Subsequent versus de novo breast cancer

In one population-based study, radiation-induced breast cancer was noted to have more adverse clinicopathological features, as evidenced by a twofold increased risk of estrogen receptor–negative, progesterone receptor–negative breast cancer observed among 15-year Hodgkin lymphoma survivors, compared with women who had sporadic breast cancer.[48]

Other studies have observed a higher proportion of more histologically aggressive subtypes (e.g., triple-negative breast cancer) than age-matched sporadic invasive cancers.[49,50]

These findings are in contrast to other smaller, hospital-based, case-control studies of breast cancer among Hodgkin lymphoma survivors that have not identified a significant variation in hormone receptor status when compared with primary breast cancer controls. Previous studies have also not demonstrated a significant difference in overall risk of high-grade versus low-grade tumors.[51,52]

A study using SEER Program data evaluated the clinicopathological features of 321 breast cancers diagnosed in 257 women (median age, 22 years; range, 18–26 years at Hodgkin lymphoma diagnosis) who were previously treated with radiation for Hodgkin lymphoma.[53]

A study using SEER Program data evaluated the clinicopathological features of 321 breast cancers diagnosed in 257 women (median age, 22 years; range, 18–26 years at Hodgkin lymphoma diagnosis) who were previously treated with radiation for Hodgkin lymphoma.[53]

Women who developed breast cancer after radiation for Hodgkin lymphoma were younger than women diagnosed with breast cancer without a prior malignancy (43 vs. 60 years) and were less likely to present with ductal carcinoma in situ (0.4% vs. 14.9%).

A study using SEER Program data evaluated the clinicopathological features of 321 breast cancers diagnosed in 257 women (median age, 22 years; range, 18–26 years at Hodgkin lymphoma diagnosis) who were previously treated with radiation for Hodgkin lymphoma.[53]

Radiation was not associated with poorer biological features, compared with breast cancers diagnosed in similarly aged women with no prior malignancy. However, higher proportions of upper outer quadrant and smaller tumors (≤2 cm) were found.

A study using SEER Program data evaluated the clinicopathological features of 321 breast cancers diagnosed in 257 women (median age, 22 years; range, 18–26 years at Hodgkin lymphoma diagnosis) who were previously treated with radiation for Hodgkin lymphoma.[53]

Most tumors in survivors of Hodgkin lymphoma were hormone sensitive (nearly two-thirds were estrogen receptor–positive/HER2-negative). This finding suggests that endocrine prevention may be an option for this high-risk population.