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Age related risk of myelodysplastic syndrome and acute myeloid leukemia among breast cancer survivors

  • Epidemiology
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Abstract

Increased incidence of acute myeloid leukemia (AML) has been identified among breast cancer (BC) survivors but measurement has not included myelodysplastic syndrome (MDS). Our aim is to identify age and stage related MDS/AML incidence post BC diagnosis. We used the 2001–2009 Surveillance, Epidemiology, and end results (SEER) database to identify first primary stage I–III BC patients. Subsequent MDS or AML diagnosis was identified with observed rates compared to expected MDS/AML incidence in the general population. Age adjusted observed/expected rate ratios and 95 % confidence intervals (CI) were calculated. The unadjusted all age and stage MDS/AML incidence rate was .15 % (470/306,691) with a progressively higher rate by age (age 20–49 = .11, age 50–64 = .14, age 65+ =.21, and age 75+ =.18) and stage (stage I = .11, stage II = .18, and stage III = .22). Compared to the general population, BC patients had a 2.75-fold [95 % CI 2.51–3.00] increased relative risk of being diagnosed with MDS/AML. Young age survivors had highest relative risk [age 20–49: relative risk (RR) = 10.60 (95 % CI 8.57–12.93); age 50–64: 5.96 (95 % CI 5.13, 6.88); age 65–74 year-olds: 2.94 (95 % CI 2.45, 3.50); and age ≥75 year-olds: 1.28 (95 % CI 1.03, 1.56)]. Separately MDS relative risk was highest among young women [30.44 (95 % CI = 19.63, 44.62)]. MDS/AML relative risk increased from 1.87 to 5.66 for stage I–III. Conclusions: Myelodysplastic syndrome and acute myeloid leukemia relative risk is substantially elevated among breast cancer survivors especially those aged 20-49. While the actual number is small, MDS/AML is a serious disease. More research is needed to identify the treatments that put women at risk and find less leukemogenic options, especially for young women.

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Acknowledgments

The authors wish to acknowledge the invaluable assistance of Dr. Anneclaire De Roos, Drexel University School of Public Health. This study was supported by the Kaplan Cancer Research Fund, the National Institutes of Health Cancer Prevention Training Grant in Nutrition, Exercise, and Genetics (R25CA094880) at the University of Washington and Fred Hutchinson Cancer Research Center (G.S.C) and Fred Hutchinson Research Center institutional support (C.I.L).

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The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Swedish Cancer Institute, 1221 E. Madison St., Seattle, WA, 98104, USA

    Henry G. Kaplan

  2. HealthStat Consulting Inc., Seattle, WA, USA

    Judith A. Malmgren

  3. Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA

    Judith A. Malmgren, Christopher I. Li & Gregory S. Calip

  4. Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Christopher I. Li & Gregory S. Calip

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  1. Henry G. Kaplan
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Correspondence to Henry G. Kaplan.

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Kaplan, H.G., Malmgren, J.A., Li, C.I. et al. Age related risk of myelodysplastic syndrome and acute myeloid leukemia among breast cancer survivors. Breast Cancer Res Treat 142, 629–636 (2013). https://doi.org/10.1007/s10549-013-2773-x

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