Radiation Therapy for Hodgkin's Disease and Breast Cancer
Dear OncoLink "Ask the Experts,"
Your article on the long-term effects of radiation failed to mention the connection between radiation therapy and breast cancer. There have been many articles including the Journal of the National Cancer Institute, Journal of the American Medical Association, New England Journal of Medicine and the Southern Medical Journal. Many young adolescents and teen girls, who received radiation therapy for Hodgkin's disease in the1980ss are unaware of the risks and not seeking the proper follow up.
VG, a VC and breast cancer survivor
John Han-Chih Chang, MD, OncoLink Editorial Assistant, responds:
Thank you for your interest and voicing your concern.
The Frequently Asked Question document you had mentioned addressed the issues surrounding the etiology of diabetes and hypothyroidism. The possibility of radiation therapy being at the root of those two problems was discussed to directly respond to the inquiry.
The question of second malignancies in patients treated for Hodgkin's disease in their adolescence is a complicated one. Is there a higher propensity for patients who have had Hodgkin's disease to have another cancer, is it because of the treatment they received, or is it for both reasons that these patients have a higher risk?
Regardless, a preponderance of data demonstrate an increased rate of second malignancies in patients treated for Hodgkin's disease with radiation with or without chemotherapy. The types of cancers include but are not limited to breast cancer, lung cancer, non-Hodgkins lymphoma, sarcomas and leukemias (mostly chemotherapy associated). The latent period is over 10 or leukemias (6 . The estimated actuarial risk of any second neoplasms at 15 years after diagnosis is approximately 5 cancer risk of 2% estimated 20 years from diagnosis for all female Hodgkin's disease patients (treated in child- or adulthood). Data from Stanford University on nearly 700 patients treated for childhood Hodgkin's disease suggest a 9% risk of developing breast cancer at 20 years from diagnosis. The New England Journal of Medicine published a review on over 1300 patients with childhood Hodgkin's treated before the age of 16 years. They described the breast cancer risk to be as high as 35% by the age of 40 years, which is higher than other reports.
The risk of second malignancies is at least 2 if they were treated during childhood or adolescence. Recommendations are for routine follow-up on an every 6 month basis (at the very least) along with monthly breast self-examinations. Screening exams should begin earlier than the recommended time period for average women.
Here are some references for a more in depth review of the subject:
- Bhatia S, et al. New England Journal of Medicine 1996; Volume 334: pages 745-751
- Shah AB, et al. International Journal of Radiation Oncology Biology and Physics 1999; Volume 44: pages 867-77
- Nyandoto P, et al. International Journal of Radiation Oncology Biology and Physics 1998; Volume 42: pages 373-8
- Wolden SL, et al. Journal of Clinical Oncology 1998; Volume 16: pages 536-44