INCREASED RISK OF BREAST-CANCER IN SPLENECTOMIZED PATIENTS UNDERGOINGRADIATION-THERAPY FOR HODGKINS-DISEASE

Purpose: Second malignancies have been reported among patients who wer e treated by radiation therapy or chemotherapy alone or in combination . Studies have implied an increased risk of breast cancer in women who received radiotherapy as part of their treatment for Hodgkin's diseas e. This review was performed to determine if there is an association b etween splenectomy and subsequent breast cancer, Methods and Materials : One hundred and thirty-six female patients with histologically prove n Hodgkin's disease were seen in the Division of Radiation Oncology be tween 1962 and 1985, All patients received mantle or mediastinal irrad iation as part of their therapy, The risk of breast cancer was assesse d and multiple linear regression analysis was performed on the followi ng variables: patient age, stage, dose and extent of radiation field, time after completing radiation therapy, splenectomy, and chemotherapy , Results: Breast cancer was observed in 11 of 74 splenectomized patie nts and in none of 62 patients not splenectomized, The mean follow-up was 13 years in splenectomized patients and 16 gears, 7 months in nons plenectomized patients, Nine patients developed invasive breast cancer and two developed ductal carcinoma irt situ., Splenectomy was the onl y variable independently associated with an increased risk of breast c ancer (p < 0.005) in multiple linear regression analysis; age, latency , and splenectomy considered together were also associated with an inc reased risk of breast cancer (p < 0.01). Conclusion: Our data show an increased risk of breast cancer in splenectomized patients who had tre atment for Hodgkin's disease, A multiinstitutional survey may better d efine the influence of splenectomy relative to developing breast cance r in patients treated for Hodgkin's disease, The risk of breast cancer should be considered when recommending staging laparotomy, and we rec ommend close follow-up examination including routine mammograms for fe male patients successfully treated for Hodgkin's disease. (C) 1997 Els evier Science Inc.