title: Breast cancer following Hodgkin's Disease: the experience of the University of Florence.
abstract: The advent of effective chemo-radiotherapy has made Hodgkin Disease (HD) a highly curable malignancy, but the great improvement in survival rates allowed the observation in long-term survivors of several treatment complications. Secondary malignancies are the most serious complications and breast cancer (BC) represents the most common solid tumor among female survivors. The aim of our analysis is to describe the clinico-pathological characteristics and management of BC occurred after HD treatment. Between 1960 and 2003, 2,039 patients were treated for HD at the Department of Radiotherapy-Oncology of the Florence University. In this study we considered 1,538 patients on whom a minimum follow up of 6 months had been obtained. Of these, 725 were women. The most represented histological subtype was nodular sclerosis (50.6%). Supradiaphragmatic alone or with subdiaphragmatic complementary extended field radiotherapy was delivered to 83.1% of patients while supradiaphragmatic involved field radiotherapy was delivered to 10.7% of patients. Concerning the characteristics and incidence of BC, we focused our analysis exclusively on the female group. We found that BC occurred in 39, with an overall incidence of 5.4%. The mean interval after Hodgkin treatment was 19.5 years (SD +/- 9.0). The median age of BC diagnosis was 50.8 years (SD +/- 13.3) while the median age of Hodgkin diagnosis was 31.2 years (SD +/- 14.5). Thirty-seven women received mediastinal irradiation. We observed a decreasing trend of the secondary BC incidence with increasing age of Hodgkin treatment with the maximum incidence registered in women treated at age 20 or younger. In Our Institute we perform a whole life follow up and recommend that annual mammography begins 10 years after HD treatment or, in any case, not later than age 40.
authors.affiliation: Department of Radiation-Oncology, University of Florence, Florence, Italy. icro.meattini@unifi.it
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Livia
authors.initials: L
authors.lastname: Marrazzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Rampini
authors.forename: Carmine
authors.initials: C
authors.lastname: Iermano
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Papi
authors.forename: Beatrice
authors.initials: B
authors.lastname: Detti
authors.forename: Silvia
authors.initials: S
authors.lastname: Scoccianti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Biti
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology*; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors