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Scientists have revealed that women who have been treated for Hodgkin lymphoma at young ages have up to a 50 per cent chance of developing breast cancer during the 40 years after treatment.
The study, the world’s largest of its kind, will give this patient group a highly individualised assessment of their risk for the first time. The paper is published online today in the Journal of Clinical Oncology.
The Breakthrough Breast Cancer funded study, conducted by scientists at The Institute of Cancer Research (ICR), in collaboration with doctors from hospitals across England and Wales, looked at 5,000 British women over a 50-year period. They found a five-fold increased risk of breast cancer for young women who received radiotherapy to their chest as a treatment for Hodgkin lymphoma. The highest risks found in this group were comparable to those in women who have a faulty BRCA gene.
Although it was known that these patients had an increased breast cancer risk, this new research shows specifically what this risk is, depending on the age a woman receives her treatment, the type of treatment she received and how long it is since she was treated. The study showed that women who had radiotherapy treatment to their chest at ages 10-14 were at the highest risk of developing the disease. Their risk was 22 times higher than that in the general population of the same age. Risks remained raised for at least 40 years, with women continuing to have raised risks of developing breast cancer when in their 50s and 60s.
This research has important implications for this patient group. The new data mean that doctors can confidently give advice on a patient’s chance of getting breast cancer and therefore make them aware of possible preventative measures.
Senior author Professor Anthony Swerdlow from The Institute of Cancer Research said: “By following such a large group of women over such a long time period, we have created the most detailed picture yet of the risk that these women face. Importantly, our study enables this group of women to receive clear information about their personal breast cancer risk, to help their doctors and them to make decisions about preventive measures. It takes us a step closer to more personalised medical plans.”
The paper also suggests tangible actions for how the results can make a difference to patients. A protocol for breast screening already exists in the UK for these women. However, these data provide additional information regarding the levels of risk and will help to refine future screening strategies. Dr Sacha Howell, a medical oncologist at the University of Manchester and The Christie Hospital, wants to use Professor Swerdlow’s research in this way.
Dr Howell said: “This research is hugely important for a group of women that are at very high risk of developing breast cancer. These results will help us to advise these women about their particular risk and ensure that the most appropriate screening is performed on a regular basis.”
All of the women studied had received radiotherapy to treat Hodgkin lymphoma under of the age 36 and were identified as part of a Department of Health initiative launched in November 2003 to identify, inform and initiate breast screening in such women. Several hundred young women are diagnosed with Hodgkin lymphoma every year, and for this group, findings like this are crucial. The risk is not substantially raised, however, in women treated for Hodgkin Lymphoma with radiotherapy over the age of 40.
Dr Julia Wilson, Head of Research at Breakthrough Breast Cancer, said: “Studies like this are fundamental to improving our understanding of rarer breast cancer groups. The rich data studied from patients across England and Wales, coupled with the clear and actionable results, means that a big difference can be made for these at risk women.”