title: Management of breast cancer after Hodgkin's disease.
abstract: OBJECTIVE
  To evaluate the incidence, detection, pathology, management, and prognosis of breast cancer occurring after Hodgkin's disease.
  
  
  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 and 42.6 years for breast cancer. The relative risk for invasive breast cancer after Hodgkin's disease was 4.7 (95% confidence interval, 3.4 to 6. 0) compared with an age-matched cohort. Cancers were detected by self-examination (63%), mammography (30%), and physician exam (7%). The histologic distribution paralleled that reported in the general population (85% ductal histology) as did other features (27% positive axillary lymph nodes, 63% positive estrogen receptors, and 25% family history). Although 87% of tumors were less than 4 cm, 95% were managed with mastectomy because of prior radiation. Two women underwent lumpectomy with breast irradiation. One of these patients developed tissue necrosis in the region of overlap with the prior mantle field. The incidence of bilateral breast cancer was 10%. Adjuvant systemic therapy was well tolerated; doxorubicin was used infrequently. Ten-year disease-specific survival was as follows: in-situ disease, 100%; stage I, 88%; stage II, 55%; stage III, 60%; and stage IV, zero.
  
  
  CONCLUSIONS
  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 population. Repeat irradiation of the breast can lead to tissue necrosis, and thus, mastectomy remains the standard of care in most cases.
authors.affiliation: Departments of Radiation Oncology, Medicine, and Surgery, Stanford University Medical Center, Stanford, CA, USA. woldens@mskcc.org
authors.forename: S L
authors.initials: SL
authors.lastname: Wolden
authors.forename: S L
authors.initials: SL
authors.lastname: Hancock
authors.forename: R W
authors.initials: RW
authors.lastname: Carlson
authors.forename: D R
authors.initials: DR
authors.lastname: Goffinet
authors.forename: S S
authors.initials: SS
authors.lastname: Jeffrey
authors.forename: R T
authors.initials: RT
authors.lastname: Hoppe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D016504:Breast Self-Examination; D018270:Carcinoma, Ductal, Breast / Q000209:etiology / Q000235:genetics / Q000473:pathology / Q000556:secondary / Q000628:therapy; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis / Q000473:pathology; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D010808:Physical Examination; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors
chemical_list: D011960:Receptors, Estrogen