in patients who have received radiation treatment, says the principal investigator, Habibul Ahsan, MD, MMedSc, Assistant Professor of Clinical Public Health at the Columbia School of Public Health at Columbia-Presbyterian. This is particularly important for patients who smoke cigarettes or drink alcohol, the two major risk factors for esophageal cancer.
The study was conducted by examining the records of more than 220,000 breast cancer patients diagnosed between 1973 and 1993. The group included both patients who received radiation therapy and those who did not. Ten or more years after diagnosis, irradiated patients were roughly four to five times more likely to develop esophageal cancer than nonirradiated patients or women in the general population, according to Dr. Ahsan and his co-investigator, Alfred Neugut, MD, PhD, Associate Professor of Clinical Medicine and Public Health at Columbia-Presbyterian. This is the first study to link radiation therapy for breast cancer with an increased risk for esophageal cancer.
In an earlier study, the researchers demonstrated that breast-cancer irradiation raises one's risk for lung cancer. The risk was substantially higher among patients who smoked. The same pattern may hold true with esophageal cancer, says Dr. Neugut. "In the lung cancer study, the effect of smoking turned out to be multiplicative. That is, you ended up with 40 times the risk if you were both a smoker and had radiation therapy. With esophageal cancer, the combined effect of irradiation and smoking may turn out to be even more dramatic. We don't know that yet. We're just starting a study that will give us some answers in a couple of years." The researchers also plan to analyze the effect of radiation dosage, alcohol consumption, and body mass index on the incidence of esophageal cancer.
"Because survival among women with breast cancer is gradually increasing, we believe that clinicians should be aware of the possibility of a second cancer in the esophagus should suspicious symptoms arise among long-term survivors, particularly those who received radiation therapy in the past and who smoke cigarettes or drink alcohol," conclude Drs. Ahsan and Neugut in their paper. The primary symptoms of esophageal cancer are difficulty swallowing and pain with swallowing. "The actual absolute risk for esophageal cancer, even among irradiated women, is still trivial," adds Dr. Neugut, putting the study in perspective. "Esophageal cancer occurs in about one out of every 2,000 women with breast cancer, so we certainly don't want to imply that women shouldn't get radiation therapy. Radiation therapy improves survival after breast cancer, and that should be the first consideration."
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