Radiologic Features of Breast Cancer after Mantle Radiation Therapy for Hodgkin Disease: A Study of 230 Cases

Purpose: To retrospectively review diagnostic mammography in women diagnosed with breast cancer who previously had mantle field radiation therapy for Hodgkin disease in England and Wales over a period of 30 years. Materials and Methods: From a national cohort study of 5002 women treated with supradiaphragmatic radiation therapy when they were younger than 36 years (mean, 22.1 years) during 19562003, 392 patients developed breast cancer. With ethics committee approval and informed consent, mammograms were obtained that showed 230 tumors in 222 (56.6%) patients from 95 hospitals, and the size and appearance of each carcinoma was recorded by two breast radiologists. Comparison was made with a historical report of more than 1000 general-population breast cancers by using Pearson x2 test. Results: Thirty-eight tumors were occult on mammograms. Mean tumor maximum diameter was 12.3 mm (n = 81) on oblique view. The quadrant distribution of the tumors was significantly different (P,.001) from the historic controls, and chest radiation therapy patients had a greater proportion of tumors in the upper outer (66.9% p107 of 160] vs 48.7% p385 of 784]) and, to a lesser extent, lower inner (10.6% p17 of 160] vs 7.8% p61 of 784]) quadrants. The dominant radiologic feature was of an irregular mass (56.8% p109 of 192]) followed by microcalcifications (25.0% p48 of 192]). Conclusion: This study suggests that in patients who previously underwent mantle radiation therapy for Hodgkin disease, breast cancers are more commonly seen within the upper outer quadrants than are cancers in the general population. Poorly defined masses were the most common appearance.