Long-term breast cancer risk post childhood cancer radiotherapy: data-driven screening recommendations for survivors.
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OBJECTIVES: Modern radiotherapy techniques have significantly reduced radiation exposure to healthy tissues. This study analysed breast tissue radiation doses in a national pediatric radiotherapy database, explored the discrepancy between prescribed and actual doses and analysed shortcomings of current breast screening guidelines. METHODS: We analysed PediaRT database data on radiotherapy dose distributions for 5079 French childhood cancer patients (2013-present), focusing on photon therapy plans with available breast dose data (n = 428). Biological equivalent dose (BED) was calculated, and statistical analyses (t-tests, chi-square, Mann-Whitney U, Fisher's exact, and logistic regression) identified factors associated with breast dose exposure. RESULTS: Among patients receiving supra-diaphragmatic radiotherapy, 99.3% had a prescribed dose >10 Gy, but 62.1% received a maximum dose greater than 10 Gy to at least one breast, and 25.5% received a mean dose greater than 10 Gy. As pediatric treatments often use fraction sizes <2 Gy, BED analysis revealed that 51.29% to 80.47% of patients prescribed >10 Gy received <10 Gy as minimal, maximal, or mean dose. These discrepancies suggest that current breast cancer screening guidelines, based on prescribed doses, may overestimate risk in survivors treated with modern techniques. CONCLUSIONS: Our findings support a shift toward dose-specific screening recommendations based on actual tissue exposure. Relying solely on prescribed doses and fields may lead to unnecessary screenings and increased burden for patients. ADVANCES IN KNOWLEDGE: This study is the first to assess actual breast tissue radiation doses using a national multicenter pediatric radiotherapy database. It highlights how current breast cancer screening guidelines based on prescribed doses may overestimate risk in survivors treated with modern radiotherapy techniques.