Friday, September 9

Future cancer risk is increased by radiation therapy.

You Need to Know That Radiation Therapy Elevates Risks for Future Cancers.

Although the risk is low, you should discuss it with your doctor.

Radiation is a standard treatment for localised prostate cancer, which refers to prostate cancer that is confined to the prostate gland. The long-term results for the majority of men treated in this manner are favourable. Radiation, like other cancer treatments, carries certain risks, including the potential for secondary cancers to develop in the body in the future.

Secondary cancers are characterised by meeting specific criteria:

They differ from the initial cancer a patient was treated for.

they are found in the irradiated area

They were not present prior to the start of radiation treatment

They manifest at least four years after the completion of treatment.

Historical evidence indicates that secondary cancers are uncommon. This conclusion has now been updated by a sizable study of men who received radiation therapy using modern radiation delivery methods.

Study findings and data

Between 2000 and 2015, researchers analysed data from 143,886 men treated for localised prostate cancer at Veterans Affairs medical facilities. The men ranged in age from 60 to 71 and were of various racial and ethnic backgrounds. 52,886 of them received radiation therapy within a year of their diagnosis. The remaining 91,000 men either opted for surgery over a comparable period of time or chose to have their cancers monitored and treated only when — or if — routine exams revealed progression.

After a median of nine years of follow-up, 3% of the men who were treated with radiation developed secondary cancers, compared to 2.5% of the men who chose other treatment options. In order of frequency of detection, the four most prevalent cancers were bladder cancer, leukaemia, lymphoma, and rectal cancer. The risk of developing these secondary cancers steadily increased over time, reaching a maximum five to six years after radiation therapy was completed.

Dr. Oliver Sartor, an oncologist at Tulane University School of Medicine in New Orleans who was not involved in the study, says men should discuss the possibility of secondary cancers with their physicians when evaluating treatment options.

Weighing risk

Unfortunately, doctors have limited ability to predict which men who have received radiation therapy are at the highest risk for secondary cancers. Dr. Sartor explains that because smoking is a major risk factor for bladder cancer, men who smoke while undergoing radiation have yet another reason to quit. Men with inherited Lynch syndrome (a type of colorectal cancer) risk are also at increased radiation risk. Gene mutations in these men make it more difficult for their cells to repair DNA damage.

Noting that Dr. Sartor makes excellent and actionable points, Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor of the Harvard Health Publishing Annual Report on Prostate Diseases, concurs that patients considering radiation should be informed that the treatment carries a small but real lifetime risk of secondary cancers, especially of the rectum and bladder, which can appear years after the initial diagnosis.

Dr. Garnick is hesitant to recommend radiation therapy for men with a history of inflammatory bowel diseases, such as ulcerative colitis, who also have an increased risk of developing abdominal cancers. In addition, he advises older men who have received radiation therapy for prostate cancer to consult their physicians before discontinuing routine colorectal screening.

Pexel photo
Harvard health
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