# Breast cancer after chest radiotherapy given young

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OnCo record `second-primary-breast-after-chest-radiotherapy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

This is the second cancer with a real screening programme attached, and the one most worth asking about by name. A woman who had radiotherapy to breast tissue between the ages of 10 and 35, most often for Hodgkin lymphoma, is eligible in England for annual magnetic resonance imaging from age 25 or 30, and being missed from that list has happened often enough that asking is reasonable.

## Summary

What is offered. In England, entry to the NHS Breast Screening Programme's very high risk pathway, which for this group means annual magnetic resonance imaging from age 25 or 30 and annual MRI plus mammography from 40. The exact ages, which depend on how old you were when irradiated, are on the screening record beside this one. Referral runs through the breast screening after radiotherapy dataset, BARD, which cross-matches cancer registry records against radiotherapy treatment records to find eligible women. Women treated for a cancer other than lymphoma are referred by their oncologist using a BARD non-lymphoma referral form.

Why the programme exists. A matched case-control study inside an international cohort of 3,817 women who survived at least a year after Hodgkin's disease diagnosed at age 30 or younger between 1965 and 1994 compared 105 who developed breast cancer with 266 who did not. A radiation dose of 4 Gy or more to the site where the breast cancer later appeared carried a relative risk of 3.2 (95% CI 1.4 to 8.2) against lower doses without alkylating agents, rising to 8.0 (2.6 to 26.4) above 40 Gy, with a dose trend at P < .001. The excess persisted 25 years or more after radiotherapy. Radiation risk "did not vary appreciably by age at exposure or reproductive history" within this already-young cohort.

The absolute numbers, which are what a woman actually wants. Using the same cohort, the authors calculated cumulative absolute risk. For a woman treated for Hodgkin lymphoma at age 25 with a chest radiation dose of at least 40 Gy and no alkylating agents, the estimated cumulative absolute risk of breast cancer was 1.4 per cent by age 35 (95% CI 0.9 to 2.1), 11.1 per cent by 45 (7.4 to 16.3) and 29.0 per cent by 55 (20.2 to 40.1). The paper states that these estimates "are applicable to HL survivors treated with regimens of the past" and that projections "should be used with caution, however, in patients treated with more recent approaches, including limited-field radiotherapy and/or ovary-sparing chemotherapy". That sentence is as important as the numbers.

The part that surprises people: chemotherapy lowered this risk. In the same study, treatment with alkylating agents alone carried a relative risk of breast cancer of 0.6 (0.2 to 2.0), and risk fell with each additional cycle of alkylating agents (P = .003). Women who received 5 Gy or more to the ovaries had a relative risk of 0.4 (0.1 to 1.1) compared with those who received less. The authors' interpretation is that "hormonal stimulation appears important for the development of radiation-induced breast cancer, as evidenced by the reduced risk associated with ovarian damage from alkylating agents or radiation". It is an uncomfortable finding: the treatment that caused early menopause also lowered this particular risk, and ovarian function after chemotherapy is covered on its own record on this front.

Who else this applies to. Any radiotherapy field that includes breast tissue in a woman under 36, not only lymphoma. The NHS guidance states that most eligible women were treated for Hodgkin or non-Hodgkin lymphoma but that "other diagnoses may also result in similar radiotherapy treatment fields", and gives a named route for checking an uncertain case. Total body irradiation before a transplant is an explicitly open question: the guidance records that women who had it "are at an elevated risk of breast cancer in the years following treatment" and that NHS England "will review the evidence to determine if previous TBI reaches the eligibility threshold for the VHR screening programme". That is a named gap in a national programme, and it is written down in the programme's own document.

The failure mode. Being eligible and never being invited. The corpus record on Hodgkin survivorship screening sets out the NHS England recall of women treated before 2003 who should have been referred and may not have been. If you had radiotherapy above the waist as a young woman and have never had a screening invitation, that is a reason to ask rather than to assume you were missed for a good reason.

## Fields

- Kind: Term
- Last checked: 2026-10-02
- Also known as: Breast cancer after Hodgkin lymphoma; Breast cancer after mantle radiotherapy; Radiation-related breast cancer
- Tags: rejuvenation; survivorship; second-cancers; breast; radiotherapy; screening

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Radiation-induced_cancer
- Travis et al., Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease (JAMA 2003): https://doi.org/10.1001/jama.290.4.465
- Travis et al., Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma (JNCI 2005): https://doi.org/10.1093/jnci/dji290
- NHS England: Eligibility criteria and screening protocols for women at very high risk of breast cancer (updated 18 November 2025): https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/tests-and-frequency-of-testing-for-women-at-very-high-risk--2
- NHS England: Protocols for surveillance of women at higher risk of developing breast cancer (updated 18 November 2025): https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/protocols-for-surveillance-of-women-at-higher-risk-of-developing-breast-cancer

## Connected records

- terms: [After Hodgkin lymphoma: the late effects, and the screening that follows them](https://onco.cc/terms/lymphoma-living-hodgkin-survivorship-screening/), [Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them](https://onco.cc/terms/lymphoma-tx-hodgkin-late-effects/), [Radiotherapy and second cancers: field, dose and age at exposure](https://onco.cc/terms/rejuv-second-radiotherapy-dose-field-and-age/), [Screening survivors: where the UK, American and European answers differ](https://onco.cc/terms/rejuv-second-screening-after-treatment-compared/), [Second cancers after radiotherapy](https://onco.cc/terms/second-cancers-after-radiotherapy/), [Second cancers after treatment: what the risk is, and what is done about it](https://onco.cc/terms/rejuv-second-cancers-overview/), [Secondary malignancy (therapy-related cancer)](https://onco.cc/terms/secondary-malignancy/), [The UK very high risk breast screening protocol after chest radiotherapy](https://onco.cc/terms/rejuv-second-uk-very-high-risk-breast-screening/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [MRI](https://onco.cc/technologies/mri/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [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/)
- key papers: [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/)

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