Breast Cancer after Hodgkin's Lymphoma: An Observational Study Breast Cancer After Hodgkin Lymphoma

Francesco Milardi (1), Silvia Michieletto (2), Fernando Bozza (3), Lisa Rigato (4), Tania Saibene (5), Matteo Cagol (6), Massimo Ferrucci (7), Daniele Passeri (8), Mariacristina Toffanin (9), Tajna Kraljic (10), Alberto Marchet (11), Laura Evangelista (12)
(1) General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy, Italy,
(2) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy., Italy,
(3) Breast Surgery Unit, Department of Surgery, Villa Salus Hospital, Venice, Italy., Italy,
(4) Breast Surgery Unit, Department of Surgery, Villa Salus Hospital, Venice, Italy., Italy,
(5) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(6) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(7) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(8) General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy, Italy,
(9) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(10) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(11) Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy, Italy,
(12) IRCCS Humanitas Research Hospital, Rozzano, , Italy

Abstract

Background: Breast cancer (BC) counts for half of the excess risk of second cancer after Hodgkin Lymphoma (HL), but evidence about the clinical and pathological features of these cancers is lacking. The aim of this study was to evaluate whether these secondary BCs have distinctive characteristics compared to sporadic ones.


Methods: This is a case-control study comparing patients who developed BC after receiving treatment for HL with an age-matched cohort of non-irradiated patients.  All the cases were treated at the Veneto Institute of Oncology (Padua, Italy) between 2002 and 2017. We analyzed the clinical and pathologic features of BCs and compared treatment modalities using Chi-squared tests. Kaplan-Meier survival analyses were conducted to investigate overall and disease-free survival in the two groups.


Results: 35 patients who were treated for HL and subsequently developed BCs were identified. BC occurred after a mean interval of 19.65 years (SD=10.08 years) from the HD diagnosis. 4 of the patients treated for HL (11.4%) had a bilateral presentation. 80% of the cases and 63% of the controls were ER+/HER- (p=0.516), while 20% of the HL group and 5.7% of the sporadic group were ER- /HER- (p=0.116). Ipsilateral BC recurrence (17.1% vs 8.6% in the sporadic BC group, p=0.346) and death events were more frequent in the HL group (11.4% vs 5.7% in the sporadic BC group, p=0.433), with a mean follow-up of 70 months (standard deviation=42.8months).


Conclusions: Our data show that BC arising after HL often presented with bilateral localization, aggressive biological profiles, and had high recurrence rates. Dedicated treatment modalities should be considered and evaluated in a multidisciplinary setting.

Full text article

Generated from XML file

References

Kennedy BJ, Fremgen AM, Menck HR. Hodgkin's disease survival by stage and age. J Am Geriatr Soc. 2000 Mar;48(3):315-7. doi: 10.1111/j.1532-5415.2000.tb02653.x. PMID: 10733060.

Canellos GP, Rosenberg SA, Friedberg JW, Lister TA, DeVita VT. Treatment of Hodgkin Lymphoma: A 50-Year Perspective. J Clin Oncol. 2014; 32: 163-168.

Hudson BMM, Poquette CA, Lee J, Greenwald CA, Shah A, Luo X, Thompson EI, Wilimas JA, Kun E, Crist WM. Increased Mortality After Successful Treatmentfor Hodgkin ’s Disease. J Clin Oncol. 1998; 16: 3592-3600

Dores M, Metayer C, Curtis RE; Lynch CF, Clarke A, Glimelius B, Storm H, Pukkala E, van Leeuwen F, Stovall M, Gosparodowics M, Travis LB. Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years. J Clin Oncol. 2002; 20: 3484-3494

Schaapveld M, Aleman BMP, van Eggermond AM, Janus C, Krol A, van der Maazen R, Roesink J, Raemaekers J, de Boer JP, Zijlstra JM, van Imhoff G, Petersen EJ, Poortmans P, Lyybert M, Mulder I, Visser O, Louwman M, Krul I, Luggtenburg P, van Leeuwen F. Second Cancer Risk Up to 40 Years after Treatment for Hodgkin’s Lymphoma. N Engl J Med. 2015; 373: 2499-2511.

Ibrahim EM, Abouelkhair KM, Kazkaz GA, Elmasri OA, Al-Foheidi M. Risk of second breast cancer in female Hodgkin’s lymphoma survivors: A meta-analysis. BMC Cancer. 2012; 12: 1-19

Moskowitz CS, Chou JF, Wolden SL, et al. Breast cancer after chest radiation therapy for childhood cancer. J Clin Oncol. 2014;32(21):2217-2223. doi:10.1200/JCO.2013.54.4601

Yahalom J. Breast cancer in patients irradiated for Hodgkin’s disease. A clinical and pathologic analysis of 45 events in 37 patients. J Clin Oncol. 1992; 10: 1674-1681.

