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A new study finds that women who are diagnosed with and treated for Hodgkin’s disease before age 30 have a significant risk of developing breast cancer as they age. In particular, radiation to the chest area increases breast cancer risk in Hodgkin’s disease survivors. However, some treatments, such as chemotherapy with certain drugs called alkylating agents and radiation to the ovaries, reduce breast cancer risk. Researchers recommend that women who have been treated for Hodgkin’s disease receive regular breast cancer screenings to increase the chances of successful treatment if they do develop breast cancer. Hodgkin’s disease, also called Hodgkin’s lymphoma, is a type of cancer that affects the lymph nodes and lymphatic system, a system which is spread out over a large portion of the body. The American Cancer Society estimates that in 2003, approximately 7,600 Americans will develop Hodgkin's disease and around 1,300 people will die of the disease. According to Lois B. Travis, MD of the National Cancer Institute and colleagues, who published their study results on Hodgkin’s disease and breast cancer risk, a second cancer is the leading cause of death among long-term survivors of Hodgkin’s disease. Dr. Travis and her team noted a particularly high risk of breast cancer in young women (under age 30) who had been treated for Hodgkin’s disease. Prior research suggests that the treatments used in Hodgkin’s disease increase breast cancer risk. To investigate the effects of radiation and chemotherapy for Hodgkin’s disease on future breast cancer risk, the researchers studied 105 young women who had been treated for Hodgkin’s disease and later developed breast cancer. They compared the women’s outcomes with 266 other young Hodgkin’s disease survivors who did not develop breast cancer. The findings showed that radiation to the chest area to treat Hodgkin’s disease increased the risk of breast cancer. Women who received a radiation dose of 4 Gy or more delivered to the breast were 3.2 times more likely to develop breast cancer compared to women who did not receive radiation to the chest. Women who received the highest doses of radiation (40 Gy) to the breast for Hodgkin’s disease were eight times more likely to develop breast cancer. These risks remained for more than 25 years after treatment for Hodgkin’s disease. Interestingly, chemotherapy with alkylating agents appeared to decrease breast cancer risk. This may be the result of premature menopause, which often results from chemotherapy. Similarly, radiation to the ovaries also lowered the risk of breast cancer. This is thought to be due to the impaired functioning of the ovaries after radiation therapy. Since women’s ovaries could no longer produce estrogen, a hormone which is known to play a role in breast cancer development, the risk of breast cancer was therefore reduced. Based on these results, Dr. Travis and her colleagues conclude that certain Hodgkin’s disease treatments (particularly radiation to the chest area) increase breast cancer risk, especially in young women. Since this risk can last up to 25 years after treatment, the researchers advocate diligent breast cancer screening and public awareness of the long-term risks of Hodgkin’s disease treatment. To help detect breast cancer in its earliest stages, when the chances of successful treatment and survival are greatest, all women (particularly those treated for Hodgkin’s disease) should receive regular clinical breast exams and may wish to practice monthly breast self-exams. Women ages 40 to 50 should also receive screening mammograms every one to two years, and women age 50 and older should receive mammograms every year.
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