High incidence of late effects found in Hodgkin's lymphoma survivors, following recall for breast cancer screening

Prolonged disease-free survival is attainable in up to 90% of patients presenting with early-stage Hodgkin’s lymphoma (HL) (Henry-Amar and Joly, 1996). Current treatment usually involves multiagent chemotherapy combined with limited field radio- therapy in selected patients. However, until recently, the standard radiotherapy regimen for supradiaphragmatic HL was the mantle field (Deniz et al , 2003; Horwich and Swerdlow, 2004). Young women who received mantle radiotherapy are at increased risk of breast cancer (Swerdlow et al , 2000; Deniz et al , 2003; Travis et al , 2003; Horwich and Swerdlow, 2004; Kenney et al , 2004). The risk is proportional to radiation dose, and time from treatment (Hancock et al , 1993a; Wolden et al , 1998). Younger age at the time of treatment gives the greatest risk (Hancock et al , 1993a; Bhatia et al , 1996). At 25 years of follow-up, the cumulative risk of breast cancer for women treated between 10 and 19 years of age is reported as 15 – 33%, and for those treated between the ages 20 and 29 years, 15 – 25% (Horwich and Swerdlow, 2004). In 2003, the UK Department of Health launched a ‘Patient Notification Exercise’ to inform patients of the increased breast cancer risk. The exercise mandated recall of all women with HL, who were diagnosed at or below the age of 35 from 1962 onwards. Mantle radiotherapy is associated with other long-term complications including second malignancies, and disorders of the thyroid, heart and lung (Morgan et al , 1985; Gustavsson et al , 1990; Allavena et al , 1992; Gustavsson et al , 1992; Henry-Amar and Joly, 1996). The aim of our study was to investigate the incidence of late effects in women recalled in the UK ‘Patient Notification Exercise’.