Abstract P5-11-02: Breast Cancer Radiation Therapy and the Risk of Developing Bronchiolitis Obliterans Organizing Pneumonia (BOOP): Communication of BOOP Risk by Breast Cancer Information Websites and General Medical Information Websites
Authors: Kelly EM 
Published: August 2014

Background: BOOP is an inflammatory pulmonary disorder consisting of organized polypoid granulation tissue in the distal airways extending into the alveolar ducts and alveoli. Clinical manifestations of BOOP include fever, cough, dyspnea on exertion, and fatigue. Patients with severe BOOP require hospitalization. The mainstay of BOOP treatment is high dose corticosteroids. Many patients relapse and require long term corticosteroids, often in combination with another immunosuppressant. Significant morbidity and disability may be associated with both the diagnosis of BOOP and the toxicities of treatment. The mortality rate of BOOP has been estimated to be about 5%.

Radiation Therapy (RT) is an important component in the treatment of breast cancer (Breast Ca). Beginning in 1995, reports of BOOP occurring in Breast Ca RT patients began to appear in the medical literature. From 1995 to the present, 43 case study reports described 121 Breast Ca RT patients who developed BOOP within one year of their RT. From 1999 to 2011, seven epidemiological studies were published that suggested that the incidence of BOOP in Breast Ca RT patients was in the range of 2% to 3%.

Objectives: The primary objective of this study was to determine if internet sources of Breast Ca information targeted to Breast Ca patients include BOOP information in their description of RT risks. The secondary objective was to determine if general medical websites conveyed BOOP/Breast Ca RT risk information.

Methods: Eight websites specifically targeted to Breast Ca patients were reviewed. Sponsors of these websites included the US government, Breast Ca advocacy groups, and medical organizations. Seven general medical websites that contained BOOP/Breast Ca RT information were also reviewed.

Results: There was no mention of BOOP in any of the websites targeted to Breast Ca patients. The websites included those from the National Cancer Institute, American Cancer Society, American Society of Therapeutic Radiology and Oncology, Susan G. Komen, and BreastCancer.org. The internet search identified seven general medical websites that did include information about the risk of BOOP from Breast Ca RT.

Discussion: It is perplexing that none of the eight website sources for Breast Ca patients included any mention of the risk of BOOP associated with Breast Ca RT, whereas seven general medical internet sources did disclose this information. This disparity raises important issues and questions. The majority of BOOP/Breast Ca RT reports were published in pulmonology journals. Is this information being disseminated to providers of Breast Ca treatment? Many of the Breast Ca information websites stated that their information was up to date and was reviewed by leading Breast Ca physicians, so it remains an enigma that the BOOP/RT association was not disclosed. The lack of any information about BOOP and Breast Ca RT may indicate Breast Ca physician unawareness. An alternative explanation for this finding may be that these physicans are aware of the BOOP/RT association, but they believe that the rarity of BOOP diagnoses justifies omitting this information in internet-based information sources.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-11-02.