The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage.
BACKGROUND
Supradiaphragmatic radiotherapy (SRT) to treat Hodgkin's lymphoma (HL) at a young age increases the risk of breast cancer (BC). A national notification risk assessment and screening programme (NRASP) for women who were treated with SRT before the age of 36 years was instituted in the United Kingdom in 2003. In this study, we report the implementation and screening results from the largest English Cancer Network.


METHODS
A total of 417 eligible women were identified through cancer registry/hospital databases and from follow-up (FU) clinics. Screening results were collated retrospectively, and registry searches were used to capture BC cases.


RESULTS
Of the 417 women invited for clinical review, 243 (58%) attended. Of these 417 women, 23 (5.5%) have been diagnosed with BC, a standardised incidence ratio of 2.9 compared with the age-matched general population. Of five invasive BCs diagnosed within the NRASP, none involved axillary lymph nodes compared with 7 of 13 (54%) diagnosed outside the programme (P<0.10). The mean latency for BC cases was 19.5+/-8.35 years and the mean FU duration for those unaffected by BC was 14.6+/-9.11 years (P<0.01), suggesting that those unaffected by BC remain at high risk. Recall and negative biopsy rates were acceptable (10.5 and 0.8%, respectively).


CONCLUSIONS
The NRASP appears to detect BC at an early stage with acceptable biopsy rates, although numbers are small. Determination of NRASP results on a national basis is required for the accurate evaluation of screening efficacy in women previously treated with SRT.
Howell
S J
SJ
Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK. Showell@picr.man.ac.uk
Searle
C
C
Goode
V
V
Gardener
T
T
Linton
K
K
Cowan
R A
RA
Harris
M A
MA
Hopwood
P
P
Swindell
R
R
Norman
A
A
Kennedy
J
J
Howell
A
A
Wardley
A M
AM
Radford
J A
JA
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis*; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D006113:United Kingdom