Summary
Lymphangiosarcoma of the upper extremity is a rare and aggressive tumour reported to occur following post-mastectomy lymphoedema (Stewart–Treves syndrome). Haemangiosarcoma, a related rare tumour, has occasionally been reported to occur in the breast following irradiation. We conducted a case-control study using the University of Southern California-Cancer Surveillance Program, the population-based cancer registry for Los Angeles County, to evaluate the relationship between invasive female breast cancer and subsequent upper extremity or chest lymphangiosarcoma and haemangiosarcoma together referred to as angiosarcoma. Cases were females diagnosed between 1972 and 1995 with angiosarcoma of the upper extremity (n = 20) or chest (n = 48) who were 25 years of age or older and residing in Los Angeles County when diagnosed. Other sarcomas at the same anatomic sites were also studied. Controls were females diagnosed with cancers other than sarcoma during the same time period (n = 266 444). Cases and controls were then compared with respect to history of a prior invasive epithelial breast cancer. A history of breast cancer increased the risk of upper extremity angiosarcoma by more than 59-fold (odds ratio [OR] = 59.3, 95% confidence interval [95% CI] = 21.9–152.8). A strong increase in risk after breast cancer was also observed for angiosarcoma of the chest and breast (OR = 11.6, 95% CI = 4.3–26.1) and for other sarcomas of the chest and breast (OR = 3.3, 95% CI = 1.1–1.7).
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References
Appelqvist, P, Salmo, M, Rissanen, P & Wiklund, T (1990). Response postmastectomy lymphangiosarcoma to radiotherapy: report of four cases. Stahlenther Onkol 166: 194–198.
Breslow, NE & Day, NE (1980). Statistical Methods in Cancer Research: Vol I – The Design and Analysis of Cohort Studies. IARC Scientific Publication No. 81, International Agency for Research on Cancer: Lyon.
d’Amore, ESG, Wick, MR, Geisinger, KR & Frizzera, G (1990). Primary malignant lymphoma arising in postmastectomy. Am J Surg Pathol 14: 456–463.
Ederer, F, Cutler, SJ, Goldenberg, IS & Eisenberg, H (1963). Causes of death among long-term survivors from breast cancer in Connecticut. J Natl Cancer Inst 30: 933–947.
Enzinger, FM & Weis, SW (1995). Vascular soft tissue tumors. In: Soft Tissue Tumors, Enzinger FW, Weis SW Mosby-Year Book: St Louis, 641–642.
Ewertz, M & Mouridsen, HT (1985). Second cancer following cancer of the female breast in Denmark, 1943–80. Natl Cancer Inst Mongr 68: 325–329.
Ferguson, DJ, Sutton, HG & Dawson, PJ (1984). Late effects of adjuvant radiotherapy for breast cancer. Cancer 54: 2319–2323.
Harvey, EB & Brinton, L (1985). A second cancer following cancer of the breast in Connecticut, 1935–82. Natl Cancer Inst Monogr 68: 99–112.
Janse, AJ, van Coevorden, F, Peterse, H, Keus, RB & van Dongen, JA (1995). Lymphedema-induced lymphangiosarcoma. Eur J Surg Oncol 21: 155–158.
Karpeh, MS, Jr, Caldwell, C, Gaynor, JJ, Hajdu, SI & Brennan, MF (1991). Vascular soft-tissue sarcomas: an analysis of tumor-related mortality. Arch Surg 126: 474–1481.
Kim, JH, Chu, FC, Woodard, HQ, Melamed, MR, Huvos, A & Cantlin, J (1978). Radiation-induced soft-tissue and bone sarcoma. Ther Radiol 4: 501–508.
Kuten, A, Sapir, D, Cohen, Y, Haim, N, Borovik, R & Robinson, E (1985). Post irradiation soft tissue sarcoma occurring in breast cancer patients: report of seven cases and results of combination chemotherapy. J Surg Oncol 28: 168–171.
