title: Risk, characteristics, and prognosis of breast cancer after Hodgkin's lymphoma.
abstract: OBJECTIVE
  To assess breast cancer (BC) risk after Hodgkin's lymphoma (HL) and compare characteristics, risk of second BC, and prognosis of patients with these BCs with patients with first primary BC.
  
  
  METHODS
  We considered all 9,620 women with HL recorded in the Surveillance, Epidemiology and End Results dataset in 1973-2007. We calculated age-period standardized incidence ratios of BC. We compared patient, tumor, and treatment characteristics, risk of second BC, and prognosis between patients with BC after HL (n = 316) and patients with other BCs occurring during the same period (n = 450,413) using logistic regression and Cox models adjusted for confounders.
  
  
  RESULTS
  HL patients had a 2.4-fold higher risk for developing BC (95% confidence interval [CI], 2.2-2.7) than the general population. Age at HL diagnosis and radiation therapy influenced this risk. Compared with first primary BCs, BCs after HL were diagnosed at a younger age, at an earlier stage, were less frequently hormone receptor positive, were located more frequently in external quadrants, and were less frequently treated using radiotherapy. These patients had a higher risk (adjusted hazard ratio [HR], 2.85; 95% CI, 1.79-4.53) for developing a second BC and had a higher BC mortality risk (adjusted HR, 1.36; 95% CI, 1.05-1.76). The higher mortality risk was only partly explained by the higher occurrence rate of a second BC.
  
  
  CONCLUSIONS
  HL survivors have a higher risk for developing BC, their BCs are more aggressive, they have a higher risk for a second BC occurrence, and they have a poorer prognosis. Guidelines of care should be adapted to decrease the impact of BC in these high-risk patients.
authors.affiliation: Geneva Cancer Registry, 55 Boulevard de la Cluse, Geneva, Switzerland.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Veit-Rubin
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rapiti
authors.forename: Massimo
authors.initials: M
authors.lastname: Usel
authors.forename: Simone
authors.initials: S
authors.lastname: Benhamou
authors.forename: Vincent
authors.initials: V
authors.lastname: Vinh-Hung
authors.forename: Georges
authors.initials: G
authors.lastname: Vlastos
authors.forename: Christine
authors.initials: C
authors.lastname: Bouchardy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult