Breast Carcinoma Following Treatment of Hodgkin Lymphoma: A Study of 31 Patients
A Goyal, C Mies. Hospital of the University of Pennsylvania, Philadelphia, PA
Background: Approximately 30% of women successfully treated with supra-diaphragmatic radiation for Hodgkin lymphoma (HL) develop breast cancer, placing them in a high-risk category. Whether and how the clinical and pathologic characteristics of breast cancer in this setting differ from those of sporadic breast cancer is essential to developing improved screening and treatment approaches in this unique group of breast cancer patients.
Design: This is a retrospective study of 31 patients with breast cancer that occurred after treatment for HL, whose breast cancers were pathologically confirmed in our department between 1991 and 2009. We studied clinical records, pathology reports and histologic slides to determine the mode of clinical presentation, pathologic features, AJCC stage and predictive marker profile of 38 cancers occurring in these 31 patients.
Results: Median age at breast cancer diagnosis was 43 years. Mode of clinical detection, known for 29 of 38 cancers, was: palpable mass = 13; mammogram = 13; MRI = 3. Most cancers occurred in the upper quadrants (81%) & were unicentric (97%), i.e. grew as a single mass. The majority of index cancers (26/31 = 84%) were invasive; 5/31 (16%) were DCIS-only at the time of diagnosis. AJCC stage for the index cancer was known for 23 patients with invasive carcinoma: Stage I = 11/23 (48%); Stage II = 9/23 (39%); Stage III = 1/23 (4%); Stage IV = 2/23 (9%). Seven patients (23%) developed contralateral carcinoma (3 synchronous; 4 metachronous), with 3 of the metachronous carcinomas occurring > 10 years after the index cancer. Contralateral cancer was invasive in 4/7 (57%) & DCIS-only in the other 3. One contralateral DCIS was detected by MRI – alone; however, very few patients had MRI exams. Five of 26 (19%) index invasive cancers were negative for ER, PR & HER-2/neu (“triple-negative”); whereas, none of the 4 contralateral invasive cancers had this phenotype.
Conclusions: Except for occurring at a higher rate, at a lower median age and perhaps, more often in the upper quadrants, breast cancer in this high-risk context shares many features with sporadic breast cancer. These cancers do not appreciably differ with respect to rate of multicentricity, bilaterality, stage at presentation or prevalence of the “triple-negative” phenotype. Efforts to improve screening in these patients should focus on increasing the number of patients identified at the in situ stage of cancer. The pathologist's tasks are the same as for sporadic breast cancer – establishing AJCC stage and the cancer's predictive marker profile.
Monday, March 22, 2010 1:00 PM
Poster Session II # 45, Monday Afternoon