title: Radiologic features of breast cancer after mantle radiation therapy for Hodgkin disease: a study of 230 cases.
abstract: OBJECTIVE
  To retrospectively review diagnostic mammography in women diagnosed with breast cancer who previously had mantle field radiation therapy for Hodgkin disease in England and Wales over a period of 30 years.
  
  
  METHODS
  From a national cohort study of 5002 women treated with supradiaphragmatic radiation therapy when they were younger than 36 years (mean, 22.1 years) during 1956-2003, 392 patients developed breast cancer. With ethics committee approval and informed consent, mammograms were obtained that showed 230 tumors in 222 (56.6%) patients from 95 hospitals, and the size and appearance of each carcinoma was recorded by two breast radiologists. Comparison was made with a historical report of more than 1000 general-population breast cancers by using Pearson χ(2) test.
  
  
  RESULTS
  Thirty-eight tumors were occult on mammograms. Mean tumor maximum diameter was 12.3 mm (n = 81) on oblique view. The quadrant distribution of the tumors was significantly different (P < .001) from the historic controls, and chest radiation therapy patients had a greater proportion of tumors in the upper outer (66.9% [107 of 160] vs 48.7% [385 of 784]) and, to a lesser extent, lower inner (10.6% [17 of 160] vs 7.8% [61 of 784]) quadrants. The dominant radiologic feature was of an irregular mass (56.8% [109 of 192]) followed by microcalcifications (25.0% [48 of 192]).
  
  
  CONCLUSIONS
  This study suggests that in patients who previously underwent mantle radiation therapy for Hodgkin disease, breast cancers are more commonly seen within the upper outer quadrants than are cancers in the general population. Poorly defined masses were the most common appearance.
authors.affiliation: From the Department of Radiology, Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, England (S.D.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Cambridgeshire, England (M.G.W.); and Divisions of Genetics and Epidemiology (R.C., A.J.S.) and Breast Cancer Research (A.J.S.), Institute of Cancer Research, Sutton, Surrey, England.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Allen
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Wallis
authors.forename: Rosie
authors.initials: R
authors.lastname: Cooke
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Swerdlow
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014852:Wales / Q000453:epidemiology