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Unilateral and bilateral breast cancer in women surviving pediatric Hodgkin's disease. Int J Radiat Oncol Biol Phys 2008 Sep 01;72(1):34-40



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Pubmed Central ID




Scopus ID

2-s2.0-49549105338   43 Citations


PURPOSE: To define demographic and therapeutic associations with the risk of breast cancer in children treated for Hodgkin's disease (HD), particularly the frequency and interval to the development of contralateral breast cancer.

METHODS AND MATERIALS: All 398 female patients (<19 years) treated for HD in five institutions during the accrual period were evaluated. Mean follow-up was 16.9 years. The standardized incidence ratio (SIR) was calculated as the ratio of the observed number of cases to the expected number of cases, estimated using age-matched controls from the Surveillance, Epidemiology, and End Results database.

RESULTS: A total of 29 women developed breast cancer (25 invasive, 4 ductal carcinoma in situ; SIR, 37.25; 95% confidence interval, 24.96-53.64). Time to diagnosis was 9.4 to 36.1 years. Cumulative incidence was 24% at 30 years. Ten patients (34%) had bilateral disease (9 metachronous, 1 synchronous). The interval to contralateral breast cancer was 12 to 34 months. On univariate analysis, significant variables included stage of HD, mantle radiation dose, pelvic radiation (protective), and follow-up time. On multivariate analysis, early stage and older age at diagnosis of HD (<or=12 vs. >12 years) were significant predictors of secondary breast cancer.

CONCLUSIONS: Women surviving pediatric HD were found to have a 37-fold increase in the risk of breast cancer and a high likelihood of rapidly developing bilateral disease. Early-stage HD and age greater than 12 years at diagnosis of HD were independent risk factors. Higher radiation doses may augment risk, and pelvic radiation may be protective. Breast cancer screening methodology and frequency, plus the role of prophylaxis in patients with unilateral disease, require definition.

Author List

Basu SK, Schwartz C, Fisher SG, Hudson MM, Tarbell N, Muhs A, Marcus KJ, Mendenhall N, Mauch P, Kun LE, Constine LS


Cindy L. Schwartz MD, MPH Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Breast Neoplasms
Carcinoma in Situ
Carcinoma, Ductal, Breast
Combined Modality Therapy
Hodgkin Disease
Middle Aged
Neoplasm Staging
Neoplasms, Radiation-Induced
Neoplasms, Second Primary
Radiotherapy Dosage
Risk Factors
jenkins-FCD Prod-461 7d7c6113fc1a2757d2947d29fae5861c878125ab