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

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Explain the differences in risk and aggression of breast cancer for Hodgkin's lymphoma survivors.Describe the difference in breast tumor sites for Hodgkin's lymphoma survivors.Use adapted guidelines for surveillance and treatment of these high-risk patients. CME This article is available for continuing medical education credit at CME.TheOncologist.com 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.