The risk of developing acute non-lymphocytic leukemia in women with breast cancer

BACKGROUND: This study had the purpose of examining the incidences, risk factors, and survival outcome of developing subsequent acute non-lymphocytic leukemia (ANLL) among a large group of breast cancer survivors. METHODS: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) program for standardized incidence ratio (SIR), risk factors, and survival of subsequent ANLL, focusing on the period between 2000 and 2014. RESULTS: There was an increased SIR among breast cancer patients for subsequent ANLL (SIR: 2.41; 95% CI: 2.26–2.58). Risk factors of subsequent ANLL were age at first cancer diagnosis (40+ vs. 15–39 years, aHR =1.572, P=0.003), tumor size (21–50 vs. ≤20 mm, aHR =1.332, P=0.003; 50+ vs. ≤20 mm, aHR =1.735, P<0.001), chemotherapy exposure (yes vs. no, aHR =1.692, P<0.001), and radiation exposure (yes vs. no, aHR =1.232, P=0.002). Meanwhile, following subsequent ANLL, survivors had an adverse overall survival (OS) compared with patients who did not develop ANLL (aHR =3.359, P<0.001). CONCLUSIONS: Breast cancer survivors have a higher risk of developing subsequent ANLL compared to the general population. Increased vigilance should be shown towards the potential development of ANLL due to older age, larger tumor size, chemotherapy, and radiation exposure in survivors.