# Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease

Source: https://onco.cc/key-papers/paper-travis-breast-cancer-after-hodgkin-radiotherapy-jama-2003/  
OnCo record `paper-travis-breast-cancer-after-hodgkin-radiotherapy-jama-2003` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In young women treated for Hodgkin lymphoma, breast cancer risk rose with the radiation dose to the breast, and fell when chemotherapy or radiation had stopped the ovaries working.

## Summary

This international case-control study inside a cohort quantified the two things that decide breast cancer risk after Hodgkin lymphoma: how much radiation the breast received, and whether the ovaries kept working afterwards. 105 women who developed breast cancer were matched to 266 women with Hodgkin lymphoma who did not, all drawn from a cohort of 3,817 one-year survivors diagnosed at age 30 or younger between 1965 and 1994 across six population-based cancer registries.

A radiation dose of 4 Gy or more to the site of the breast cancer was associated with a 3.2-fold increased risk (95 per cent confidence interval 1.4 to 8.2) compared with women who received lower doses and no alkylating agents. Risk rose to eightfold (2.6 to 26.4) with a dose above 40 Gy. The risk did not diminish at the highest doses or with the longest follow-up.

The protective finding is the mechanistic one. Ovarian damage from alkylating agents or from radiation to the ovaries reduced risk, which indicates that hormonal stimulation is required for radiation-induced breast cancer to develop. That is a biologically coherent and clinically unwelcome result: the treatment that lowers one risk raises others and causes infertility.

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: Travis 2003; Radiation dose and breast cancer risk after Hodgkin lymphoma
- Tags: lymphoma-evidence
- Journal: JAMA
- Year: 2003
- DOI: 10.1001/jama.290.4.465
- Authors: Travis LB, Hill DA, Dores GM, et al.
- Findings: A radiation dose of 4 Gy or more to the breast was associated with a 3.2-fold increased breast cancer risk (95 per cent confidence interval 1.4 to 8.2) compared with lower doses and no alkylating agents.; Risk rose to eightfold (2.6 to 26.4) with a dose above 40 Gy.; The radiation-related risk did not diminish at the highest doses or with the longest follow-up.; Ovarian damage from alkylating agents or from radiation to the ovaries was associated with reduced breast cancer risk, indicating that hormonal stimulation is important for radiation-induced breast cancer.; 105 breast cancer cases were matched to 266 controls within a cohort of 3,817 women diagnosed with Hodgkin lymphoma at age 30 or younger.
- What it means: The dose-response curve behind breast surveillance programmes for women irradiated for Hodgkin lymphoma as teenagers or young adults, which in several countries start at 25 or eight years after radiotherapy and use magnetic resonance imaging as well as mammography.
- Caveats: A case-control study within a cohort, with radiation doses reconstructed from treatment records rather than measured.; Treatment eras up to 1994, with mantle fields far larger than modern involved-site radiotherapy.; 105 cases gives wide confidence intervals, particularly in the highest dose stratum.; The protective effect of ovarian failure is not a treatment recommendation: premature menopause carries its own substantial harms.

## Sources

- JAMA 2003: https://doi.org/10.1001/jama.290.4.465
- PubMed: https://pubmed.ncbi.nlm.nih.gov/12876089/
- Europe PMC: https://europepmc.org/article/MED/12876089

## Connected records

- key papers: [Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk](https://onco.cc/key-papers/paper-van-nimwegen-cardiovascular-disease-after-hodgkin-jama-intern-med-2015/), [Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma](https://onco.cc/key-papers/paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015/)
- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Radiation Therapy](https://onco.cc/fronts/radiation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Radiotherapy](https://onco.cc/terms/radiotherapy/)
- technologies: [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [JAMA](https://onco.cc/journals/jama/)
- ideas: [Measure the late effects of the treatments being given now, not the ones given in 1975](https://onco.cc/ideas/lymphoma-ev-late-effects-of-the-treatments-given-now/)

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