Early breast cancer followed 19 years later by a radiation-related breast sarcoma

What happened, in summary

A 75-year-old woman had been diagnosed in 1998 with a 1.4 cm, node-negative stage IA cancer of the right breast containing both invasive ductal and lobular features. The tumor was strongly positive for estrogen and progesterone receptors.

Treatment included lumpectomy and axillary dissection, four cycles of doxorubicin and cyclophosphamide, and radiation to the breast. She received 50.4 Gy in 28 fractions followed by a 10 Gy boost to the lumpectomy cavity, for a total dose of 60.4 Gy. She then took tamoxifen for five years and continued routine screening mammography.

The breast carcinoma remained disease-free for 19 years. In the summer of 2017, she felt a new lump in the upper outer part of the same breast. Evaluation showed that this was not a recurrence of the original ductal and lobular carcinoma. It was an undifferentiated pleomorphic sarcoma arising in the previously irradiated breast, a separate malignancy associated with earlier radiation exposure.

The sarcoma was treated with wide local excision and further radiation, while chemotherapy for the sarcoma was discussed and declined. The later surgery and radiation were directed at the sarcoma rather than the original breast carcinoma. Her experience reflects a durable outcome from early breast carcinoma alongside the rare possibility of a different cancer developing many years after radiation.