Janov AJ, Tulecke M, O’Neill A. Clinical and pathologic features of breast cancers in women treated for Hodgkin’s disease: A case-control study. Breast J. 2001; 7: 46-52

Gervais-Fagnou DD, Girouard C, Laperriere N, Pintillie M, Goss PE. Breast cancer in women following supradiaphragmatic irradiation for Hodgkin’s disease. Oncology. 1999; 57: 224-231

Horst KC, Hancock SL, Ognibene G, Chen C, Advani R, Rosenberg A, Donaldson S, Hoppe RT. Histologic subtypes of breast cancer following radiotherapy for hodgkin lymphoma. Ann Oncol. 2014; 25: 848-851

Castiglioni F, Terenziani M, Carcangiu ML, Miliano R, Aiello P, Bertola L, Triulzi T, Gasparini P, Camerini T, Sozzi G, Fossati-Bellani F, Menard S, Tagliebue E.. Radiation effects on development of HER2-positive breast carcinomas. Clin Cancer Res. 2007; 13: 46-51

Boughey JC, Attai DJ, Chen SL, Cody HS, Dietz JR, Feldman SM, Greenberg CC, Kass RB, Landercasper J, Lemaine V, MacNeill F, Song D, Staley AC, Wilke LG, Willey SC, Yao KA, Margenthaler A. Contralateral Prophylactic Mastectomy (CPM) Consensus Statement from the American Society of Breast Surgeons: Data on CPM Outcomes and Risks. Ann Surg Oncol. 2016; 23: 3100-3105.

Broeks A, Braaf LM, Wessels LFA, van de Vijver, De Bruin M,Stovall ML, Russell M, van Leeuwen N, Van 't Veer F, Laura J. . Radiation-Associated Breast Tumors Display a Distinct Gene Expression Profile. Int J Radiat Oncol Biol Phys. 2010; 76: 540-547.

Arthur DW, Winter KA, Kuerer HM, et al. Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: The NRG Oncology/RTOG 1014 Phase 2 Clinical Trial. JAMA Oncol. 2020;6(1):75-82. doi:10.1001/jamaoncol.2019.4320

Walstra CJEF, Schipper RJ, Poodt IGM, et al. Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: A systematic review. Eur J Surg Oncol. 2019;45(8):1317-1327. doi:10.1016/j.ejso.2019.02.008

Burt, LM, Poppe, M, Kokeny, KE, Comparison of treatment modalities for breast cancer arising in Hodgkin’s lymphoma survivors. Journal of Radiation Oncology, 2016, 1(6), 65-72.

Krul IM, Opstal-van Winden AWJ, Aleman BMP, et al. Breast Cancer Risk After Radiation Therapy for Hodgkin Lymphoma: Influence of Gonadal Hormone Exposure. Int J Radiat Oncol Biol Phys. 2017;99(4):843-853. doi:10.1016/j.ijrobp.2017.07.016

Travis LB, Hill DA, Dores GM, et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease [published correction appears in JAMA. 2003 Sep 10;290(10):1318]. JAMA. 2003;290(4):465-475. doi:10.1001/jama.290.4.465

Kraus-Tiefenbacher U, Bauer L, Scheda A, et al. Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer. 2007;7:178. Published 2007 Sep 14. doi:10.1186/1471-2407-7-178

Sanna G, Lorizzo K, Rotmensz N, et al. Breast cancer in Hodgkin's disease and non-Hodgkin's lymphoma survivors. Ann Oncol. 2007;18(2):288-292. doi:10.1093/annonc/mdl399

Baxstrom K, Peterson BA, Lee C, Vogel RI, Blaes AH. A pilot investigation on impact of participation in a long-term follow-up clinic (LTFU) on breast cancer and cardiovascular screening among women who received chest radiation for Hodgkin lymphoma. Support Care Cancer. 2018;26(7):2361-2368. doi:10.1007/s00520-018-4072-x

Mulder RL, Kremer LC, Hudson MM, et al. Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2013;14(13):e621-e629. doi:10.1016/S1470-2045(13)70303-

Authors

Francesco Milardi
milardi94@gmail.com (Primary Contact)
Silvia Michieletto
Fernando Bozza
Lisa Rigato
Tania Saibene
Matteo Cagol
Massimo Ferrucci
Daniele Passeri
Mariacristina Toffanin
Tajna Kraljic
Alberto Marchet
Laura Evangelista
1.
Milardi F, Michieletto S, Bozza F, Rigato L, Saibene T, Cagol M, Ferrucci M, Passeri D, Toffanin M, Kraljic T, Marchet A, Evangelista L. Breast Cancer after Hodgkin’s Lymphoma: An Observational Study : Breast Cancer After Hodgkin Lymphoma. Arch Breast Cancer [Internet]. [cited 2024 Dec. 11];12(1). Available from: https://archbreastcancer.com/index.php/abc/article/view/1029

Article Details