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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.
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.
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.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy, Survivorship and late effects are neglected, 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 and the tag lymphoma-evidence.
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy, Survivorship and late effects are neglected, 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 and the tag lymphoma-evidence.
Shares Survivorship and late effects are neglected, 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, Toxicity and quality of life are undervalued and the tag lymphoma-evidence.