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Surgical Management and Contralateral Breast Cancer Risk in Women with History of Radiation Therapy for Hodgkin Lymphoma: Results from a Population-Based Cohort

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Surgery, McGill University Medical School, Montreal, QC, Canada

    Elisheva R. Eisenberg BSc, Ipshita Prakash MD, MSc, Mark Basik MD, Jean Francois Boileau MD, MSc & Stephanie M. Wong MD, MPH

  2. Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada

    Elisheva R. Eisenberg BSc, Ipshita Prakash MD, MSc, Michael N. Pollak MD & Stephanie M. Wong MD, MPH

  3. Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Anna Weiss MD

  4. Department of Oncology, McGill University Medical School, Montreal, QC, Canada

    Ipshita Prakash MD, MSc, Mark Basik MD, Jean Francois Boileau MD, MSc, Michael N. Pollak MD & Stephanie M. Wong MD, MPH

  5. Department of Radiation Oncology, McGill University Medical School, Montreal, QC, Canada

    Sonia Skamene MD

  6. Department of Hematology Oncology, McGill University Medical School, Montreal, QC, Canada

    Lissa Ajjamada MD

  7. Department of Hematology Oncology, University of Montreal, Montreal, QC, Canada

    Lissa Ajjamada MD

  8. Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada

    Stephanie M. Wong MD, MPH

Authors
  1. Elisheva R. Eisenberg BSc
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  2. Anna Weiss MD
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Corresponding author

Correspondence to Stephanie M. Wong MD, MPH.

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Disclosures

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

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