Original Article
Risk of Breast Cancer and Breast Cancer Characteristics in Women Treated With Supradiaphragmatic Radiation for Hodgkin Lymphoma: Mayo Clinic Experience

https://doi.org/10.4065/78.6.708Get rights and content

Objective

To evaluate the overall risk of breast cancer and breast cancer characteristics in women given supradiaphragmatic radiation therapy for Hodgkin lymphoma.

Patients and Methods

Medical records of 653 female patients who received supradiaphragmatic radiation therapy for Hodgkin lymphoma at the Mayo Clinic in Rochester, Minn, between 1950 and 1993 were abstracted, and follow-up questionnaires were mailed. In 4 patients, breast cancer was diagnosed before Hodgkin lymphoma was discovered.

Results

The median age of 649 patients at supra-diaphragmatic radiation therapy was 31.8 years (range, 2.6–86.5 years). The median duration of follow-up was 8.7 years (range, <1–47.9 years). In 30 patients, breast cancer developed (bilaterally in 4 patients) after supradiaphragmatic radiation therapy; the median interval was 19.9 years (range, 0.7–42.3 years). The median age at breast cancer diagnosis was 44.4 years (range, 27.5–70.8 years). The standardized morbidity ratio for breast cancer after supradiaphragmatic radiation therapy was 2.9 (95% confidence interval [CI], 2.0–4.2) (P<.001). Breast cancer risk significantly increased 15 to 30 years after patients received supradiaphragmatic radiation therapy, and risk was inversely related to age at supradiaphragmatic radiation therapy until age 30 years. The standardized morbidity ratio for patients younger than 30 years at supra-diaphragmatic radiation was 8.5 (95% CI, 5.3–13.1) vs 1.2 (95% CI, 0.5–2.2) for those aged 30 years or older (P<.001). Splenectomy increased breast cancer risk (P=.01). Breast cancer detection was by self-examination in 15 cancers, by mammography in 13, and by clinical examination in 4; in 2 cancers, the mode of detection was unknown. Modified radical mastectomy was used to treat breast cancer.

Conclusion

The increased risk of breast cancer in survivors of Hodgkin lymphoma given supradiaphragmatic radiation therapy appears to be limited to patients who are younger than 30 years at radiation therapy or to those who have undergone splenectomy.

Section snippets

Population

Between 1950 and 1993, 653 women with an initial diagnosis of Hodgkin lymphoma received radiation therapy to nodal areas above the diaphragm as their initial treatment at the Mayo Clinic in Rochester, Minn. Four of these women had a diagnosis of breast cancer before they received their diagnosis of Hodgkin lymphoma. The remaining 649 women were included in the study.

Patient Data

The complete Mayo Clinic medical records of all women in our study until 2000 were abstracted to obtain demographic and clinical

Risk of Breast Cancer After Treatment of Hodgkin Lymphoma

The 649 female patients were followed through their Mayo Clinic medical records from the initiation of radiation therapy until the last date recorded, for a total of 7216 person-years (median, 8.6 years; range, <1–47.4 years), during which time 27 cases of breast cancer were observed. With only 9.1 cases expected, this corresponds to an estimated SMR of 3.0 (95% CI, 1.9–4.3). The Mayo Clinic records indicated that 295 of these women were deceased. The remaining 354 patients, presumably alive,

DISCUSSION

The risk of breast cancer developing after supradiaphragmatic radiation therapy for Hodgkin lymphoma among 649 patients who were treated at the Mayo Clinic between 1950 and 1993 was 3-fold higher (SMR, 2.9) than the risk in the general population, indicating a significant increase of breast cancer in the Hodgkin lymphoma cohort (P<.001). Similar,2, 16, 17 lower,7 and higher12 risks have been reported in the literature. These variations in risk may be explained by differences in duration of

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