Any late side effects of Hodgekins? Radiation Chemo

Silvana Martino, M.D.
The Angeles Clinic Foundation

Radiation exposure, even many years previously, is known to increase the risk of many cancers, including breast cancer. Women previously treated for Hodgkin’s lymphoma, particularly if radiation was part of their treatment have been recognized as being at higher risk for the subsequent development of breast cancer. An article, published in the June 2012 issue of The Oncologist, adds detail to our understanding of these women. 

The data used was obtained from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute. It encompassed the dates 1973-2007. Included were 9,620 women with a diagnosis of Hodgkin’s lymphoma (HL). Among them, 316 subsequent breast cancers occurred. During this same period, 450,413 women without Hodgkin’s lymphoma were diagnosed with breast cancer and were used for comparison. Several important observations were made in this comparison.

As a group, the women with a prior diagnosis of HL were 2.4 times more likely to develop breast cancer. The risk was highest among patients who were 19 years of age or younger at time of their treatment. The risk decreased progressively as the age of diagnosis of HL increased and approached that of the general population as the women were diagnosed with lymphoma at age 50 or later. This confirms prior observations demonstrating that the female breast is most vulnerable to the damaging effects of radiation during the teenage years when the breasts are developing. The increased risk for breast cancer was noted from 5 years post HL treatment onward. Those whose treatment included radiation had a higher risk of breast cancer than those whose treatment did not include radiation. The difference between these two groups persisted for at least 30 years.

Women with breast cancer developing after treatment for HL were younger at diagnosis, were more likely to have breast cancer in the external portions of the breast, were more likely to have tumors that did not express hormone receptors, and were more likely to be diagnosed at a somewhat lower stage. The lower stage at diagnosis is possibly a reflection that these women were being watched and screened more closely. In spite of this, their prognosis is not better, but is somewhat worse. Their breast cancer tends to be more aggressive and they are also more prone to develop a second breast cancer of the opposite breast as well.

I found this article to be one of the more informative on this topic in part because of its level of detail. We previously thought that these women were more prone to breast cancer on the inner half of the breast, but as radiation techniques have changed in the treatment of Hodgkin’s lymphoma, so has the location of breast cancer. 

The incidence of Hodgkin’s lymphoma is increasing among both children and young adults. More intensive therapy has resulted in a cure rate of approximately 75%. This reflects clear therapeutic success. However, we need to recognize that young women with this diagnosis, especially if they received radiation, must be watched closely for the subsequent development of bilateral breast cancer.

Reference: Risk, Characteristics, and Prognosis of Breast Cancer after Hodgkin’s Lymphoma, Veit-Rubin N, Rapiti E, Usel M, Benhamou S, VinhHung V, Vlastos G, Bouchardy C, The Oncologist 2012:17: 783-791.