Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer

Yuehan Wang*, Cécile M. Ronckers, Flora E. van Leeuwen, Chaya S. Moskowitz, Wendy Leisenring, Gregory T. Armstrong, Florent de Vathaire, Melissa M. Hudson, Claudia E. Kuehni, Michael A. Arnold, Charlotte Demoor-Goldschmidt, Daniel M. Green, Tara O. Henderson, Rebecca M. Howell, Matthew J. Ehrhardt, Joseph P. Neglia, Kevin C. Oeffinger, Helena J.H. van der Pal, Leslie L. Robison, Michael SchaapveldLucie M. Turcotte, Nicolas Waespe, Leontien C.M. Kremer, Jop C. Teepen, Flora E. van Leeuwen, Florent de Vathaire, Helena J.H. van der Pal, Nadia Haddy, Ibrahima Diallo, K. Scott Baker, Amy Berrington de González, Miriam R. Conces, Louis S. Constine, Mike Hawkins, Jacqueline J. Loonen, Marloes Louwerens, Geert O. Janssens, Lene Mellemkjaer, Raoul Reulen, Jeanette F. Winther

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Downloads (Pure)


Anthracycline-based chemotherapy is associated with increased subsequent breast cancer (SBC) risk in female childhood cancer survivors, but the current evidence is insufficient to support early breast cancer screening recommendations for survivors treated with anthracyclines. In this study, we pooled individual patient data of 17,903 survivors from six well-established studies, of whom 782 (4.4%) developed a SBC, and analyzed dose-dependent effects of individual anthracycline agents on developing SBC and interactions with chest radiotherapy. A dose-dependent increased SBC risk was seen for doxorubicin (hazard ratio (HR) per 100 mg m2: 1.24, 95% confidence interval (CI): 1.18–1.31), with more than twofold increased risk for survivors treated with ≥200 mg m−2 cumulative doxorubicin dose versus no doxorubicin (HR: 2.50 for 200–299 mg m2, HR: 2.33 for 300–399 mg m2 and HR: 2.78 for ≥400 mg m2). For daunorubicin, the associations were not statistically significant. Epirubicin was associated with increased SBC risk (yes/no, HR: 3.25, 95% CI: 1.59–6.63). For patients treated with or without chest irradiation, HRs per 100 mg m2 of doxorubicin were 1.11 (95% CI: 1.02–1.21) and 1.26 (95% CI: 1.17–1.36), respectively. Our findings support that early initiation of SBC surveillance may be reasonable for survivors who received ≥200 mg m2 cumulative doxorubicin dose and should be considered in SBC surveillance guidelines for survivors and future treatment protocols.

Original languageEnglish
Pages (from-to)2268-2277
Number of pages10
JournalNature Medicine
Issue number9
Publication statusPublished - Sept 2023


Dive into the research topics of 'Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer'. Together they form a unique fingerprint.

Cite this