Breast carcinoma in women previously treated for Hodgkin disease: mammographic evaluation

Although the risk of second malignancies occurring after curative therapy for Hodgkin disease (HD) is well known, few cases of breast carcinoma developing in this setting have been reported. The authors performed a retrospective review of institutional records and identified 27 women with 29 breast carcinomas who had previously undergone treatment of HD and for whom mammograms were available. Two of the 29 carcinomas were synchronous, bilateral tumors. Although the patients' ages ranged from 33 to 75 years, most were young; 16 patients (55%) were younger than 45 years, and nine (31%) were younger than 40 years. Time from treatment for HD to development of breast cancer ranged from 8 to 34 years (mean, 18 years). All women developed ductal carcinoma. Mammography demonstrated 26 of the 29 cancers (90%); 11 of the 29 cancers (38%) were detected only with mammography. In 26 tumors for which clinical findings were known, the results of physical examination were positive in 18 (69%). Women previously treated for HD may be at increased risk of developing breast cancer, which may be bilateral and develop at a young age. This increased risk may be due to scattered radiation to the breast during mantle irradiation. Mammographic screening of these women is indicated. In women who were treated for HD at a young age, routine screening before the age of 35 years is recommended.