This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wolden, S. L. Articles by Hoppe, R. T. Search for Related Content PubMed PubMed Citation Articles by Wolden, S. L. Articles by Hoppe, R. T.

Management of Breast Cancer After Hodgkin’s Disease

From the Departments of Radiation Oncology, Medicine, and Surgery, Stanford University Medical Center, Stanford, CA.

Address reprint requests to Suzanne Wolden, MD, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email woldens{at}mskcc.org

PURPOSE: To evaluate the incidence, detection, pathology, management, and prognosis of breast cancer occurring after Hodgkin’s disease.

PATIENTS AND METHODS: Seventy-one cases of breast cancer in 65 survivors of Hodgkin’s disease were analyzed.

RESULTS: The median age at diagnosis was 24.6 years for Hodgkin’s disease and 42.6 years for breast cancer. The relative risk for invasive breast cancer after Hodgkin’s disease was 4.7 (95% confidence interval, 3.4 to 6.0) compared with an age-matched cohort. Cancers were detected by self-examination (63%), mammography (30%), and physician exam (7%). The histologic distribution paralleled that reported in the general population (85% ductal histology) as did other features (27% positive axillary lymph nodes, 63% positive estrogen receptors, and 25% family history). Although 87% of tumors were less than 4 cm, 95% were managed with mastectomy because of prior radiation. Two women underwent lumpectomy with breast irradiation. One of these patients developed tissue necrosis in the region of overlap with the prior mantle field. The incidence of bilateral breast cancer was 10%. Adjuvant systemic therapy was well tolerated; doxorubicin was used infrequently. Ten-year disease-specific survival was as follows: in-situ disease, 100%; stage I, 88%; stage II, 55%; stage III, 60%; and stage IV, zero.

CONCLUSION: The risk of breast cancer is increased after Hodgkin’s disease. Screening has been successful in detecting early-stage cancers. Pathologic features and prognosis are similar to that reported in the general population. Repeat irradiation of the breast can lead to tissue necrosis, and thus, mastectomy remains the standard of care in most cases.

Presented in part at the Thirty-Ninth Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Orlando, FL, October 21, 1997.

This article has been cited by other articles:

				L. Lee, M. Pintilie, D. C. Hodgson, P. E. Goss, and M. Crump Screening mammography for young women treated with supradiaphragmatic radiation for Hodgkin's lymphoma Ann. Onc., January 1, 2008; 19(1): 62 - 67. [Abstract] [Full Text] [PDF]

				K. Armstrong, E. Moye, S. Williams, J. A. Berlin, and E. E. Reynolds Screening Mammography in Women 40 to 49 Years of Age: A Systematic Review for the American College of Physicians Ann Intern Med, April 3, 2007; 146(7): 516 - 526. [Abstract] [Full Text] [PDF]

				J. D. Dickerman The Late Effects of Childhood Cancer Therapy Pediatrics, March 1, 2007; 119(3): 554 - 568. [Abstract] [Full Text] [PDF]

				M. Intra, C. Leonardi, A. Luini, P. Veronesi, R. Gennari, G. Gatti, M. Ciocca, J. Soteldo, F. Bassi, M. Venturino, et al. Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery: Broadening the Indications Arch Surg, October 1, 2005; 140(10): 936 - 939. [Abstract] [Full Text] [PDF]

				L. B. Kenney, Y. Yasui, P. D. Inskip, S. Hammond, J. P. Neglia, A. C. Mertens, A. T. Meadows, D. Friedman, L. L. Robison, and L. Diller Breast Cancer after Childhood Cancer: A Report from the Childhood Cancer Survivor Study Ann Intern Med, October 19, 2004; 141(8): 590 - 597. [Abstract] [Full Text] [PDF]

				K. C. Oeffinger and M. M. Hudson Long-term Complications Following Childhood and Adolescent Cancer: Foundations for Providing Risk-based Health Care for Survivors CA Cancer J Clin, July 1, 2004; 54(4): 208 - 236. [Abstract] [Full Text] [PDF]

				A. K. Ng, S. Li, D. Neuberg, B. Silver, J. Weeks, and P. Mauch Factors influencing treatment recommendations in early-stage Hodgkin's disease: a survey of physicians Ann. Onc., February 1, 2004; 15(2): 261 - 269. [Abstract] [Full Text] [PDF]

				L. B. Travis, D. A. Hill, G. M. Dores, M. Gospodarowicz, F. E. van Leeuwen, E. Holowaty, B. Glimelius, M. Andersson, T. Wiklund, C. F. Lynch, et al. Breast Cancer Following Radiotherapy and Chemotherapy Among Young Women With Hodgkin Disease JAMA, July 23, 2003; 290(4): 465 - 475. [Abstract] [Full Text] [PDF]

				A. K. Ng, M. V. P. Bernardo, E. Weller, K. Backstrand, B. Silver, K. C. Marcus, N. J. Tarbell, M. A. Stevenson, J. W. Friedberg, and P. M. Mauch Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors Blood, August 28, 2002; 100(6): 1989 - 1996. [Abstract] [Full Text] [PDF]

				L. Diller, C. M. Nancarrow, K. Shaffer, U. Matulonis, P. Mauch, D. Neuberg, N. J. Tarbell, H. Litman, and J. Garber Breast Cancer Screening in Women Previously Treated for Hodgkin's Disease: A Prospective Cohort Study J. Clin. Oncol., April 15, 2002; 20(8): 2085 - 2091. [Abstract] [Full Text] [PDF]

				D. C. Linch, R. G. Gosden, T. Tulandi, S.-L. Tan, and S. L. Hancock Hodgkin's Lymphoma: Choice of Therapy and Late Complications Hematology, January 1, 2000; 2000(1): 205 - 221. [Abstract] [Full Text] [PDF]