[gdpawel]

Risk, Characteristics, and Prognosis of Breast Cancer after Hodgkin's Lymphoma

Nikolaus Veit-Rubin, a, Elisabetta Rapiti, c, Massimo Usel, c, Simone Benhamou, c,d,e, Vincent Vinh-Hung, b, Georges Vlastos, a and Christine Bouchardy, c

a. Unit of Senology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva
b. Division of Radiation Oncology, Geneva University Hospitals, Geneva, Switzerland
c. Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, Geneva, Switzerland
d. INSERM, U946, Fondation Jean Dausset - CEPH, Paris, France
e. CNRS, UMR 8200, Gustave-Roussy Institute, Villejuif, France

Correspondence: Christine Bouchardy, M.D., M.P.H., Ph.D., Geneva Cancer Registry, 55 Boulevard de la Cluse, 1205 Geneva, Switzerland; [email] Christine.BouchardyMagnin@unige.ch

Abstract

Purpose:

To assess breast cancer (BC) risk after Hodgkin's lymphoma (HL) and compare characteristics, risk of second BC, and prognosis of patients with these BCs with patients with first primary BC.

Patients and Methods:

We considered all 9,620 women with HL recorded in the Surveillance, Epidemiology and End Results dataset in 1973–2007. We calculated age-period standardized incidence ratios of BC. We compared patient, tumor, and treatment characteristics, risk of second BC, and prognosis between patients with BC after HL (n = 316) and patients with other BCs occurring during the same period (n = 450,413) using logistic regression and Cox models adjusted for confounders.

Results:

HL patients had a 2.4-fold higher risk for developing BC (95% confidence interval [CI], 2.2–2.7) than the general population. Age at HL diagnosis and radiation therapy influenced this risk. Compared with first primary BCs, BCs after HL were diagnosed at a younger age, at an earlier stage, were less frequently hormone receptor positive, were located more frequently in external quadrants, and were less frequently treated using radiotherapy. These patients had a higher risk (adjusted hazard ratio [HR], 2.85; 95% CI, 1.79–4.53) for developing a second BC and had a higher BC mortality risk (adjusted HR, 1.36; 95% CI, 1.05–1.76). The higher mortality risk was only partly explained by the higher occurrence rate of a second BC.

Conclusion:

HL survivors have a higher risk for developing BC, their BCs are more aggressive, they have a higher risk for a second BC occurrence, and they have a poorer prognosis. Guidelines of care should be adapted to decrease the impact of BC in these high-risk patients.

The Oncologist June 2012 vol. 17 no. 6 783-791

http://theoncologist.alphamedpress.org/content/17/6/783.abstract?sid=1a1a2c2b-1fcb-424f-a236-812959d3f37f