Second primary breast cancer after Hodgkin's disease

Abstract

Although the potential carcinogenic risk of radiotherapy is well known, it has become clear that there is a particularly high risk of radiation-induced breast cancer in women treated for Hodgkin's disease at young ages. Thankfully, death from breast cancer in this population is uncommon, but it is important to understand factors contributing to the risk, including treatment parameters, and to develop a logical and efficient method for medical management of those at risk. In this minireview, we examine the evidence which should inform such a management policy. The prognosis of patients with Hodgkin's disease has been improved dramatically over the last 40 years by the development of extended field radiotherapy techniques and then by combination chemotherapy (DeVita et al, 1980;Rosenberg and Kaplan, 1985). However, long-term follow-up of survivors has demonstrated that a price of this success has been an increased risk of second cancers. Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy. This effect of age is unsurprising, as similar gradients are seen in other cohorts of radiation-exposed women (United Nations Scientific Committee on the Effects of Atomic Radiation, 1994).The size of risk of breast cancer found in Hodgkin's disease patients has varied between studies. For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at...

Breast cancer occurred after Hodgkin's disease: Clinico-pathological features, treatments and outcome: Analysis of 214 cases

“…Breast cancer (BC) is the most frequent ST occurring in women treated for HD [8][9][10][11][12][13][14][15][16][17]. The "latency interval" is quite long, i.e.…”

High incidence of late effects found in Hodgkin's lymphoma survivors, following recall for breast cancer screening

“…Current treatment usually involves multiagent chemotherapy combined with limited field radiotherapy in selected patients. However, until recently, the standard radiotherapy regimen for supradiaphragmatic HL was the mantle field (Deniz et al, 2003;Horwich and Swerdlow, 2004).Young women who received mantle radiotherapy are at increased risk of breast cancer (Swerdlow et al, 2000;Deniz et al, 2003;Travis et al, 2003;Horwich and Swerdlow, 2004;Kenney et al, 2004). The risk is proportional to radiation dose, and time from treatment (Hancock et al, 1993a;Wolden et al, 1998).…”

“…Young women who received mantle radiotherapy are at increased risk of breast cancer (Swerdlow et al, 2000;Deniz et al, 2003;Travis et al, 2003;Horwich and Swerdlow, 2004;Kenney et al, 2004). The risk is proportional to radiation dose, and time from treatment (Hancock et al, 1993a;Wolden et al, 1998).…”

“…Younger age at the time of treatment gives the greatest risk (Hancock et al, 1993a;Bhatia et al, 1996). At 25 years of follow-up, the cumulative risk of breast cancer for women treated between 10 and 19 years of age is reported as 15 -33%, and for those treated between the ages 20 and 29 years, 15 -25% (Horwich and Swerdlow, 2004). In 2003, the UK Department of Health launched a 'Patient Notification Exercise' to inform patients of the increased breast cancer risk.…”

“…Current treatment usually involves multiagent chemotherapy combined with limited field radiotherapy in selected patients. However, until recently, the standard radiotherapy regimen for supradiaphragmatic HL was the mantle field (Deniz et al, 2003;Horwich and Swerdlow, 2004).…”