BREAST CANCER AND MDS RISK 

Correlation Between Breast Cancer Stage and AML

Medscape: What were your findings?

Dr. Kaplan: In the SEER database study,^[3] the findings -- as far as correlation with treatment -- conform to the hypothesis. In patients in later-stage disease who get more chemotherapy and radiation, there is certainly an increased risk for MDS, as well as acute leukemia.

The other thing that was quite interesting to us and is contrary to some of what we have seen in the literature is that when we broke it down by age, in every subcategory that we looked at, the younger patients had an increased risk for both AML and MDS. This is significant, because that is the group of patients whom we hope will have the longest survival after treatment, and there is actually quite a dramatic correlation of younger age with increased risk for bone marrow problems.

Dr. Malmgren: We found a significantly increased risk for AML and MDS, especially in women aged 20-49 years, and that the rate of MDS was 30 times what you would find in the regular population. We were surprised that it was that high, so when we broke it down, the AML risk is what everybody else has found, but because SEER added the MDS code in 2001 and we have 2001-2009 data, we were able to find out more about the age of people who are the most at risk. Women aged 75 years or older have very little increased risk, and those aged 65-74 years somewhat increased risk, but the 20- to 49-year-old women are most at risk. Those are the people that even at stage I, II, or III have to get adjuvant chemotherapy if they are going to survive.

Medscape: Any final comment?

Dr. Kaplan: The key thing is that with the whole push for genomic analysis of individual patients, we need to find a better way to individualize treatment for patients. With such tests as Oncotype DX® (Genomic Health, Redwood City, California), it would be nice to be able to select only the patients who absolutely need leukemogenic chemotherapy and eliminate chemotherapy for the people who don't need it. This fits right into personalized medicine. You only want to treat the patients whom you have to.