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Breast Cancer Screening in Women Previously Treated for Hodgkin’s Disease: A Prospective Cohort Study

From the Departments of Medicine, Pediatrics, and Radiation Oncology, Harvard Medical School; Departments of Pediatrics, Adult Oncology, Radiology, and Biostatistics, Dana-Farber Cancer Institute; Massachusetts General Hospital; Brigham and Women’s Hospital; and Children’s Hospital, Boston, MA.

Address reprint requests to Lisa Diller, MD, Dana-Farber Cancer Institute, 44 Binney St, Dana 367, Boston, MA 02115; email: Lisa_Diller{at}dfci.harvard.edu

PURPOSE: Young women who are exposed to chest irradiation for Hodgkin’s disease (HD) are at increased risk of breast cancer; this study investigated patient awareness of breast cancer risk and patient screening behavior and assessed the utility of mammographic screening in HD survivors.

PATIENTS AND METHODS: This is a prospective cohort study of 90 female long-term survivors of HD who had been treated 8 years previously with mantle irradiation (current age, 24 to 51 years). Participants completed surveys of their perceptions of breast cancer risk and screening behaviors and received written recommendations for breast examinations and mammography. Annual follow-up was conducted through medical records, telephone, and/or mailed questionnaires.

RESULTS: At baseline, women were often unaware of their increased risk of breast cancer; 40% (35 of 87) reported themselves to be at equal or lower risk than women of the same age. Only 47% (41 of 87) reported having had a mammogram in the previous 24 months. Women who had received information from an oncologist were more likely to assess correctly their risk than women who received information from other sources (P < .001). Ten women developed 12 breast cancers (ductal carcinoma-in-situ [n = 2], invasive ductal carcinoma [n = 10]) during the study; two were diagnosed at study entry, and 10 during follow-up (median, 3.1 years). All cancers were evident on mammogram, and eight of 10 invasive cancers were node negative.

CONCLUSION: Practitioners who care for women after HD therapy need to educate patients regarding their risks and begin early screening. Screening by mammography can detect small, node-negative breast cancers in these patients.

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