HIGH-RISK OF BREAST-CARCINOMA AFTER IRRADIATION OF YOUNG-WOMEN WITH HODGKINS-DISEASE

BACKGROUND. Treatment-associated second neoplasms have emerged as a ma jor threat to the continued survival of patients cured of Hodgkin's di sease. In this study, the authors investigated the risk of breast carc inoma in an irradiated Hodgkin's disease population. METHODS. One hund red and eleven women younger than 60 years presenting between 1964 and 1984 with Stage I and II Hodgkin's disease who received mantle irradi ation were retrospectively analyzed and compared with an age specific population. Median follow-up was 18 years (range, 10-30 years), and th e median age at initiation of therapy was 24 years. Kaplan-Meier actua rial risks, relative risks (RRs) (the ratio of the observed to the exp ected cases) with 95% confidence intervals (CIs), and the log rank tes t for trends were calculated. RESULTS. Fourteen women developed breast carcinoma: 8 of 33 patients younger than 20 pears at the time of irra diation, 5 of 48 patients age 20 to 29 years, and 1 of 30 patients age 30 years or older. Actuarial calculation predicted a 34.0% (CI, 14.2- 53.8) risk of breast carcinoma at 25 years after therapy for the young est group, 22.3% (CI, 4.1-40.5) for the group of intermediate age, and 3.5% (CI, 0-10.1) for the oldest group. The RR of breast carcinoma wa s 56 (CI, 23.3-107) for those 19 years or younger at the time of treat ment, 7.0 (CI, 2.3-16.4) for those age 20-29 years, and 0.9 (CI, 0-5.3 ) for those 30 years and older. Excluding 1 patient who was age 38 yea rs at the time of irradiation, the remaining 13 breast carcinomas were tightly clustered in women irradiated between the ages of 14 through 25, and were detected in years 11 through 25 after treatment, with 7 o ccurring in years 15 through 18. CONCLUSIONS. Women younger than 30 ye ars, particularly those younger than 20 years, who have received mantl e irradiation for Hodgkin's disease require meticulous follow-up for b reast carcinoma. The high incidence of breast carcinoma in this patien t population should be considered when making treatment decisions in y oung women with early stage Hodgkin's disease. (C) 1997 American Cance r Society.