Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Travis, Lois B.; Hill, Deirdre A.; Dores, Graça M.; Gospodarowicz, Mary K.; Leeuwen, Flora E. van; Holowaty, Eric J.; Glimelius, Bengt; Andersson, Michael; Pukkala, Eero; Lynch, Charles F.; Pee, David; Smith, Susan A.; Veer, M. B. Van't; Joensuu, Timo; Storm, Hans H.; Stovall, Marilyn; Boice, John D.; Gilbert, Ethel S.; Gail, Mitchell H.

doi:10.1093/jnci/dji290

Cited by 378 publications

(243 citation statements)

References 40 publications

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“…2,4 Some of these females have received radiation and/or chemotherapy for a prior malignancy during childhood and are known to have an increased risk of developing a subsequent breast cancer. [5][6][7][8] These childhood cancer survivors are recommended to have regular breast cancer screening, with the frequency and modality of screening dependent on level of risk for the development of a subsequent cancer. 9 For female Hodgkin's lymphoma survivors, the cumulative risk of developing a breast cancer before age 50 is similar to that of BRCA mutation carriers, irrespective of the radiation dose received.…”

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confidence: 99%

Comparison of primary and secondary breast cancers in adolescents and young adults

Sadler

Goldfarb

2014

Cancer

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BACKGROUND: Breast cancer is one of the most common cancers in adolescent and young adult (AYA) patients (ages 15-39) and may develop de novo or in patients previously treated for cancer. This study compares the demographic, tumor, treatment characteristics, and overall survival (OS) of primary versus secondary (SMN) breast cancer in female AYAs. METHODS: All cases of invasive female AYA breast cancer in the 1998-2010 American College of Surgeons National Cancer Database were divided into 2 cohorts according to primary or secondary occurrence. Comparisons using appropriate statistical methods were performed. RESULTS: Of 106,771 patients, 6241 (5.8%) had experienced a prior, histologically distinct malignancy. Breast SMNs were more likely ER-/PR-(OR, 1.24; 95% CI, 1.15-1.34), <1 cm (OR, 1.86; 95% CI, 1.73-1.99) tumors and present at a lower T, N (OR, 1.43; 95% CI, 1.34-1.52), and summary stage but with more distant metastases (OR, 1.42; 95% CI, 1.21-1.67) compared with primary cancers. Adjusted by stage, SMN patients underwent more total mastectomies and received less chemotherapy, radiation, and hormonal therapy. However, SMN patients received definitive surgical treatment almost twice as fast compared with primary cancers (36.12 vs 67.26 days, P <.001). Patients with SMNs had a significantly decreased 3-year OS (79% vs 88.5%, P <.001), with SMN status an independent risk factor for increased mortality (HR, 1.58; 95% CI, 1.41-1.77). CONCLUSIONS: Nonprimary breast cancer in AYAs has different tumor characteristics, presents at a lower stage, and receives less adjuvant therapy than primary cancers. SMN status is an independent risk factor for decreased OS, with an almost 10% decrease at 3 years. Whether the outcome disparity results from previous cancer treatment or differences in biology, environment, or access to care needs further investigation. Cancer 2015;121:1295-302.

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confidence: 99%

Comparison of primary and secondary breast cancers in adolescents and young adults

Sadler

Goldfarb

2014

Cancer

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“…It has been known for more than 20 years that the use of radiation therapy was associated with significant rates of second cancers presenting 10 or more years after treatment completion. 25 However, in the era of chemotherapy with nitrogen mustard, vincristine (Oncovin ® ), prednisone and procarbazine (MOPP), chemotherapy was associated with a 5% risk of almost uniformly fatal acute leukemia that occurred within 5 years of treatment, and infertility. Radiation therapy was thus a better alternative.…”

Section: Issues Of Late Effectsmentioning

confidence: 99%

“…Newer studies of late effects characterized the risk further. [23][24][25][26][27][28] We now know that thoracic radiation in women treated under the age of 30 years results in a very high rate of breast cancer that approximates 30% at 30 years following treatment 25 but that this risk is much lower in women who received alkylating agent chemotherapy with no hormone replacement therapy. 27 We also know that heavy smokers after thoracic radiation for Hodgkin lymphoma have a 20 times higher risk of lung cancers while light or nonsmokers have a 7 times higher risk.…”

Section: Issues Of Late Effectsmentioning

confidence: 99%

The Management of Patients with Limited-Stage Classical Hodgkin Lymphoma

Gospodarowicz

Meyer

2006

Hematology

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The term limited-stage Hodgkin lymphoma refers to those patients with stage I-II disease and an absence of bulky disease. Among those patients with classical Hodgkin lymphoma, approximately one-third of patients will fall into this category. As long-term disease control can now be anticipated in more than 90% of these patients, management strategies must increasingly address the need to reduce the long-term treatment-related risks. Current treatment options include use of combined modality therapy that includes an abbreviated course of chemotherapy and involved-field radiation or treatment with chemotherapy, currently consisting of ABVD, as a single modality. The choice of treatment between these two options involves specific trade-offs that must balance issues of disease control against long-term risk of late effects.

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“…With current multimodality treatment, most patients achieve lifelong complete remission, but poor health status and second cancers remain serious late effects of treatment 5 , 6 . Female HL survivors are at high risk of radiation induced breast cancer, particularly those treated at a young age 7 , 8 . Lung cancer is one of the principal causes of death from second cancer following HL 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

Chen

Jin

Wang

et al. 2012

J Applied Clin Med Phys

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The purpose of this study is to apply noncoplanar intensity‐modulated radiation therapy (Nonco_IMRT) to young female patients with mediastinal lymphoma. Nonco_IMRT was evaluated through a planning comparison study with coplanar IMRT (Co_IMRT) and conventional anteroposterior and posteroanterior fields (AP–PA) plans. Co_IMRT was performed with five equally spaced beams starting from a gantry angle of 216°. Nonco_IMRT used two noncoplanar beams in the sagittal plane to replace the Co_IMRT beams that directly irradiated the breasts. Nineteen young female patients were enrolled in the retrospective study. Dose coverage of the planning target volume (PTV) and the dose delivered to organs at risk (OARs) were analyzed. For all patients, PTV coverage and heart V30 were similar between the two IMRT techniques (p < 0.05). Compared to Co_IMRT, the mean dose delivered and regions receiving a low radiation dose were significantly reduced for bilateral breasts and lungs in Nonco_IMRT (p < 0.05). Breast V5 and lung V5 were relatively reduced by 21% and 12%, respectively. Compared with the conventional AP–PA plan, Nonco_IMRT had better PTV coverage and OARs sparing, except for being larger in V5 to breast and lung. In IMRT for young female patients with mediastinal lymphoma, using of Nonco_IMRT significantly reduces the radiation dose to the breasts and lungs compared with Co_IMRT, and consequently reduces the risk of breast second cancer and pulmonary toxicity. Besides young female patients, Nonco_IMRT can also benefit other mediastinal lymphoma patients.PACS number: 87.55.D‐

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Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Cited by 378 publications

References 40 publications

Comparison of primary and secondary breast cancers in adolescents and young adults

Comparison of primary and secondary breast cancers in adolescents and young adults

The Management of Patients with Limited-Stage Classical Hodgkin Lymphoma

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

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