Management of breast cancer after Hodgkin's disease

Purpose: To evaluate the incidence, detection, pathology, management, and p rognosis 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 a nd 42.6 years for breast cancer, The relative risk for inversive breast can cer after Hodgkin's disease wets 4.7 (95% confidence interval, 3.4 to 6.0) compared with an age-matched cohort. Cancers were detected by self-examinat ion (63%), mammography (30%), and physician exam (7%), The histologic distr ibution paralleled that reported in the general population (85% ductal hist ology) as did other features (27% positive axillary lymph nodes, 63% positi ve estrogen receptors, and 25% family history). Although 87% of tumors were less than 4 cm, 95% were managed with mastectomy because of prior radiatio n. Two women underwent lumpectomy with breast irradiation. One of these pat ients developed tissue necrosis in the region of overlap with the prior man tle field. The incidence of bilateral breast cancer was 10%. Adjuvant syste mic therapy was well tolerated; doxorubicin was used infrequently. Ten-year disease-specific survival was as follows: in-situ disease, 100%; stage 1, 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 populat ion. Repeat irradiation of the breast can lead to tissue necrosis, and thus , mastectomy remains the standard of care in mast cases. (C) 2000 by Americ an Society of Clinical Oncology.