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A sarcoma arising in tissue that was irradiated is uncommon, appears after about seven years or more, and is recognised by where it is rather than by any test. In the treated breast it most often takes the form of angiosarcoma, and because it can look like a bruise or a cluster of reddish-blue nodules it is the one second cancer a person might reasonably mistake for something harmless.
What to do about it. There is no screening for this and no blood test. The whole of the answer is recognising it: any new lump, thickening, bruise-like patch or cluster of reddish or bluish nodules in skin or tissue that was irradiated, appearing years after treatment, is a reason to be seen rather than watched. Treatment is surgical and is planned at a sarcoma centre, which is a referral worth asking for by name.
How it is defined. The criteria have been in use since Cahan's 1948 report of eleven cases of sarcoma in irradiated bone: the tumour arises in a field that was irradiated, after a latent period, and is histologically different from the cancer that was treated. The definition is positional, which is why knowing the field matters more here than for any other second cancer.
How often, after breast cancer. In a nationwide Finnish registry study, 132,512 women were diagnosed with invasive breast cancer between 1953 and 2014; a subsequent sarcoma was recorded in 355, and after review and exclusion 96 were confirmed as radiation-associated sarcoma at or close to the treated volume. Angiosarcoma was the commonest histology, 50 of the 96 (52 per cent), and its share rose steadily across the six decades studied as breast-conserving surgery with radiotherapy replaced mastectomy. The five-year sarcoma-specific survival among those treated with curative intent was 75.1 per cent.
How it has changed shape. In a population-based cohort from southern Sweden covering 1958 to 2008, 31 angiosarcomas developed after breast cancer, at a median age of 71. They fell into two groups. Fourteen women treated by radical mastectomy and radiotherapy between 1949 and 1988 developed angiosarcoma in a swollen arm, the pattern named Stewart-Treves syndrome, after a median of 11 years. Seventeen treated by segmental resection, anti-hormonal treatment and radiotherapy between 1980 and 2005 developed it in the irradiated field on the chest wall after a median of 7.3 years. The authors record that "the clinical presentations were heterogeneous and included hematoma-like lesions, multiple bluish-reddish nodules, and asymptomatic lumps". Overall five-year survival in that cohort was 16 per cent, in a group with a median age of 71 treated between 1958 and 2008; half of those counted lived longer, and the Finnish series treated with curative intent did considerably better.
The size of the risk, in context. In the meta-analysis of 762,468 women treated for breast cancer, radiotherapy was associated with second sarcoma at a relative risk of 2.53 (95% CI 1.74 to 3.70) at five or more years. Against general-population rates, the standardised incidence ratio for sarcoma in irradiated women at ten years or more was 6.54, while unirradiated women had an overall figure of 1.42 with no excess remaining after ten years. A relative risk of that size still describes a rare event: these are tens of cases in cohorts of a hundred thousand women.
The honest tension. Breast radiotherapy reduces local recurrence and improves survival; this is one of the costs on the other side of that ledger, and it is a small one. The reason to write it down is not to change the decision but so that a woman who finds a bruise-like patch on an irradiated chest wall eight years later knows to have it looked at.
Showing the technology this term belongs to: Survivorship care and late-effects surveillance.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Screening survivors: where the UK, American and European answers differ and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Screening survivors: where the UK, American and European answers differ and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Screening survivors: where the UK, American and European answers differ and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Screening survivors: where the UK, American and European answers differ and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Screening survivors: where the UK, American and European answers differ, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Screening survivors: where the UK, American and European answers differ, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers.