Breast Cancer After Childhood Cancer


Risk for breast cancer is higher for some survivors of childhood cancer than it is for people of the same age in the general population. Here's what you need to know to assess your risk and help prevent breast cancer.

Am I at Risk?

Research has shown that people who received radiation to the chest for cancer in childhood, adolescence, or young adulthood have a higher risk for breast cancer than people of the same age who never had radiation. Risk increases with higher doses of radiation.

Other factors, which apply to all women (not just those who had radiation to the chest), include:

  • getting your period before age 12 years,
  • starting menopause after age 55 years,
  • never having a baby or having a first baby after age 30 years,
  • having a close family member with breast cancer,
  • being overweight, and
  • not getting enough exercise.

Additional factors that might be linked with breast cancer include:

  • high-fat diets,
  • drinking too much alcohol,
  • never breastfeeding,
  • smoking,
  • using birth control pills, and
  • taking hormone therapy for long periods of time.

Risk for breast cancer begins to increase five to nine years after radiation and continues to rise thereafter. This means that survivors of childhood cancer who develop breast cancer do so at a much younger age (usually between 30 to 40 years old) than women who never received radiation (usually age 50 or older).

What If I Am at Risk for Breast Cancer?

Although most people who received radiation to the chest won't develop breast cancer, it's still important to monitor your breasts. That way, if a cancer occurs it is more likely to be found early when it's easiest to treat. There are also healthy choices that you can make to lower your risk.

Discuss Screening with Your Doctor 

Check your treatment records to find out how much radiation you received for childhood cancer. When calculating your radiation exposure, make sure to include any radiation from total body irradiation. It's also a good idea to arrange for your doctor to get a written summary of your cancer treatment (see related Health Link: "Long-Term Follow-Up after Childhood Cancer").

Follow these screening guidelines if you received radiation to the chest at doses of 20 Gy (3000 cGy/rads) or higher:

  • Perform monthly breast self-exams and report any lumps or changes to your doctor right away.
  • Have a clinical breast exam performed by your doctor at least once per year until age 25 years, then every 6 months thereafter.
  • Have a yearly mammogram and breast MRI starting at age 25 or 8 years after radiation (whichever comes last).
  • Share this information with your doctor and let him or her know that more information is available at www.survivorshipguidelines.org if he or she is not familiar with these recommendations.
  • If you received less than 20 Gy (3000 cGy/rads), or if you had total body irradiation, you might still be at risk, but the risk will be lower compared with those who received higher dose radiation. Talk with your doctor about timing for starting breast cancer screening.

Make Healthy Lifestyle Choices 

The following lifestyle changes may help lower risk for breast cancer. They will also help you stay as healthy as possible.

  • Eat five or more servings of many kinds of vegetables and fruits each day.
  • Get at least 30 minutes of moderate physical activity, such as brisk walking, on most days of the week.
  • If you are overweight, lose the extra weight.
  • Limit your alcohol intake to no more than one drink per day.
  • If you smoke, quit.
  • If you have a baby, try to breastfeed for at least four months.
  • If you need hormone therapy or use birth control pills, discuss the risks and benefits with your doctor.
  • Limit your exposure to potentially harmful chemicals and pesticides. Use protective equipment if you are exposed to chemicals in your workplace.

Be sure to talk with your doctor if you have questions about your risk for breast cancer and how to protect your health.

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