Breast cancer in women after treatment for Hodgkin's disease

Although substantial progress has been made in the management of Hodgkin's lymphoma during the past 30 years, the development of secondary malignant diseases has emerged as a serious consequence of treatment. In particular, extended follow-up of patients with Hodgkin's disease has revealed an increased risk of breast cancer. We have systematically reviewed all published literature on breast cancer after treatment for Hodgkin's disease and show that high risk is particularly associated with treatment at a young age, mantle radiotherapy, and chemotherapy. Breast cancers in this context differ from sporadic disease because they develop in younger women, are associated with a high incidence of bilateral disease, and are generally located near the midline of the body. The risk of breast cancer is lower in patients who receive newer, combined modality treatments for Hodgkin's disease. In this review we discuss a protocol for formal follow-up and screening of patients who have recovered from Hodgkin's disease to aid early diagnosis and ensure the possibility of effective management.