Female breast cancer is a well-documented late effect of exposure to doses of ionizing radiation as low as 0.1 to 0.5 Sievert (Sv).1 Sievert is the unit dose equivalent and the product of the absorbed dose in gray and quality factors; in this article, Sv will be used interchangeably with Gray (Gy), the unit of absorbed dose, kerma, and specific energy imparted.
Ample data are available on radiation-associated breast cancer based on epidemiologic studies of atomic bomb survivors,1-9 and cohorts of women who underwent repeated diagnostic exposure,10-13 or therapeutic radiation to treat either benign conditions14-24 or cancer.25-40 Although the radiation administered to these populations varied in terms of quality, dose rate, fractionation, and cumulative amount, and the patients differed in terms of age at exposure and background risk, consistent findings between studies have emerged. These observations include a diminishing risk for breast cancer with increasing age at radiation exposure, and a significant relationship between increasing radiation dose and increasing breast cancer risk, although the precise shape of the dose—response curve can vary.
Preston et al.41 reviewed 8 cohorts of irradiated women, including atomic bomb survivors and 7 other groups who received medical exposures. Results from this pooled analysis suggested that radiation exposure at any age was associated with an increased risk for breast cancer. Although breast cancer excesses decreased with increasing age at exposure, significantly elevated risks persisted throughout life, with the largest excess rates occurring late in life, as background rates increase. Although a cell-killing effect for high dose-rate exposures totaling several Gy or more was suggested, the pooled analysis showed no evidence contrary to a linear dose response in the low-dose region. In subsequent studies that focused on Hodgkin lymphoma (HL) survivors who underwent radiation in therapeutic dose ranges, there was also no evidence of a downturn in risk, even in the highest dose ranges.34,35
A thorough understanding of the relation between radiation exposure and subsequent breast cancer excesses can facilitate the development of radiobiologic risk models for estimating risks in various settings. Furthermore, this information can then provide the foundation for patient counseling, and also guide recommendations for optimal breast cancer screening and prevention strategies in exposed women.
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