How does radiation therapy affect the risk of second cancers?

Radiation therapy was recognized as a potential cause of cancer many years ago. In fact, much of what we know about the possible health effects of radiation therapy has come from studying survivors of atomic bomb blasts in Japan. We also have learned from workers in certain jobs that included radiation exposure, and patients treated with radiation therapy for cancer and other diseases.

How does radiation affect the risk of leukemia and myelodysplastic syndrome?

Most kinds of leukemia, including acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), and acute lymphoblastic leukemia (ALL) can be caused by past radiation exposure. Myelodysplastic syndrome (MDS), a bone marrow cancer that can turn into acute leukemia, has also been linked to past radiation exposure. The risk of these diseases after radiation treatment depends on a number of factors such as:

  • How much of the bone marrow was exposed to radiation
  • The amount of radiation that reached the bone marrow
  • The radiation dose rate (how much was given in each dose, how long it took to give the dose, and how often it was given)

The person's age when they were treated with radiation does not seem to be a risk factor. Most often, these cancers develop within several years of radiation treatment, peaking at 5 to 9 years after exposure. Then the number of new cancers slowly declines over the following years.

How does radiation affect the risk of solid tumors?

In contrast, other cancers, which are mostly solid tumors, have been shown to take much longer to develop. Most of these cancers are not seen for at least 10 years after radiation therapy, and some are diagnosed even more than 15 years later. The effect of radiation on the risk of developing a solid tumor cancer depends on such factors as:

  • The dose of radiation
  • The area treated
  • The age of the patient when they were treated with radiation

In general, the risk of developing a solid tumor after radiation treatment goes up as the dose of radiation increases. Some cancers require larger doses of radiation than others, and certain treatment techniques use more radiation.

The area treated is also important, since these cancers tend to develop in or near the area that was treated with radiation. Certain organs, such as the breast and thyroid, seem to be more likely to develop cancers after radiation than others.

Age at the time of treatment also affects the risk of solid tumors. For example, the risk of developing breast cancer after radiation is higher in those who were treated when they were young compared with those given radiation as adults. The chance of developing breast cancer after radiation seems to be highest in those exposed as children. Risk decreases as the age at the time of radiation increases, with little or no increase in breast cancer risk among women who had radiation after the age of 40. Age at the time of radiation treatment has a similar effect on the development of other solid tumors, including lung cancer, thyroid cancer, bone sarcoma, and gastrointestinal or stomach cancers.

Other factors can also affect the risk of radiation-related cancers. Smoking, for example, increases the risk of lung cancer after radiation even more. Early menopause, which can be caused by chemotherapy, can lower the risk of radiation-related breast cancer. For some cancers though, the risk is higher if chemotherapy was given along with radiation.

Future research will look at how genetics and radiation therapy interact, as well as the link between radiation therapy and other cancer-causing agents.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 11, 2014 Last Revised: December 11, 2014

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