Breast cancer recurrence and mortality among survivors of childhood cancer.

Im, Cindy; Hasan, Hasibul; Srinivasan, Aparna; Stene, Emily; Mcdonald, Aaron J; Moskowitz, Chaya S; Henderson, Tara O; Armstrong, Gregory T et al. · J Natl Cancer Inst · 2026

retrospective_cohort · Level III

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Abstract

Childhood cancer survivors are at high risk for developing breast cancer (BC) as a treatment-related neoplasm. Their risk for, and survival after, BC recurrence has not been characterized. In this study, female survivors had a ten-year BC recurrence risk of 14% (95% CI: 10-20%), similar to controls with sporadic BC matched by age, race, ethnicity, and disease characteristics (N = 201 pairs; P = .62). Among survivors with recurrent BC (N = 68), first BCs were largely early stage (0/I/II: 77%). Nearly half (47%) underwent bilateral mastectomies, with 81% performed before recurrence, predominantly from distant metastases. Survivors' ten-year mortality risk after BC recurrence was 89% (95% CI: 61-97%), significantly exceeding controls (40%, 95% CI: 16-57%; P = .0013), for an adjusted 2.8-fold greater risk. BC was the leading cause of death in these survivors; the ten-year cause-specific mortality probability was 67% (95% CI: 53-83%). Comprehensive investigations of BC recurrence drivers and adverse outcomes in this population are needed.