Reply to Wilms tumor and breast cancer.

Abstract

We thank Drs. Lehrer and Rosenzweig for their insightful comments and opportunity to expand on our discussion regarding breast cancer in survivors of Wilms tumor.1 We acknowledge that the development of breast cancer in men was not specifically addressed in our comments. To our knowledge, breast cancer in male survivors of Wilms tumor or other pediatric cancers has not been reported. Reports from the Childhood Cancer Survivor Study on breast cancer as a second malignant neoplasm have focused exclusively on female survivors, making it difficult to ascertain whether male survivors were affected.2, 3 According to the Surveillance, Epidemiology, and End Results program, breast cancer in the general population occurs in 1.44 per 100,000 men, compared with 129.56 per 100,000 women.4 If radiotherapy increases the relative risk of secondary breast cancer by a multiple of the risk in the general population, one would expect that the incidence of secondary breast cancer in male cancer survivors would be substantially lower than in female cancer survivors, but not nonexistent. The pediatric cancer survivorship cohorts may not be sufficiently large to detect breast cancer in male survivors. Another consideration is that the peak age of male breast cancer is 71 years.4 The late onset may contribute to the lack of cases in childhood cancer survivors because the current cohorts may not have aged sufficiently. It appears prudent that clinicians who care for cancer survivors be aware of a potential risk of breast cancer in men who received chest radiotherapy. Because male breast cancer typically presents as a palpable lump,5 it should usually be readily detectable on physical examination without the use of surveillance imaging. Although the risk of male breast cancer after radiotherapy is very low, we caution against concluding that radiotherapy is safe for boys and young men. We hope that continued longitudinal studies will address the development of breast cancer in men and women so that we can continue to provide our patients and their providers with the most up-to-date surveillance guidelines. No specific funding was disclosed. The authors made no disclosures. Jennifer B. Dean, MDJeffrey S. Dome, MD, PhD Division of Oncology Children's National Health System Washington, DC