Case-control studycited by the Tayebat archiveabstract only checked★ key study A-CHM-06 in-depth review

Chest radiation for Hodgkin disease raises later breast-cancer risk in young women

Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease.

Overview

Travis LB et al.. JAMA 2003 · PMID 12876089 · DOI 10.1001/jama.290.4.465

Risk was about 3 times higher with >=4 Gy and 8 times higher with >40 Gy to the breast.

Does the study support the specific claim? Yes · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Quantify radiation-related breast cancer.
How was the study done?: Nested case-control.
How many people, animals or samples were studied?: 105 cases, 266 controls.
What was actually found?: Dose-dependent RR 3.2-8.0.
How large was the observed effect?: RR 8.0 above 40 Gy.
What do the results mean in everyday life?: Women treated with chest radiation young need breast screening.
What are the study's limitations?: Old techniques, wide CIs.
What does it say about Elawady's specific claim?: Supports existence of second cancers.
Do the results apply to Germany and Europe?: Moderate.
What can explicitly not be concluded from this study?: That Hodgkin treatment does net harm.

Authors: Travis LB, Hill DA, Dores GM, Gospodarowicz M, van Leeuwen FE, Holowaty E, Glimelius B, Andersson M, Wiklund T, Lynch CF, Van't Veer MB, Glimelius I, Storm H, Pukkala E, Stovall M, Curtis R, Boice JD, Gilbert E
Journal: JAMA
Year: 2003
Identifier: PMID 12876089 DOI 10.1001/jama.290.4.465
Verification: verified – PubMed E-utilities efetch, 2026-10-25
Retracted: no
Corrections: PubMed lists: ErratumIn (JAMA. 2003 Sep 10;290(10):1318)
Extent checked: abstract only
Conflicts of interest and funding: not stated in abstract | Grants: NCI NIH HHS

Dose-response of breast-cancer risk after radiotherapy and chemotherapy for Hodgkin disease in young women.

Study design: Case-control study – Matched case-control study nested in a cohort of female Hodgkin disease survivors
Population: 3,817 female 1-year survivors of HD diagnosed at age <=30 years, 1965-1994
Country: 6 population-based registries (North America/Europe; countries not listed in abstract)
Period: 1965-1994 diagnoses; study 1996-1998
Sample size: 105 cases, 266 matched controls
Inclusion and exclusion criteria: Female HD survivors <=30 years at diagnosis

Exposure / intervention: Radiation dose to breast site; ovarian dose; alkylating agents
Comparator: <4 Gy and no alkylating agents
Endpoints: Breast cancer
Statistical methods: Conditional logistic regression; RR with 95% CI

Results: >=4 Gy to breast: RR 3.2 (95% CI 1.4-8.2); >40 Gy: RR 8.0 (2.6-26.4), P<.001 for trend. Risk persisted >=25 years. Alkylating agents alone RR 0.6 (0.2-2.0); ovarian dose >=5 Gy RR 0.4 (0.1-1.1).
Absolute risks: not reported in abstract
Authors' conclusion: Radiation-related breast cancer risk is high and persistent; hormonal stimulation matters; lifetime surveillance needed.

Orienting tool: ROBINS-E
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: low
Rationale: Nested design with individual dosimetry; main limitation is imprecision.

Clear dose-response; wide confidence intervals; relative risks only.

Supports radiation-induced second breast cancer.

A-CHM-07: in adults only about 8% of second cancers after radiotherapy are attributable to it.

Moderate (historical treatment).

Correctly cited key study on second cancers.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	low
Precision of results	low
Directness	direct
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	correctly reported

Risk with modern reduced fields.

Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.

What the archive says about the study: Travis 2003 JAMA: >=4 Gy to breast raised secondary breast-cancer risk 3.2-fold, rising to 8-fold above 40 Gy.
A. What was actually studied?: Breast cancer after HD treatment.
B. What did the authors find?: Dose-dependent RR 3.2 to 8.0.
C. What conclusions do the authors themselves draw?: Lifetime surveillance of exposed women.
D. What does the archive derive from it?: Second cancers years after cure.
E. Is this derivation scientifically justified?: Correct. Note that these women were cured of Hodgkin disease and that treatment fields and doses have since been reduced.
Adequacy of the interpretation (by the archive): correctly reported