Larson, D, Weinstein, M & Goldberg, I (1986). Edema of the arm as a function of the extent of axillary surgery in patients with stage 1 and 2 carcinoma of the breast treated with primary radiotherapy. Int J Rad Oncol Biol Phys 12: 877
Lowenstein, S (1906). Der atiologische Zusammenhand zwischen akutem einmaligem Trauma and Sarkom. Beitrage zur Klinsichen Chirurgie 48: 780–824.
Mack, TM (1977). Population-based cancer surveillance in Los Angeles County. J Natl Cancer Inst 47: 99–101.
Mack, TM (1995). Sarcomas and other malignancies of soft tissue, retroperitoneum, peritoneum, pleura, heart, mediastinum and spleen. Cancer 75: 211–245.
Maddox, JC & Evans, HL (1981). Angiosarcoma of skin and soft tissue: a study of forty-four cases. Cancer 48: 1907–1921.
Malkin, D, Li, FP, Strong, LC, Fraumeni, JF Jr, Nelson, CE, Kim, DH, Kassel, J, Gryka, MA, Bischoff, FZ, Tainsky, MA & Friend, SH (1990). Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas and other neoplasms. Science 250: 1233–1238.
Mark, RJ, Poen, J, Luu, MT, Yao, SF, Selch, MT & Parker, RG (1994). Postirradiation sarcomas: a single-institution study and review of the literature. Cancer 73: 2653–2662.
McClanahan, BJ & Hogg, L (1954). Angiosarcoma of the breast. Cancer 7: 586–594.
Percy, C, Van Holten, V & Muir, C (eds) (1991). International Classification of Diseases for Oncology. World Health Organization: Geneva.
Rubin, E, Maddox, WA & Mazur, MT (1990). Cutaneous angiosarcoma of the breast 7 years after lumpectomy and radiation therapy. Radiology 174: 258–260.
Sanchez, RB, Quinn, SF, Walling, A, Estrada, J & White, V (1989). Case report 569. Skeletal Radiol 18: 485–487.
Schottenfeld, D & Berg, J (1971). Incidence of multiple primary cancers. IV. Cancers of the female breast and genital organs. J Natl Cancer Inst 46: 161–170.
Senyszyn, JJ, Johnston, AD, Jacox, HW & Chu, FCH (1970). Radiation-induced sarcoma after treatment of breast cancer. Cancer 26: 394–403.
Somasundaram, K, Zhang, H, Zeng, YX, Houvras, Y, Peng, Y, Zhang, H, Wu, GS, Licht, JD, Weber, BL & El-Deiry, WS (1997). Arrest of the cell cycle by the tumour-suppressor BRCA1 requires the CDK-inhibitor p21WAF1/Cip1. Nature 389: 187–190.
Souba, WW, McKenna, RJ, Meis, J, Benjamin, R, Raymond, AK & Mountain, CF (1986). Radiation-induced sarcomas of the chest wall. Cancer 57: 610–615.
Steingaszner, L, Enzinger, FM & Taylor, HB (1965). Hemangiosarcoma of the breast. Cancer 18: 352–361.
Stewart, FW & Treves, N (1948). Lymphangiosarcoma in postmastectomy lymphedema: a report of six cases in elephantiasis chirurgica. Cancer 1: 64–81.
Taghian, A, de Vathaire, F, Terrier, P, Le, M, Auquier, A, Mouriesse, H, Grimaud, E, Sarrazin, D & Tubiana, M (1991). Long-term risk of sarcoma following radiation treatment for breast cancer. Int J Rad Oncol Biol Phys 21: 361–367.
Wiklund, TA, Blomqvist, CP, Raty, J, Elomaa, I, Rissanen, P & Miettinen, M (1991). Postirradiation sarcoma: analysis of nationwide cancer registry material. Cancer 68: 524–531.
Woodward, AH, Ivins, JC & Soule, EH (1972). Lymphangiosarcoma arising in chronic lymphedematous extremities. Cancer 30: 562–572.
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Correspondence to: W Cozen
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Cozen, W., Bernstein, L., Wang, F. et al. The risk of angiosarcoma following primary breast cancer. Br J Cancer 81, 532–536 (1999). https://doi.org/10.1038/sj.bjc.6690726
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DOI: https://doi.org/10.1038/sj.bjc.6690726
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