Long-term survival among 298 Hodgkin lymphoma (HL) patients who develop breast cancer (BC): A population-based study.

Abstract

1502 Background: The markedly increased risk of BC among women receiving chest radiotherapy for HL is well established. However, no large, population-based studies exist that describe overall survival (OS) and cause-specific survival (CSS) compared to women with a first primary BC. Methods: For 298 HL survivors who developed BC (HL-BC patients) and 405,223 women with a first or only BC (BC-1 patients), actuarial OS and CSS were compared, accounting for age, BC stage, hormone receptor status, sociodemographic status, radiation for HL and other variables. All patients were derived from the population-based Surveillance, Epidemiology, and End Results program. Results: Compared with BC-1 patients, the HL-BC group was significantly younger at BC diagnosis (p < 0.0001), had a greater likelihood of high grade BC (p > 0.02), and greater likelihood of estrogen negative BC (p < 0.004) and progesterone receptor negative BC (p > 0.005 for localized BC and p > 0.06 for regional BC). HL-BC patients were > 1.5 times (p < 0.0001) more likely to undergo mastectomy (rather than breast conserving surgery) compared with BC-1 pts, and were > 2 times (p < 0.0001) less likely to have received radiation than BC-1 patients. Fifteen-year OS among HL-BC patients was significantly inferior to BC-1 patients: 48% versus 69% respectively (p<0.0001) for localized BC, and 33% versus 43% (p < 0.0001) for regional/distant BC. HL-BC patients had a significantly increased 7-fold risk (p < 0.0001) of death from other cancers (i.e., not HL or BC) compared to BC-1 patients. Mortality due to heart disease among HL-BC patients with either localized or regional/distant disease was also significantly increased (hazard ratio 2.22, p > 0.04; and hazard ratio 4.28, p > 0.02 respectively) compared to BC-1 patients. While 10-year BC CSS was similar for HL-BC and BC-1 patients with regional/distant disease, it was inferior for patients with localized BC (82% versus 88% respectively (p > 0.002). Conclusions: Women with HL may survive a subsequent diagnosis of BC only to experience significant excesses of death from other primary cancers and cardiac disease. Greater awareness of screening for cardiac disease and subsequent primary cancers in HL-BC patients is warranted. No significant financial relationships to disclose.