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Article: Mammographic screening in women at increased risk of breast cancer after treatment of Hodgkin's disease

TitleMammographic screening in women at increased risk of breast cancer after treatment of Hodgkin's disease
Authors
KeywordsBreast cancer
Hodgkin's disease
Screening
Issue Date2008
PublisherBlackwell Publishing, Inc. The Journal's web site is located at http://www.blackwellpublishing.com/journals/TBJ
Citation
Breast Journal, 2008, v. 14 n. 1, p. 39-48 How to Cite?
AbstractTreatment regimens for Hodgkin's disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age. We contacted by mail a cohort of 291 women between 25 and 55 years of age who had received thoracic irradiation before 35 years of age for HD with or without chemotherapy. Subjects were offered information about risks identified after HD therapy with questionnaires to assess response to this information. Ten patients refused participation, 93 did not respond, and 21 were excluded after they reported a prior diagnosis of invasive (1) or in situ (2) breast cancer. One hundred and sixty seven women received information about secondary breast cancer risk and were advised to initiate or maintain mammographic screening. Available mammograms were reviewed by two radiologists and classified according to the ACR BI-RADS™ Mammography Lexicon. Abnormal findings were correlated to pathology results from biopsies. One hundred and fifteen subjects reported that they obtained new mammograms during the period of the study. Ninety-nine were available for secondary review. Patients were studied an average of 16.9 years after HD treatment (Range: 4.5-32.5 years) at an average of 41 years of age (range 25-55 years). High density breast tissue was identified in 60% (60/99). Seventeen of the women (17.2%) were recalled for further imaging. This was more common in women with heterogeneously dense breast tissue. Seven of those recalled (41%) were advised to undergo biopsies that identified ductal carcinoma in situ (DCIS) in one and benign findings in the others. Among 16 women whose mammograms were unavailable for review, three were diagnosed with DCIS; two of these had microscopic evidence of invasive breast cancer. The four in situ or microinvasive cancers were diagnosed in the study participants at 25-40 years of age and from 5 to 23 years after HD therapy. Biopsies were performed because mammograms detected microcalcifications without palpable abnormality in three of these cases. Women who have had thoracic nodal irradiation for Hodgkin's disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects. © 2007 Blackwell Publishing, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/182274
ISSN
2015 Impact Factor: 1.92
2015 SCImago Journal Rankings: 0.803
References

 

DC FieldValueLanguage
dc.contributor.authorKwong, Aen_HK
dc.contributor.authorHancock, SLen_HK
dc.contributor.authorBloom, JRen_HK
dc.contributor.authorPal, Sen_HK
dc.contributor.authorBirdwell, RLen_HK
dc.contributor.authorMariscal, Cen_HK
dc.contributor.authorIkeda, DMen_HK
dc.date.accessioned2013-04-19T09:14:58Z-
dc.date.available2013-04-19T09:14:58Z-
dc.date.issued2008en_HK
dc.identifier.citationBreast Journal, 2008, v. 14 n. 1, p. 39-48en_HK
dc.identifier.issn1075-122Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/182274-
dc.description.abstractTreatment regimens for Hodgkin's disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age. We contacted by mail a cohort of 291 women between 25 and 55 years of age who had received thoracic irradiation before 35 years of age for HD with or without chemotherapy. Subjects were offered information about risks identified after HD therapy with questionnaires to assess response to this information. Ten patients refused participation, 93 did not respond, and 21 were excluded after they reported a prior diagnosis of invasive (1) or in situ (2) breast cancer. One hundred and sixty seven women received information about secondary breast cancer risk and were advised to initiate or maintain mammographic screening. Available mammograms were reviewed by two radiologists and classified according to the ACR BI-RADS™ Mammography Lexicon. Abnormal findings were correlated to pathology results from biopsies. One hundred and fifteen subjects reported that they obtained new mammograms during the period of the study. Ninety-nine were available for secondary review. Patients were studied an average of 16.9 years after HD treatment (Range: 4.5-32.5 years) at an average of 41 years of age (range 25-55 years). High density breast tissue was identified in 60% (60/99). Seventeen of the women (17.2%) were recalled for further imaging. This was more common in women with heterogeneously dense breast tissue. Seven of those recalled (41%) were advised to undergo biopsies that identified ductal carcinoma in situ (DCIS) in one and benign findings in the others. Among 16 women whose mammograms were unavailable for review, three were diagnosed with DCIS; two of these had microscopic evidence of invasive breast cancer. The four in situ or microinvasive cancers were diagnosed in the study participants at 25-40 years of age and from 5 to 23 years after HD therapy. Biopsies were performed because mammograms detected microcalcifications without palpable abnormality in three of these cases. Women who have had thoracic nodal irradiation for Hodgkin's disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects. © 2007 Blackwell Publishing, Inc.en_HK
dc.languageeng-
dc.publisherBlackwell Publishing, Inc. The Journal's web site is located at http://www.blackwellpublishing.com/journals/TBJen_HK
dc.relation.ispartofBreast Journalen_HK
dc.rightsThe definitive version is available at www.blackwell-synergy.com-
dc.subjectBreast canceren_HK
dc.subjectHodgkin's diseaseen_HK
dc.subjectScreeningen_HK
dc.subject.meshBreast Neoplasms - radiography-
dc.subject.meshHodgkin Disease - radiotherapy-
dc.subject.meshMammography-
dc.subject.meshNeoplasms, Radiation-Induced - radiography-
dc.subject.meshNeoplasms, Second Primary - radiography-
dc.titleMammographic screening in women at increased risk of breast cancer after treatment of Hodgkin's diseaseen_HK
dc.typeArticleen_HK
dc.identifier.emailKwong, A: avakwong@hkucc.hku.hken_HK
dc.identifier.authorityKwong, A=rp01734en_HK
dc.identifier.doi10.1111/j.1524-4741.2007.00524.xen_HK
dc.identifier.pmid18186864-
dc.identifier.scopuseid_2-s2.0-37849025805en_HK
dc.identifier.hkuros141613-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-37849025805&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume14en_HK
dc.identifier.issue1en_HK
dc.identifier.spage39en_HK
dc.identifier.epage48en_HK
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridKwong, A=8913654300en_HK
dc.identifier.scopusauthoridHancock, SL=7006327815en_HK
dc.identifier.scopusauthoridBloom, JR=7201379250en_HK
dc.identifier.scopusauthoridPal, S=7402277967en_HK
dc.identifier.scopusauthoridBirdwell, RL=7004724231en_HK
dc.identifier.scopusauthoridMariscal, C=6507459023en_HK
dc.identifier.scopusauthoridIkeda, DM=26643252200en_HK

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