Adult sequelae of Hodgkin's therapy for kids
C. LUNDGREN, MD, of Calgary, AB, inquires, "At the age of 13, a young girl was diagnosed with Hodgkin's disease stage IA supradiaphragmatic, nodular sclerosing. She was treated with extended radiation. She's now 30 years old. When does she need to start mammograms? Are there any other treatment sequelae that I should be on the lookout for?"
Patients such as this one have a much higher incidence of breast cancer, specifically in the inner quadrants of the breasts (I've seen 3 cases in the last 10 years). This is because the mantle irradiation includes only the inner aspects of the breasts. Prior to age 15, the risk is substantially higher, but by age 40, the risk becomes minimal. The treatment of Hodgkin's disease with radiation in these young women has evolved due to this as well as other long-term complications of therapy.
The normal rules for mammography don't apply in a case like this, as she's not in the same risk category as the general population. It's reasonable to get a baseline mammogram now, and then depending on the density of the breast and quality of the exam, some sort of regular follow-up would be in order. Yearly mammograms wouldn't necessarily be done in such a young woman, and some centres may be considering using breast MRI for these patients.
Other sequelae include musculoskeletal growth retardation such as shortened height, intraclavicular narrowing, decreased mandible growth and reduced muscle growth in the treated area, hypothyroidism and other secondary cancers including sarcomas. BC