I have been reading a lot of research articles lately, something that’s sure to increase as I begin an evidence-based practice internship and continue on with my studies. Lately, however, I have selected articles by choice that have piqued my interest.
The latest article was a population-based study on the risk of getting secondary cancers after being treated for breast cancer. The point of the study was to look at breast cancer patients who were later diagnosed with acute myeloid leukemia (AML).
The research study from 2009 looked at stage and age at diagnosis and originally included both males and females. They later removed males due to insufficient data. The authors of the study acknowledged that treatment for breast cancer does not only lead to increased risk for AML down the road, but also raises the risk for ovarian, breast, and uterine cancers. Though the authors didn’t acknowledge it in their text, they did include a table that also depicted an increased risk for bone and joint malignancy following treatment for breast cancer.
It is best understood that secondary uterine cancer is more likely due to the use of the popular breast cancer drug Tamoxifen. This risk is only increased in post-menopausal women taking Tamoxifen.¹
The study, however, did show that women who are younger at time of initial diagnosis and treatment for breast cancer are more likely to develop a secondary cancer, regardless of stage. This makes sense, because the younger a woamn is, the longer lifespan she has post-treatment. Most women in this study were diagnosed in Stage 1 rather than Stage 3. As might be expected, women diagnosed at Stage 3 were more likely to develop a secondary malignancy; something the authors attributed to more intensive treatment.
The authors of this study found that the period of latency between treatment for breast cancer and secondary diagnosis was about five years when looking at all ages. For younger women (those under 50 at initial diagnosis), the latency period was, unfortunately, only three years.
On a positive note, a diagnosis of, and treatment for, breast cancer was shown to give survivors a decreased risk of a later diagnosis of cervical cancer or CLL.
I found this article to be interesting because it helps us, as nurses, better educate our patients. Many women treated for breast cancer are treated and think they are “out of the woods” (so to speak) once treatment is complete. They also are most likely (based on what I’ve heard from patients) to be more cognizant of their own breast health (if they didn’t have a double mastectomy), but not so concerned about the risk of developing other cancers, especially not non-reproductive cancers.
We need to make sure we are educating them all, especially the younger survivors, about their increased risk for potentially developing AML due to the treatment they received. We also need to make sure we are educating post-menopausal patients about their increased risk for endometrial/uterine cancer. This is something the doctors should be discussing with their patients pre-chemotherapy.
However that time is often a blur to patients. They hear the word "cancer" and quickly move forward with treatment in an effort to achieve the best prognosis.
It is our role as nurses to make sure our patients understand all the risks associated with cancer treatment as well as the importance of continuing with follow-up appointments with their oncologists and family doctors post-treatment and into survivorship.
- Article/source: Martin, M., Welch, J., Luo, J., Ellis, M., Graubert, T., & Walter, M. (2009). Therapy related acute myeloid leukemia in breast cancer survivors, a population-based study. Breast Cancer Research And Treatment, 118(3), 593-598. doi:10.1007/s10549-009-0376-3