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Hodgkin's Radiation Raises Breast Cancer Risk
Screening Important for Women Diagnosed at a Young Ages
August 2, 2003 11:31:30 PM PST
Doctors have long known that young women who survive Hodgkin disease have a greater risk of developing breast cancer later in life. A new study quantifying that risk may help doctors refine Hodgkin treatment to reduce the danger to their young female patients.
Writing in the Journal of the American Medical Association (Vol. 290, No. 4: 465-475), researchers from the National Cancer Institute and colleagues describe the different degrees of breast cancer risk associated with various treatments for Hodgkin disease (also known as Hodgkin's disease).
They compared 105 Hodgkin survivors who developed breast cancer with 266 similar Hodgkin survivors who did not get breast cancer. All the women had been diagnosed with Hodgkin disease at age 30 or younger, and almost all had been treated for it with radiation.
Higher Radiation Means More Risk
They found that the risk of breast cancer increased with the amount of radiation to the chest the women received. Women who received more than 4 gray (Gy, a unit of radiation dose) of radiation were more than three times as likely to develop breast cancer as women who received the lowest doses (less than 4 Gy) or no radiation, while women who got the highest doses (more than 40 Gy) had eight times the risk of developing breast cancer.
However, chemotherapy with certain types of drugs called alkylating agents seemed to reduce the risk. Women who got both radiation and chemotherapy had just 1.4 times the risk of developing breast cancer, and that risk decreased as the number of chemotherapy cycles went up.
Women who received only chemotherapy actually had a reduced risk of developing breast cancer, as did women who received radiation to the ovaries. The researchers explained that these treatments likely damaged the ovaries so that they no longer produced estrogen, which is believed to spur the growth of breast cancer. Many of the women who received these treatments became menopausal afterward.
Hope of Improvement with Modern Treatments
These findings suggest that doctors should use the lowest possible dose of radiation that can effectively treat the Hodgkin disease, the researchers said.
In an editorial accompanying the study, Joachim Yahalom, MD, an expert in Hodgkin disease and breast cancer at Memorial Sloan-Kettering Cancer Center, agreed. However, he noted that some amount of radiation is necessary to reduce the risk of the Hodgkin disease recurring.
Doctors should also consider reducing the area of the body that receives radiation, Yahalom said. To some extent this has already happened over the last decade; current patients typically receive radiation only to the lymph nodes where the cancer originated, as opposed to the entire chest.
The combination of lower radiation doses and a smaller radiation field "is likely to dramatically change the long-term risk profile" of young women who survive Hodgkin disease, he wrote.
Still, because the increased risk of breast cancer in these patients (and especially among those treated in previous decades) appears to last for 25 years or more, the researchers recommend long-term screening for signs of breast cancer, as well as public education efforts to make sure these women are aware of the risks.
