Case Presentation

Correct Answer: D. Prior history of mantle radiation therapy

Micaela Weaver, DO, FACS

Correct Answer: D. Prior history of mantle radiation therapy.

From the original case report1: "The risk of prior radiation is a key aspect of this case presentation. Although more research needs to be done on the effect of radiation and the risk of breast cancer in men, data from the Childhood Cancer Survivor Study showed that women who underwent chest radiation for childhood cancers had an elevated risk of breast cancer on par with those who have BRCA mutations.2

The effect radiation has on the future risk of breast cancer is well known. A case-control study of 6647 women who were survivors of childhood cancer found that women who received radiation with 40 Gy had an 11 times increased risk for developing breast cancer compared with nonirradiated patients.3 While this study found a linear correlation between radiation dose and breast cancer risk, a 2014 study found a high risk of breast cancer even following radiation with a lower median dose of 14 Gy.2 There are a few studies concerning the role of radiation in breast cancer among men. One study of 45,880 Japanese men who were atomic bomb survivors showed a statistically significant dose-response relation between external radiation and breast cancer in men.4 Another study of 227 men with breast cancer found that ionizing radiation was a risk factor and that the likelihood increased with a higher frequency of chest X-rays".5

Transcription from Case Presentation Video

Micaela Weaver, DO, FACS: "The answer is D. It is well-established that mantle radiation therapy has a high risk of future breast cancers, especially among women. This is most prominent when that radiation therapy is received before the age of 30.

In women who have a history of mantle radiation, they actually begin high-risk screening with mammogram and MRI at a very young age, and this draws the attention to the risk for men and breast cancer as well in these cases of mantle radiation therapy. Since this patient only had a unilateral mastectomy, he still has some gynecomastia and tissue on the contralateral side. Therefore, he is undergoing screening mammograms on a yearly or every other year basis for screening for breast cancer of his contralateral breast.”

References:

  1. Rabinovich D, Weaver M. A man with breast cancer after mantle radiation. Consultant. 2023;63(11):e1. doi:10.25270/con.2023.11.000004
  2. Moskowitz CS, Chou JF, Wolden SL, et al. Breast cancer after chest radiation therapy for childhood cancer. J Clin Oncol. 2014;32(21):2217-2223. doi:10.1200/JCO.2013.54.4601.
  3. Inskip PD, Robison LL, Stovall M, et al. Radiation dose and breast cancer risk in the childhood cancer survivor study. J Clin Oncol. 2009;27(24):3901-3907. doi:10.1200/JCO.2008.20.7738.
  4. Ron E, Ikeda T, Preston DL, Tokuoka S. Male breast cancer incidence among atomic bomb survivors. J Natl Cancer Inst. 2005;97(8):603-605. doi:10.1093/jnci/dji097.
  5. Thomas DB, Rosenblatt K, Jimenez LM, et al. Ionizing radiation and breast cancer in men (United States). Cancer Causes Control. 1994;5(1):9-14. doi:10.1007/BF01830721.