title: Breast cancer occurred after treatment for Hodgkin's disease: analysis of 133 cases.
abstract: OBJECTIVE
  To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therapies and prevention methods.
  
  
  METHODS
  In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 133 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 cases (59%), stage III in 13 cases (11%), stage IV in six cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was used 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 classification (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 and ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement rate was 50%. Seventy-four tumours were treated by mastectomy without (67) or with (ten) RT. Forty-four tumours 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%) developed 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 sharply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN>3 and/or T3T4), and many tumours with a 'slow spreading' such as DCIS and microinvasive lesions. These lesions developed especially in patients treated exclusively by RT.
  
  
  CONCLUSIONS
  The young women and girls treated for HD should be carefully monitored in the long-term by clinical examination, mammography and ultrasonography. We suggest that a baseline mammography is performed 5-8 years after supradiaphragmatic irradiation (complete mantle or involved field) in patients who were treated before 30 years of age. Subsequent mammographies should be performed every 2 years or each year, depending on the characteristics of the breast tissue (e.g. density) and especially in the case of an association with other BC risk factors. This screening seems of importance due to excellent prognosis in our T(1S)T(1) groups, and the possibility of offering these young women a conservative treatment.
authors.affiliation: Department of Radiotherapy, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67085 Cedex, Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Cutuli
authors.forename: C
authors.initials: C
authors.lastname: Borel
authors.forename: F
authors.initials: F
authors.lastname: Dhermain
authors.forename: S M
authors.initials: SM
authors.lastname: Magrini
authors.forename: T H
authors.initials: TH
authors.lastname: Wasserman
authors.forename: J A
authors.initials: JA
authors.lastname: Bogart
authors.forename: M
authors.initials: M
authors.lastname: Provencio
authors.forename: B
authors.initials: B
authors.lastname: de Lafontan
authors.forename: A
authors.initials: A
authors.lastname: de la Rochefordiere
authors.forename: E
authors.initials: E
authors.lastname: Cellai
authors.forename: Y
authors.initials: Y
authors.lastname: Graic
authors.forename: P
authors.initials: P
authors.lastname: Kerbrat
authors.forename: C
authors.initials: C
authors.lastname: Alzieu
authors.forename: E
authors.initials: E
authors.lastname: Teissier
authors.forename: J M
authors.initials: JM
authors.lastname: Dilhuydy
authors.forename: H
authors.initials: H
authors.lastname: Mignotte
authors.forename: M
authors.initials: M
authors.lastname: Velten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D018567:Breast Neoplasms, Male / Q000209:etiology*; D002648:Child; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology