Hodgkins & Breast Cancer

[Strike3]

Is there a "typical" presentation of Breast Cancer in Hodgkins Lymphoma patients who have received mantle & axillary radiation?

Is DCIS in such a patient more likely to become invasive than in the general population?

[BhumikaMD]

Hi,

Though there are various studies available which say about the presentation of the  type of breast cancer, it is generally thought that the histological type follows the pattern of the general population, i.e. that the majority of cases post Hodgkins treatment are of ductal pathology. Further studies on the invasiveness of ductal lesions are available but its difficult to generalize all studies to a particular case. In case you have a specific doubt you must see your doctor and he would be able to tell you the risk you may face.


Let us know if this answered your question and if you may have any other queries. You may send us more details on your case to help you better.

Best regards.

[Strike3]

Thank you for your response. I can' t tell if your response regarding "further studies on the invasiveness of ductal lesions" pertained to DCIS in lymphoma patients in particular or the general population.  I say this because I have read much of the data available for the general population, but can't find information regarding the specifics of DCIS in persons who have received mantle & axillary RT for lymphoma.

Bilateral Sterotactic biopsy revealed bilateral DCIS, Upper/Outer Quadrants (most likely a result of the axillary RT). Both sides just under 1 cm, ER/PR +, Right side low grade. Left side high grade with comedo necrosis.

The recommended treatment in my case is bilateral mastectomy, as lumpectomy cannot be followed by additional RT. I am unhappy with this recommendation. I would like to know if DCIS in a person with history of lymphoma treated with RT has a GREATER chance of recurrence than the general population (for whom massive quantities of studies and the statistics that follow already exist) and if such recurrences are more likely to be invasive than in the general population.

Although it has been widely known for many years that mantle/axillary RT patients have a higher risk of breast cancer I can't find any studies or reports that say if the BC tends to act more or less aggressively or exactly the same as in the general population once it manifests.

Thank you.

[BhumikaMD]

Hi,

DCIS is generally considered a less invasive kind of breast ca, however as far as the treatment options are concerned, mastectomy is the usual method.

For your reference there is one study, which suggests that the prognosis remains the same in Breast Cancer patients generally and Breast Cancer patients post RT for Hodgkins. You can access the abstract of this Stanford study at pubmed: http://www.ncbi.nlm.nih.gov/pubmed/10673517. You may find the complete article on Jouran of Clinical oncology: http://jco.ascopubs.org/cgi/content/full/18/4/765. There are some details on DCIS there and if you want we can interpret sections for you which you find difficult.

I hope this helps you make a better decision. Let us know if we have been of any help at all and if you have any other queries.

Best regards.

[Strike3]

Thank you very much for pointing me toward the particular article.  I am still dissecting it. Until this diagnosis I was unaware that physicians also required degrees in Actuarial Accounting.

I am aware that DCIS is, by definition, non-invasive. That is my problem. It seems that bilateral mastectomy is far too drastic a treatment for something that may not ever progress and almost certainly will not be the cause of my death. It's like using a cannon to kill a mosquito.

I have read that sometimes lumpectomy without RT (which I cannot have due to prior RT for lymphoma) is sometimes on option.  However, none of my physicians place this treatment option first on their lists.

I suppose I am looking for the most data I can find in order to evaluate my own particular actuarial odds with each treatment option, knowing, of course, that bilateral mastectomy provides the best statistics.

Thank you again for taking the time to respond.  It is very useful.

[BhumikaMD]

Hi,

You could go ahead and talk to your breast specialist or oncologist about the doubts you have and your preferred mode of approach and then discuss the advantages and disadvantages of it.

This should help you to come to a decision and also see the physician's perspective on this.

Hope this helps.

Regards.