Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma.

BACKGROUND Many women develop breast cancer after treatment for Hodgkin lymphoma (HL) at a young age. We estimated this future risk, taking into account age and calendar year of HL diagnosis, HL treatment information, population breast cancer incidence rates, and competing causes of death. METHODS Relative risks of breast cancer for categories defined by radiation dose to the chest (0, 20- < 40 Gy, or > or = 40 Gy) and use of alkylating agents (yes or no) were estimated from a case-control study conducted within an international population-based cohort of 3817 female 1-year survivors of HL diagnosed at age 30 years or younger from January 1, 1965, through December 31, 1994. To compute cumulative absolute risks of breast cancer, we used modified standardized incidence ratios to relate cohort breast cancer risks to those in the general population, enabling application of population-based breast cancer rates, and we allowed for competing risks by using population-based mortality rates in female HL survivors. RESULTS Cumulative absolute risks of breast cancer increased with age at end of follow-up, time since HL diagnosis, and radiation dose. For an HL survivor who was treated at age 25 years with a chest radiation dose of at least 40 Gy without alkylating agents, estimated cumulative absolute risks of breast cancer by age 35, 45, and 55 years were 1.4% (95% confidence interval [CI] = 0.9% to 2.1%), 11.1% (95% CI = 7.4% to 16.3%), and 29.0% (95% CI = 20.2% to 40.1%), respectively. Cumulative absolute risks were lower in women treated with alkylating agents. CONCLUSIONS Breast cancer projections varied considerably by type of HL therapy, time since HL diagnosis, and age at end of follow-up. These estimates are applicable to HL survivors treated with regimens of the past and can be used to counsel such patients and plan management and preventive strategies. Projections should be used with caution, however, in patients treated with more recent approaches, including limited-field radiotherapy and/or ovary-sparing chemotherapy.

[1]  P. Dempsey.  2–13 Surveillance of BRCA1 and BRCA2 Mutation Carriers With Magnetic Resonance Imaging, Ultrasound, Mammography, and Clinical Breast Examination , 2005 .

[2]  Ellen Warner,et al.  Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination , 2004, JAMA.

[3]  J. Friedberg,et al.  Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. , 2002, Blood.

[4]  Graham Colditz,et al.  Breast cancer risk prediction with a log-incidence model: evaluation of accuracy. , 2003, Journal of clinical epidemiology.

[5]  J. Yahalom.  Changing role and decreasing size: Current trends in radiotherapy for hodgkin’s disease , 2002, Current oncology reports.

[6]  A. Broeks,et al.  Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin's disease. , 2003, Journal of the National Cancer Institute.

[7]  J. Ferlay,et al.  Cancer Incidence in Five Continents , 1970, Union Internationale Contre Le Cancer / International Union against Cancer.

[8]  A. Miller,et al.  Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. , 1995, Journal of the National Cancer Institute.

[9]  B. Achinstein,et al.  Journal of the National Cancer Institute, Vol. 29, 1962: Action of bacterial polysaccharide on tumors. II. Damage of sarcoma 37 by serum of mice treated with Serratia marcescens polysaccharide, and induced tolerance. , 2009, Nutrition reviews.

[10]  M. Stovall,et al.  Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. , 2003, JAMA.

[11]  G. Colditz,et al.  A prospective study of benign breast disease and the risk of breast cancer , 1992, JAMA.

[12]  D. Neuberg,et al.  Breast cancer screening in women previously treated for Hodgkin's disease: a prospective cohort study. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  M. Henry-Amar.  Second cancer after the treatment for Hodgkin's disease: a report from the International Database on Hodgkin's Disease. , 1992, Annals of oncology : official journal of the European Society for Medical Oncology.

[14]  J Benichou,et al.  Validation studies for models projecting the risk of invasive and total breast cancer incidence. , 1999, Journal of the National Cancer Institute.

[15]  M. Gail,et al.  Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. , 1989, Journal of the National Cancer Institute.

[16]  T. Lancet.  Cancer survivors: living longer, and now, better , 2004, The Lancet.

[17]  L. Robison,et al.  Breast cancer and other second neoplasms after childhood Hodgkin's disease. , 1996, The New England journal of medicine.

[18]  A Kreuger,et al.  Risk of subsequent malignant neoplasms among 1,641 Hodgkin's disease patients diagnosed in childhood and adolescence: a population-based cohort study in the five Nordic countries. Association of the Nordic Cancer Registries and the Nordic Society of Pediatric Hematology and Oncology. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  B. Meunier,et al.  [Breast cancer after treatment of Hodgkin's disease]. , 1995, Journal de gynecologie, obstetrique et biologie de la reproduction.

[20]  J. Friedberg,et al.  Long-term survival and competing causes of death in patients with early-stage Hodgkin's disease treated at age 50 or younger. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  C. Metayer,et al.  “Second Malignant Neoplasms Among Long-Term Survivors of Hodgkinʼs Disease: A Population-Based Evaluation Over 25 Years” , 2002 .

[22]  N Risch,et al.  Autosomal dominant inheritance of early‐onset breast cancer. Implications for risk prediction , 1994, Cancer.

[23]  H. Bartelink,et al.  Long-term cause-specific mortality of patients treated for Hodgkin's disease. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  J Crowley,et al.  Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. , 1999, Statistics in medicine.

[25]  Erik Holmberg,et al.  Radiation Effects on Breast Cancer Risk: A Pooled Analysis of Eight Cohorts , 2002, Radiation research.

[26]  C. Bokemeyer,et al.  Long-term gonadal toxicity after therapy for Hodgkin's and non-Hodgkin's lymphoma , 1994, Annals of Hematology.

[27]  K. Propert,et al.  Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. , 1992, The New England journal of medicine.

[28]  J. Yahalom.  Breast cancer after Hodgkin disease: hope for a safer cure. , 2003, JAMA.

[29]  C. Willett,et al.  High risk of breast carcinoma after irradiation of young women with Hodgkin's disease , 1997, Cancer.

[30]  T. Lister,et al.  Risk of second malignancy after Hodgkin's disease in a collaborative British cohort: the relation to age at treatment. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  G. Colditz,et al.  Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses' Health Study. , 2000, American journal of epidemiology.

[32]  H. Ekert.  Late effects of treatment for childhood Hodgkin's disease. , 1996, The New England journal of medicine.

[33]  L. Robison,et al.  High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin's disease: report from the Late Effects Study Group. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  M. Brigden.  Treatment of early-stage Hodgkin's disease. , 1985, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[35]  G. Giles,et al.  Population-based estimate of the average age-specific cumulative risk of breast cancer for a defined set of protein-truncating mutations in BRCA1 and BRCA2. Australian Breast Cancer Family Study. , 1999, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[36]  A. Hagenbeek,et al.  Long-term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence or young adulthood. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  J. Stockman.  Breast Cancer After Childhood Cancer: A Report From the Childhood Cancer Survivor Study , 2006 .

[38]  S. Horning,et al.  Female Reproductive Potential after Treatment for Hodgkin's Disease , 1981, The New England journal of medicine.

[39]  R. Hoppe.  Hodgkin's disease: complications of therapy and excess mortality. , 1997, Annals of oncology : official journal of the European Society for Medical Oncology.

[40]  J. Manson,et al.  Family history, age, and risk of breast cancer. Prospective data from the Nurses' Health Study. , 1993, JAMA.

[41]  A. Whittemore,et al.  Breast Cancer Risks for BRCA1/2 Carriers , 2004, Science.