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  • Open Access

PB.17. Are patients who have had total body irradiation at similar risk of breast cancer to those having mantle radiotherapy? A review of the evidence and suggestions on breast imaging surveillance

  • 1, 2 and
  • 1
Breast Cancer Research201416 (Suppl 1) :P45

  • Published:


  • Breast Cancer
  • Radiation Dose
  • Breast Cancer Risk
  • Bone Marrow Transplant
  • Marrow Transplant


There are an increasing number of total body irradiation (TBI) survivors. UK haematology and oncology units follow international guidelines and advise that they should have annual mammography from age 40.


A literature review found a single large study published in Blood in 2008 based on 3,337 women from 83 centres, who had survived at least 5 years after transplant [1]. The radiation dose was 8 to 16 Grey distributed homogeneously rather than to the mediastinum in mantle radiotherapy. Fifty-two women developed breast cancer at a median of 12.5 years after transplantation, and 47 of these had TBI as well as bone marrow transplant. Their breast cancer incidence was compared with the standardised incidence.


The study found that: overall breast cancer risk was moderately increased, by 2.2 (95% CI = 1.7 to 2.9); risk was concentrated in younger patients, those treated in their teens and twenties; and the standardised incidence of those presenting after 20 years was also 10-fold that expected.


There are similarities between the risks of TBI and mantle radiotherapy, cancers occurring if irradiated when young and cumulative risk increasing disproportionately with length of follow up. More work needs to be done comparing the radiation dose to the breast and relative breast cancer risk of TBI and mantle radiotherapy. If this shows that the dose and risk are similar, then TBI patients are most likely to benefit from similar breast imaging follow up.

Authors’ Affiliations

Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
Mater Dei Hospital, Msida, Malta


  1. Freidman DL, Rovo A, et al: Increased risk of breast cancer among survivors of allogenic hemopoetic cell transplantation. Blood. 2008, 11: P939-P944.View ArticleGoogle Scholar


© Muscat and Rubin; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.