Breast Cancer Following Pediatric Hodgkin's Disease: Risk Factors and Intervention

摘要

Analysis of 1380 survivors of Hodgkin's Disease (HO) has shown a 75- fo1d increased risk of breast cancer. The purpose of this proposal is to identify a sub-population among survivors of HD, at an increased risk for developing breast cancer. Construction of pedigrees of patients with secondary breast cancer did not reveal excess cancer among family members. We also planned to identify somatic and/or germline mutations in candidate genes such as p53, BRCAl & 2, and ATM. Four of the six breast cancer samples examined so far, contained mutations in exons 5-9 of the p53 gene. Three of three blood samples examined for mutations in ATM gene have shown no mutations. Two of two samples examined for mutations in BRCAl & 2 have shown no mutations. We are recommending a baseline mammogram at 25 years of age, repeated every three years till the age of 40, and then annually. For patients with an increased risk of breast cancer due to other risk factors, we recommend annual mammograms, beginning at age 25 years. We propose to institute these recommendations among a limited number of institutions of the Children's Oncology Group - to address feasibility and compliance issues. In addition, we have updated the LESG cohort in order to identify new second cancers and associated risk factors.