title: Breast cancer risk following Hodgkin lymphoma radiotherapy in relation to menstrual and reproductive factors.
abstract: BACKGROUND
  Women treated with supradiaphragmatic radiotherapy (sRT) for Hodgkin lymphoma (HL) at young ages have a substantially increased breast cancer risk. Little is known about how menarcheal and reproductive factors modify this risk.
  
  
  METHODS
  We examined the effects of menarcheal age, pregnancy, and menopausal age on breast cancer risk following sRT in case-control data from questionnaires completed by 2497 women from a cohort of 5002 treated with sRT for HL at ages <36 during 1956-2003.
  
  
  RESULTS
  Two-hundred and sixty women had been diagnosed with breast cancer. Breast cancer risk was significantly increased in patients treated within 6 months of menarche (odds ratio (OR) 5.52, 95% confidence interval (CI) (1.97-15.46)), and increased significantly with proximity of sRT to menarche (Ptrend<0.001). It was greatest when sRT was close to a late menarche, but based on small numbers and needing reexamination elsewhere. Risk was not significantly affected by full-term pregnancies before or after treatment. Risk was significantly reduced by early menopause (OR 0.55, 95% CI (0.35-0.85)), and increased with number of premenopausal years after treatment (Ptrend=0.003).
  
  
  CONCLUSIONS
  In summary, this paper shows for the first time that sRT close to menarche substantially increases breast cancer risk. Careful consideration should be given to follow-up of these women, and to measures that might reduce their future breast cancer risk.
authors: Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. rosie.cooke@icr.ac.uk
authors: R
authors: R
authors: Cooke
authors: M E
authors: ME
authors: Jones
authors: D
authors: D
authors: Cunningham
authors: S J
authors: SJ
authors: Falk
authors: D
authors: D
authors: Gilson
authors: B W
authors: BW
authors: Hancock
authors: S J
authors: SJ
authors: Harris
authors: A
authors: A
authors: Horwich
authors: P J
authors: PJ
authors: Hoskin
authors: T
authors: T
authors: Illidge
authors: D C
authors: DC
authors: Linch
authors: T A
authors: TA
authors: Lister
authors: H H
authors: HH
authors: Lucraft
authors: J A
authors: JA
authors: Radford
authors: A M
authors: AM
authors: Stevens
authors: I
authors: I
authors: Syndikus
authors: M V
authors: MV
authors: Williams
authors: A J
authors: AJ
authors: Swerdlow
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008572:Menarche; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D017584:Reproductive History; D014852:Wales / Q000453:epidemiology
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