Breast cancer occurred after treatment for Hodgkin's disease: analysis of 133 cases

Purpose: To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therap ies and prevention methods. Materials and Methods: In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 1.33 BCs. The median age at diagnosis of HD was 24 years. The HD stages were stage I in 25 cases (21 %), stage II in 70 casts (59%), stage III in 13 cases (11%). stage IV in si x cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was us ed alone in 74 patients (63%) and combined modalities with chemotherapy (CT ) was used in 43 patients (37%). Results: BC occurred after a median interval of 16 years. TNM classificatio n (UICC, 1978) showed 15 T0 (11.3%), 44 T1 (33.1%), 36 T2. (27.1%), nine T3 (6.7%), 15 T4 (11.3%) and 14 Tx (10.5%,). Ductal infiltrating carcinoma an d ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement ra te was 50%. Seventy-four rumours were treated by mastectomy without (67) or with (ten) RT. Forty-four rumours had lumpectomy without (12) or with (32) RT. Another four received RT alone, and one CT alone. Sixteen patients (12 %) developed isolated local recurrence. Thirty-nine patients (31.7%) develo ped metastases and 34 died; 38 are in complete remission whereas five died of intercurrent disease. The 5-year disease-specific survival rate was 65.1 %. The 5-year disease-specific survival rates for the pN0, pN1-3 and pN > 3 groups were 91, 66 and 15%, respectively (P < 0.0001). and 100, 88, and 64 % for the TIS, T1 and T2. For the T3 and T4, the survival rates decreased s harply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive rumours with a very unfavourable prognosis (espe cially in the case of pN > 3 and/or T3T4), and many rumours with a 'slow sp reading such as DCIS and microinvasive lesions. These lesions developed esp ecially in patients treated exclusively by RT. Conclusions: The young women and girls treated for HD should be carefully m onitored in the long-term by clinical examination, mammography and ultrason ography. We suggest that a baseline mammography is performed 5-8 years afte r supradiaphragmatic irradiation (complete mantle or involved field) in pat ients who were treated before 30 years of age. Subsequent mammographics sho uld be performed every 2 years or each year. depending on the characteristi cs of the breast tissue (e.g. density) and especially in the case of an ass ociation with other BC risk factors. This screening seems of importance due to excellent prognosis in our T1ST1 groups, and the possibility of offerin g these young women a conservative treatment. (C) 2001 Elsevier Science Ire land Ltd. All rights reserved.