11059 Background: Many studies showed that women who are cured of HD have an increased risk of developing BC. Our purpose is to evaluate detection, pathology, management and prognosis of BC occurring after HD. Methods: Thirty-eight cases of BC in 27 survivors of HD were analyzed. All patients received supradiaphragmatic RT and 13 had also chemotherapy for HD. Results: The median age of the patients at diagnosis of HD was 25.5 years. The median interval to develop BC was 15.9 years. The median age at diagnosis of BC was 45.8 years. Ten women (37%) had bilateral disease; one of them had DCIS, 7 years before developing bilateral disease. Cancers were detected by mammography (59.4%), symptom presentation (24.3%), clinical examination (8%), and incidental during elective mastectomy (8%). Using Fisher’s Exact test, DCIS was more frequent (27%), where nodal involvement (29.6%), and ER positivity (81.5%) were paralleled that reported in general population. Thirty tumors (79%) were managed by mastectomy due to prior RT. Two women received RT following mastectomy. Eight tumors treated by lumpectomy, followed by RT in two women; one received whole breast RT, while the other received fractionated partial breast irradiation using 3D-conformal technique (50Gy/25 fractions) and she is doing well 1 1/2 years after RT. Adjuvant systemic therapy, given to 17 patients, was well tolerated. The median follow-up after BC was 61 months. Using Kaplan-Maier procedure, the 6-year actuarial relapse-free survival for node-negative BC after HD was 100%. Node positive patients had a significantly lower RFS of 58.3% ± 19% (P = 0.01). Conclusions: Compared to patients with primary BC, patients developing BC after HD are more likely to be younger, have bilateral disease and have more frequent DCIS. Other pathological features and prognosis are similar to that reported in general population. Patient awareness, breast examination and mammography should be part of the follow-up program for HD survivors. Mastectomy remains the standard of care in most of cases; however, lumpectomy followed by fractionated partial breast irradiation might be a reasonable approach to investigate for women who refuse mastectomy. No significant financial relationships to disclose.
