TY - JOUR
T1 - Breast Cancer Risk After Radiation Therapy for Hodgkin Lymphoma
T2 - Influence of Gonadal Hormone Exposure
AU - Krul, Inge M.
AU - Opstal-van Winden, Annemieke W.J.
AU - Aleman, Berthe M.P.
AU - Janus, Cécile P.M.
AU - van Eggermond, Anna M.
AU - De Bruin, Marie L.
AU - Hauptmann, Michael
AU - Krol, Augustinus D.G.
AU - Schaapveld, Michael
AU - Broeks, Annegien
AU - Kooijman, Karen R.
AU - Fase, Sandra
AU - Lybeert, Marnix L.
AU - Zijlstra, Josée M.
AU - van der Maazen, Richard W.M.
AU - Kesminiene, Ausrele
AU - Diallo, Ibrahima
AU - de Vathaire, Florent
AU - Russell, Nicola S.
AU - van Leeuwen, Flora E.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11/15
Y1 - 2017/11/15
N2 - Background Young women treated with chest radiation therapy (RT) for Hodgkin lymphoma (HL) experience a strongly increased risk of breast cancer (BC). It is unknown whether endogenous and exogenous gonadal hormones affect RT-associated BC risk. Methods We conducted a nested case-control study among female 5-year HL survivors treated before age 41. Hormone exposure and HL treatment data were collected through medical records and questionnaires for 174 BC case patients and 466 control patients. Radiation dose to breast tumor location was estimated based on RT charts, simulation films, and mammography reports. Results We observed a linear radiation dose-response curve with an adjusted excess odds ratio (EOR) of 6.1%/Gy (95% confidence interval [CI]: 2.1%-15.4%). Women with menopause <30 years (caused by high-dose procarbazine or pelvic RT) had a lower BC risk (OR, 0.13; 95% CI, 0.03-0.51) than did women with menopause ≥50 years. BC risk increased by 6.4% per additional year of post-RT intact ovarian function (P<.001). Among women with early menopause (<45 years), hormone replacement therapy (HRT) use for ≥2 years did not increase BC risk (OR, 0.86; 95% CI, 0.32-2.32), whereas this risk was nonsignificantly increased among women without early menopause (OR, 3.69; 95% CI, 0.97-14.0; P for interaction:.06). Stratification by duration of post-RT intact ovarian function or HRT use did not statistically significantly modify the radiation dose-response curve. Conclusions BC risk in female HL survivors increases linearly with radiation dose. HRT does not appear to increase BC risk for HL survivors with therapy-induced early menopause. There are no indications that endogenous and exogenous gonadal hormones affect the radiation dose-response relationship.
AB - Background Young women treated with chest radiation therapy (RT) for Hodgkin lymphoma (HL) experience a strongly increased risk of breast cancer (BC). It is unknown whether endogenous and exogenous gonadal hormones affect RT-associated BC risk. Methods We conducted a nested case-control study among female 5-year HL survivors treated before age 41. Hormone exposure and HL treatment data were collected through medical records and questionnaires for 174 BC case patients and 466 control patients. Radiation dose to breast tumor location was estimated based on RT charts, simulation films, and mammography reports. Results We observed a linear radiation dose-response curve with an adjusted excess odds ratio (EOR) of 6.1%/Gy (95% confidence interval [CI]: 2.1%-15.4%). Women with menopause <30 years (caused by high-dose procarbazine or pelvic RT) had a lower BC risk (OR, 0.13; 95% CI, 0.03-0.51) than did women with menopause ≥50 years. BC risk increased by 6.4% per additional year of post-RT intact ovarian function (P<.001). Among women with early menopause (<45 years), hormone replacement therapy (HRT) use for ≥2 years did not increase BC risk (OR, 0.86; 95% CI, 0.32-2.32), whereas this risk was nonsignificantly increased among women without early menopause (OR, 3.69; 95% CI, 0.97-14.0; P for interaction:.06). Stratification by duration of post-RT intact ovarian function or HRT use did not statistically significantly modify the radiation dose-response curve. Conclusions BC risk in female HL survivors increases linearly with radiation dose. HRT does not appear to increase BC risk for HL survivors with therapy-induced early menopause. There are no indications that endogenous and exogenous gonadal hormones affect the radiation dose-response relationship.
UR - http://www.scopus.com/inward/record.url?scp=85028745257&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2017.07.016
DO - 10.1016/j.ijrobp.2017.07.016
M3 - Article
C2 - 28888722
AN - SCOPUS:85028745257
SN - 0360-3016
VL - 99
SP - 843
EP - 853
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -