Breast cancer in Hodgkin's disease and non-Hodgkin's lymphoma survivors

Università degli Studi di Milano-Bicocca, Milano, Lombardy, Italy
Annals of Oncology (Impact Factor: 7.04). 03/2007; 18(2):288-92. DOI: 10.1093/annonc/mdl399
Source: PubMed

ABSTRACT Better therapeutic approaches for patients with Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL) resulted in high cure rates, at cost of serious late side effects. Second primary tumours are a major concern for long-term survivors, and breast cancer (BC) is the most common solid tumour among women treated for HD. Materials and methods: Fifty-three women treated for primary BC with previous history of malignant lymphoma were identified in our institution, 35 with HD (66%), 18 (34%) with NHL. A comparison group was randomly selected from our database matching for each patient with previous lymphoma, two patients with primary BC (rate 1 : 2) for age, stage (pathological tumour size [pT] status and nodal status), year of diagnosis, and estrogen and progesterone status (positive versus negative). The primary end points were disease-free survival (DFS) and overall survival (OS).
The two groups of patients were compared for biological features: histopathological diagnosis, grading, lymphatic invasion, c-erbB2 overexpression, and Ki-67. Considering these variables, no significant differences were observed between the two groups with the exception of Ki-67, which was found higher in those with previous HD or NHL (65% versus 49%, respectively, P = 0.0526, borderline significant). Comparing the two groups for treatment approach, no differences were found for surgical and medical therapy (endocrine therapy and chemotherapy). However, regarding patients with node-positive disease (14 versus 35 patients), five patients in the lymphoma group (36%), compared with 24 (69%) in the matched group received anthracycline-based therapy (P = 0.0345). As expected, radiotherapy was used very differently in the two groups, with 36% of patients in the study group undergoing intraoperative radiotherapy with electrons versus 10% in the control group (P = 0.0001). Five-year DFS was 54.5% for the study cohort compared with 91% for controls (P < 0.0001). Five-year OS percentages were also statistically different (86.6% and 98.6%, respectively, P = 0.031).
Previous history of malignant lymphoma is a negative prognostic factor for women diagnosed subsequently with BC. Some undertreatment of women with the latter might be hypothesised as the reason for the worse outcome. Influence of other variables, like previous exposure to cytotoxics, or some unknown biological features related to the previous disease and treatment, should still be investigated in the attempt to improve the dire outcome of these patients.

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    • "Similar to others studies (Yahalom et al, 1992; Gaffney et al, 2001; Janov et al, 2001; Castiglioni et al, 2007; Sanna et al, 2007), we did not observe significant differences in overall risk of high-grade and low-grade tumours. However, with increasing time since HL diagnosis, risk of high-grade BC exceeded that of low-grade BC, suggesting a radiation effect. "
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    ABSTRACT: It is unknown whether breast cancer (BC) characteristics among young women treated with radiotherapy (RT) for Hodgkin's lymphoma (HL) differ from sporadic BC. Using population-based data, we calculated BC risk following HL according to clinicopathologic features. Compared with BC in the general population, risks of oestrogen receptor (ER)-positive/progesterone receptor (PR)-positive and ER-negative/PR-negative BC in young, irradiated HL survivors were increased five-fold (95% confidence interval (CI)=3.81-6.35) and nine-fold (95% CI=6.93-12.25), respectively. Among 15-year survivors, relative risk of ER-negative/PR-negative BC exceeded by two-fold (P=0.002) than that of ER-positive/PR-positive BC. Radiotherapy may disproportionately contribute to the development of BC with adverse prognostic features among young HL survivors.
    British Journal of Cancer 09/2010; 103(7):1081-4. DOI:10.1038/sj.bjc.6605877 · 4.84 Impact Factor
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    • "Data from the current study and other studies [10,13] reported that the histological features of BC after HL are similar to those of primary BC. Sanna et al [40] reported the same findings with the exception of the proliferation index that showed higher rates in BC among the lymphoma group as compared to the group of primary BC. "
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    ABSTRACT: To evaluate diagnosis, management and outcome of breast cancer (BC) occurring after irradiation for Hodgkin's lymphoma (HL). 39 cases of BC in 28 HL survivors were retrospectively reviewed. 21 patients were included in a case-control analysis. The median age at diagnosis of HL and BC was 25.3 and 45.3 years, respectively. The median interval to develop BC was 16.1 years. Eleven women (39.2%) had bilateral disease. Mode of detection of the index breast cancers was by mammographic screening in 17 patients (60.7%), palpable lump in 8 patients (28.6%), clinical examination in two patients (7.1%), and unknown in one patient (3.6%). Case-control analysis showed that histological features and prognosis of BC after HL were similar to those of primary BC, however, for BC after HL, mastectomy was the predominant surgery (P = .001) and adjuvant radiotherapy and anthracycline-based chemotherapy were less frequently used as compared to primary BC (P < .001 and .003, respectively). The previous history of HL does not appear to be a poor prognostic factor for BC occurring thereafter.
    Radiation Oncology 07/2009; 4(1):19. DOI:10.1186/1748-717X-4-19 · 2.55 Impact Factor
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