Breast Cancer Following Multiple Fluoroscopies

THE role of ionizing radiation as a cause of carcinogenesis has long been recognized and it is now generally accepted that in man it may cause leukaemias (of the M series), carcinoma of the skin, lung and thyroid, and sarcoma of bone. More recently Smith (1962) has drawn attention to its possible role in some cases of carcinoma of the rectum following irradiation for carcinoma of the cervix but it has not hitherto been implicated clinically in malignant disease of other organs. The following facts are presented to substantiate the possibility that, in certain circumstances, it may play a part in the development of mammary carcinoma. Attention was first drawn to this possibility some 3 years ago, when a patient presented with a rapidly growing tumour in the upper inner quadrant of the right breast. It was observed that the skin over the right chest wall, breast and sternal region showed very marked radiation dermatitis (Fig. 1) and on questioning her it transpired that, some 14-15 years previously, she had had pulmonary tuberculosis and had been treated with bilateral artificial pneumothorax therapy over a period of 46 months, during which time she had been fluoroscoped repeatedly, this being done each time she had had the pneumothoraces refilled. She stated that the dermatitis dated from this period and reference to her sanatorium records revealed that she had had a minimum of 200 fluoroscopies spread over the 46 month period. The radiation reaction present suggested that in this time she had received at least 4000 roentgens. Following this, other cases of breast carcinoma who had previously been treated for pulmonary tuberculosis in a sanatorium or at a tuberculosis clinic were looked for, these being sought among the old cases of mammary cancer who returned to the Tumour Clinic periodically for review, and also among the new cases who appeared at the Clinic for the first time. Each patient who fulfilled the conditions was interviewed and questioned about her past history of pulmonary tuberculosis; subsequently details of her records with regard to both pulmonary and breast diseases were obtained, the former from the sanatorium and tuberculosis clinics which she had attended and the latter from the Tumour Clinic records. In addition a number of other cases were brought to our attention by colleagues, and the records of a few cases who had died before the start of the enquiry were discovered in the Tumour Clinic files. In all cases every effort was made to obtain full details of the duration and type of treatment from the various sanatoria and tuberculosis clinics at which they had been patients, and of the clinical and pathological reports of the breast condition. Only those who had an