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July 4, 1977

Breast Cancer, Chemotherapy, and Second Malignant Neoplasms

JAMA. 1977;238(1):28-29. doi:10.1001/jama.1977.03280010028010

To the Editor.—  R. Bell et al recently reported in The Journal (236:1609, 1976) on two patients with multiple myeloma treated with melphalan in whom carcinoma of the breast developed 19 and 14 months later, respectively. In addition to melphalan, both patients received prednisolone and one also received procarbazine hydrochloride, well known for its carcinogenicity.1An editorial at that time (236:1612, 1976) called on the profession to assess the suppressive effect of melphalan on tumor growth in those patients who do not have multiple myeloma or some other condition that may impair immunocompetence.We are currently treating a 46-year-old woman who received busulfan (Myleran) intermittently for 5 1/2 years for idiopathic thrombocythemia; breast carcinoma developed in this patient last fall.We are also aware of five patients with breast carcinoma who received chemotherapy and in whom acute leukemia developed.2 Obversely, we found four other cases of breast cancer