title: Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma: a multi-institutional, matched cohort study.
abstract: OBJECTIVE
  To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL).
  
  
  METHODS
  Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records.
  
  
  RESULTS
  A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4).
  
  
  CONCLUSIONS
  In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.
authors.affiliation: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Klem
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ishill
authors.forename: David
authors.initials: D
authors.lastname: Hodgson
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Ng
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: Joanne
authors.initials: J
authors.lastname: Weidhaas
authors.forename: Gary M
authors.initials: GM
authors.lastname: Freedman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
authors.forename: Sten
authors.initials: S
authors.lastname: Myrehaug
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult