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Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy

Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Malmström, Per LU ; Alsadius, David; Sundberg, Agnetha; Wilderang, Ulrica; Holmberg, Erik; Johansson, Karl-Axel and Karlsson, Per (2012) In International Journal of Radiation Oncology, Biology, Physics 83(1). p.71-78
Abstract
Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care... (More)
Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, locoregional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long-lasting breast pain compared to older women. Time since treatment may decrease the occurrence of pain. (C) 2012 Elsevier Inc. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Radiotherapy, Breast cancer, Long-lasting, Breast pain, Risk factors
in
International Journal of Radiation Oncology, Biology, Physics
volume
83
issue
1
pages
71 - 78
publisher
Elsevier
external identifiers
  • wos:000302993900033
  • scopus:84859814616
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2011.05.065
language
English
LU publication?
yes
id
216b7db3-c09c-4243-b98d-78c572ae1153 (old id 2570902)
date added to LUP
2012-06-01 08:52:30
date last changed
2017-10-22 03:10:39
@article{216b7db3-c09c-4243-b98d-78c572ae1153,
  abstract     = {Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, locoregional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long-lasting breast pain compared to older women. Time since treatment may decrease the occurrence of pain. (C) 2012 Elsevier Inc.},
  author       = {Lundstedt, Dan and Gustafsson, Magnus and Steineck, Gunnar and Malmström, Per and Alsadius, David and Sundberg, Agnetha and Wilderang, Ulrica and Holmberg, Erik and Johansson, Karl-Axel and Karlsson, Per},
  issn         = {0360-3016},
  keyword      = {Radiotherapy,Breast cancer,Long-lasting,Breast pain,Risk factors},
  language     = {eng},
  number       = {1},
  pages        = {71--78},
  publisher    = {Elsevier},
  series       = {International Journal of Radiation Oncology, Biology, Physics},
  title        = {Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy},
  url          = {http://dx.doi.org/10.1016/j.ijrobp.2011.05.065},
  volume       = {83},
  year         = {2012},
}