Secondary breast cancer in patients treated for Hodgkin lymphoma: Adherence to screening recommendations in a high-risk population

Abstract

1540 Background: The survival of patients (pts) treated for Hodgkin's lymphoma (HL) has improved dramatically in the past few decades, however, secondary complications, including breast cancer (SBC), remain a serious late effect of treatment. Screening mammography (SM) has been recommended starting 10 years after completion of treatment of HL. It became widely available in British Columbia in 1988. Methods: Using the BCCA Lymphoid Cancer Database and the BCCA Breast Cancer Outcomes and Surveillance Database, we retrospectively reviewed all females who were treated for HL and subsequently developed breast cancer. Results: 62 female pts treated for HL between April 1963 and March 2002 were found to subsequently have developed SBC. The median age at diagnosis of HL was 24 y (12-86). 53 pts received radiotherapy (RT) as part of HL treatment, mainly mantle field (45, 73%). 35 pts received multiagent chemotherapy (9 alone and 26 combined with RT). SBC was diagnosed after a median latency from the diagnosis of HL of 20y (1.5–37). Median age at diagnosis of SBC was 49y (29–90). Most pts had their SBC discovered by self-detection or physician exam (n=36, 58%), 19 (31%) were diagnosed by SM and detection method was unknown for 7 patients. Among SBC diagnosed after 1988, (n=56), only 2/14 patients < 40 y had undergone SM compared to 26/42 diagnosed > 40 y. Overall, 6 women had a false-negative SM. SBC stage was (n) in situ disease (8), stage I (22), stage II (16), stage III (8), stage IV (5) and unknown (3). Most breast tumours were ductal carcinomas (48) (mixed histology 7, lobular 3). The majority of tumours were ER/PR-positive (n=30, 48%); 13 were negative and 19 unknown. Her-2-Neu expression was reported for 25 cases (20 negative, 5 positive). Conclusions: SBC constitutes a serious threat for female with a history of HL, particularly those treated with RT. Despite provincial guidelines in place, only a small proportion of women are being diagnosed following SM. Both pts and physicians must become more aware of screening recommendations and better means of encouraging appropriate screening must be found. No significant financial relationships to disclose.