Young women who are treated for Hodgkin lymphoma with chestradiation therapy have a high cumulative absolute risk of developingbreast cancer later in life. This risk increases with age at end offollow-up, time since diagnosis, and radiation dose, according to a newstudy in the October 5 issue of the Journal of the National CancerInstitute.
Due to advances in the treatment of Hodgkin lymphoma,there are now many long-term survivors who are at risk for thedevelopment of secondary cancers that frequently reflect the late sideeffects of treatment. Second primary cancers are the leading cause ofdeath among long-term survivors, and breast cancer is the most commonsecondary cancer in female Hodgkin lymphoma survivors.
Toestimate the future cumulative absolute risk of breast cancer for youngwomen treated for Hodgkin lymphoma, Lois B. Travis, M.D., of theNational Cancer Institute, and colleagues analyzed data from acase-control study within an international population-based cohort of3,817 female 1-year survivors of Hodgkin lymphoma who had beendiagnosed at age 30 or younger between 1965 and 1994.
Thecumulative absolute risk of developing breast cancer increased with ageat end of follow-up, time since diagnosis, and radiation dose. Forexample, a woman who was treated for Hodgkin lymphoma at age 20 with achest radiation dose of at least 40 Gy without alkylating agents wouldhave a 0.4% risk of developing breast cancer by age 30, a 4.9% risk byage 40, and a 19.1% risk by age 50. By comparison, for white women inthe general population, the absolute risks of breast cancer from age 20to ages 30, 40, and 50 are, respectively, 0.04%, 0.5%, and 2.0%.
"However,it should always be noted that the gains in long-term survival providedby successful radiotherapy and chemotherapy outweigh the associatedrisks of breast cancer and other late sequelae. Moreover, currentmodifications in treatment will likely result in lower risks of breastcancer in the future," the authors write.
In an editorial, Dan L.Longo, M.D., of the National Institute on Aging, questions thecontinued routine use of radiation therapy for the treatment of Hodgkindisease when alternative approaches, such as combination chemotherapyalone, have similar success in curing the disease without the magnitudeof late fatal complications. "We need to stop exposing women to therisk of subsequent breast cancer (and other malignancies and heartdisease) by needlessly using radiation therapy as a component of theirHodgkin disease treatment," he writes. "A Pyrrhic victory in theabsence of reasonable alternative ways to accomplish the goal can betragic but necessary; a Pyrrhic victory that could be avoided whilestill accomplishing the goal is just foolish."
#Article: Travis LB, Hill D, Dores GM, Gospodarowicz M, van Leeuwen FE,Holowaty E, et al. Cumulative Absolute Breast Cancer Risk for YoungWomen Treated for Hodgkin Lymphoma. J Natl Cancer Inst 2005;97:1428
# Editorial: Longo DL. Radiation Therapy in Hodgkin Disease: Why Risk A Pyrrhic Victory? J Natl Cancer Inst 2005;97:1394
Note:The Journal of the National Cancer Institute is published by OxfordUniversity Press and is not affiliated with the National CancerInstitute. Visit the Journal online at http://jncicancerspectrum.oxfordjournals.org/.
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