Abstract
Background
Women with history of chest irradiation for Hodgkin lymphoma are at increased risk of developing bilateral breast cancer, although contralateral breast cancer risk estimates in this population remain undefined.
Methods
We queried the SEER database for women treated with radiation therapy for Hodgkin lymphoma prior to age 30 years and were diagnosed with a subsequent breast cancer between 1990–2016. Trends in surgical management and the 5- and 10-year cumulative incidence of contralateral breast cancer were evaluated.
Results
The cohort included 295 women with a median age of 22 years (range 8–30 years) at Hodgkin lymphoma diagnosis, and 42 years (range 22–65 years) at breast cancer diagnosis. Overall, 263 (89.2%) presented with unilateral breast cancer, while 32 (10.8%) presented with synchronous bilateral breast cancer. Breast-conserving surgery was performed in 17.3% of patients, while mastectomy was performed in 82.7%. In 263 patients presenting with unilateral breast cancer, 50 (19.0%) underwent breast-conserving surgery and 213 (81.0%) underwent mastectomy. Subgroup analysis of mastectomy patients demonstrated a 40.5% bilateral mastectomy rate. The 5-year incidence of contralateral breast cancer in women who underwent unilateral surgery was 9.4% [95% confidence interval (CI), 5.6–15.4%], increasing to 20.2% (95% CI, 13.7–29.2%) at 10-year and 29.9% (95% CI, 20.8–41.9%) at 15-year follow-up.
Conclusions
Women with a history of prior chest radiation for Hodgkin lymphoma with a diagnosis of breast cancer have a 10-year contralateral breast cancer risk of 20%. These findings support consideration of contralateral prophylactic mastectomy during surgical decision-making for management of this high-risk patient population.
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Acknowledgements
This work was supported by award 309854 (SW) from the Fonds de Recherche du Quebec Santé.
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Lissa Ajjamada reports research funding from Incyte pharmaceuticals and honoraria from Merck, and Bristol Myers Squibb outside the submitted work. Anna Weiss reports research funding from Myriad Laboratories, Inc. outside the submitted work. Jean-Francois Boileau reports honoraria from Roche, Novartis, Genomic Health, Pfizer, Allergan, and Merck; personal fees from Roche, Genomic Health, NanoString Technologies, Pfizer, Eli Lilly, Novartis, and Merck; and travel support from Roche, GlaxoSmithKline, Novartis, Pfizer, and Lifecell outside the submitted work. The remaining authors have no conflicts of interest to disclose.
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Appendix: Stepwise cohort ascertainment
Appendix: Stepwise cohort ascertainment
Remaining | Removed (% cohort) | |
---|---|---|
All female patients with Hodgkin lymphoma | 58,238 | |
Include those diagnosed prior to 30 years of age | 21,310 | 36,928 (63.4%) |
Include those treated with radiation therapy | 9623 | 11,687 (54.8%) |
Include those with a documented subsequent breast cancer > 6 months following their diagnosis of Hodgkin Lymphoma | 336 | 9287 (96.5%) |
Exclude those with breast cancers diagnosed before 1990 | 326 | 10 (3.0%) |
Exclude patients diagnosed with stage IV breast cancer | 306 | 20 (6.1%) |
Exclude patients who did not undergo surgery/surgical details unknown | 295 | 11 (3.6%) |
Final cohort | 295 |
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Eisenberg, E.R., Weiss, A., Prakash, I. et al. Surgical Management and Contralateral Breast Cancer Risk in Women with History of Radiation Therapy for Hodgkin Lymphoma: Results from a Population-Based Cohort. Ann Surg Oncol 29, 6673–6680 (2022). https://doi.org/10.1245/s10434-022-11947-w
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DOI: https://doi.org/10.1245/s10434-022-11947-w