title: Breast cancer occurred after Hodgkin's disease: clinico-pathological features, treatments and outcome: analysis of 214 cases.
abstract: BACKGROUND
  Secondary tumours (ST) represent a major concern in survivors of Hodgkin's disease (HD). Breast cancer (BC) is the most frequent ST among young treated women.
  
  
  METHODS
  One hundred and eighty-nine women treated for HD by radiotherapy (RT) and/or chemotherapy (CT) subsequently developed 214 BCs.
  
  
  RESULTS
  Median age at HD diagnosis was 25 years (34% were less than 20). Median interval between HD and BC was 18.6 years, with a 42-year median age at first BC. According to the TNM classification, there were 30 (14%) T0 (non palbable lesions), 86 (40%) T1, 56 (26%) T2, 13 (6%) T3T4 and 29 (14%) Tx. There were 25 (13.2%) contralateral BC. 160 (75%) and 15 (7%) tumours were infiltrating ductal and lobular carcinomas, 7 (3.3%) were other subtypes and 27 (22%) DCIS. The rate of axillary nodal involvement was 32%. Among 203 operated tumours, 79 (39%) were treated by breast conserving surgery (BCS), with RT in 56 (71%) cases. CT and hormonal treatment were delivered in 51% and 45% of the patients. With a 50-month median follow-up, local recurrence occurred in 12% of the tumours (9% after mastectomy, 21% after lumpectomy alone and 13.7% after lumpectomy with RT). Metastasis occurred in 47 (26%) patients. The risk factors were pN+, pT, high SBR grade and young age (< 50 years). The ten-year overall and specific survival rates were 53% and 63.5%, respectively. The ten-year specific survival rates were 79% for pT0T1T2, 48% for pT3T4 (p = 0.0002) and 79% for pN0 versus 38.5% for pN+ (p = 0.00026). Among 67 deaths, 43 (73%) were due to BC.
  
  
  CONCLUSIONS
  Patients and physicians should be aware that BC is the most frequent secondary tumour in young women treated for HD. The new RT modalities (lower doses and involved fields) may decrease the risk in the future. However, these women require a careful monitoring as from 8 to 10 years after HD treatment, combining mammography, ultrasound and MRI according to several ongoing studies. BC with whole breast irradiation is feasible in some selected cases.
authors.affiliation: Radiation Oncology Department, Polyclinique de Courlancy, 38 rue de Courlancy, 51100 Reims, France. bcutuli@iccreims.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Cutuli
authors.forename: Samia
authors.initials: S
authors.lastname: Kanoun
authors.forename: Christine
authors.initials: C
authors.lastname: Tunon De Lara
authors.forename: Marc
authors.initials: M
authors.lastname: Baron
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Cristelle
authors.initials: C
authors.lastname: Levy
authors.forename: Christine
authors.initials: C
authors.lastname: Cohen-Solal-Lenir
authors.forename: Anne
authors.initials: A
authors.lastname: Lesur
authors.forename: Pierre
authors.initials: P
authors.lastname: Kerbrat
authors.forename: Mariano
authors.initials: M
authors.lastname: Provencio
authors.forename: Laurence
authors.initials: L
authors.lastname: Gonzague-Casabianca
authors.forename: Alice
authors.initials: A
authors.lastname: Mege
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Catherine
authors.initials: C
authors.lastname: Delva
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lancrenon
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
mesh_terms: D001943:Breast Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome