Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma

A multi-institutional, matched cohort study

Elena B. Elkin, Michelle L. Klem, Anne Marie Gonzales, Nicole M. Ishill, David Hodgson, Andrea K. Ng, Lawrence B. Marks, Joanne Weidhaas, Gary M. Freedman, Robert C. Miller, Louis S. Constine, Sten Myrehaug, Joachim Yahalom

Research output: Contribution to journalArticle

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Abstract

Purpose: To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). Patients and Methods: Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. Results: A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). Conclusion: In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.

Original languageEnglish (US)
Pages (from-to)2466-2473
Number of pages8
JournalJournal of Clinical Oncology
Volume29
Issue number18
DOIs
StatePublished - Jun 20 2011

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Hodgkin Disease
Cohort Studies
Radiation
Breast Neoplasms
Radiotherapy
Medical Records
Survivors
Neoplasms
Primary Health Care

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma : A multi-institutional, matched cohort study. / Elkin, Elena B.; Klem, Michelle L.; Gonzales, Anne Marie; Ishill, Nicole M.; Hodgson, David; Ng, Andrea K.; Marks, Lawrence B.; Weidhaas, Joanne; Freedman, Gary M.; Miller, Robert C.; Constine, Louis S.; Myrehaug, Sten; Yahalom, Joachim.

In: Journal of Clinical Oncology, Vol. 29, No. 18, 20.06.2011, p. 2466-2473.

Research output: Contribution to journalArticle

Elkin, EB, Klem, ML, Gonzales, AM, Ishill, NM, Hodgson, D, Ng, AK, Marks, LB, Weidhaas, J, Freedman, GM, Miller, RC, Constine, LS, Myrehaug, S & Yahalom, J 2011, 'Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma: A multi-institutional, matched cohort study', Journal of Clinical Oncology, vol. 29, no. 18, pp. 2466-2473. https://doi.org/10.1200/JCO.2010.32.4079
Elkin, Elena B. ; Klem, Michelle L. ; Gonzales, Anne Marie ; Ishill, Nicole M. ; Hodgson, David ; Ng, Andrea K. ; Marks, Lawrence B. ; Weidhaas, Joanne ; Freedman, Gary M. ; Miller, Robert C. ; Constine, Louis S. ; Myrehaug, Sten ; Yahalom, Joachim. / Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma : A multi-institutional, matched cohort study. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 18. pp. 2466-2473.
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abstract = "Purpose: To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). Patients and Methods: Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. Results: A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95{\%} CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95{\%} CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95{\%} CI, 0.7 to 3.4). Conclusion: In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.",
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T1 - Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma

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AU - Elkin, Elena B.

AU - Klem, Michelle L.

AU - Gonzales, Anne Marie

AU - Ishill, Nicole M.

AU - Hodgson, David

AU - Ng, Andrea K.

AU - Marks, Lawrence B.

AU - Weidhaas, Joanne

AU - Freedman, Gary M.

AU - Miller, Robert C.

AU - Constine, Louis S.

AU - Myrehaug, Sten

AU - Yahalom, Joachim

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N2 - Purpose: To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). Patients and Methods: Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. Results: A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). Conclusion: In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.

AB - Purpose: To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). Patients and Methods: Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. Results: A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). Conclusion: In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.

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