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Oncology (General Cancer)/Breast Cancer risk from Hodgkins

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Hello,

I had Hodgkins when I was 19, I was treated with 2 rounds of AVBD chemo followed by radiation to the neck and chest for about 5 weeks, which they used shields to block as much of my organs and breasts as possible.  I am now 15 years out and long term effects have started: I had a nodule on my thyroid biopsied 2 years ago and it was found benign, however I do have hypothyroidism which is being controlled by medication.  I started having breast screening 3 years ago, an mri in 2009 which showed no abnormalities and one in 2011 which showed what was described to me as "extra cells" and attributed to weight gain that occurred in a  short amount of time and yearly follow-up was recommended.  This year I had my first mammogram at the age of 34 and all I know right now is that something showed up in the same breast that had the "extra cells" a year ago.  I had my annual appointment at the oncology clinic, with a new doctor due to mine retiring, and he seemed very concerned and it almost felt like he was preparing me for it to be breast cancer or just making sure I knew that if something did come up he was experienced and would know how to treat me.  I don't know him well enough to really read him yet.  I do have a second mammogram scheduled for additional imaging, as requested by the radiologist who read the first one.  My doctor did say that if anything at all was found that a biopsy should be done, he also said to have the radiologist call him while I was there if he saw anything concerning.  I have not found anything while doing self breast exams and the doctor had a hard time feeling anything, but did feel what he described as "some good sized cysts".  I have had a few scares of recurrence or secondary cancers in my 15 years since treatment, but this time I'm more worried.  What is the likelihood of this being breast cancer and what is treatment like for those who have breast cancer as a result of radiation therapy to treat hodgkins?  I do know the rates of occurrence are significantly higher for women who have had hodgkins treated by radiation, that it is usually caught sooner, but also read that that doesn't mean the prognosis is better, rather that the prognosis is usually worse.  Any information you can give me would be greatly appreciated!
Thank you!

Answer
The risk of breast cancer after treatment for hodgin's disease depends on the amount of breast tissue that is subjected to radiation.  Even though they do shielding, some breast tissue usually does get involved.  The overall risk has been estimated as between 1.4 and 3.2 times that of a normal woman.  There are many variables, including the amount of radiation, what chemotherapy was used, etc.  
It is not unusual for someone who is overweight not to be able to feel small lumps in the breast.  That doesn't mean monthly self-exams should not be done, however.  As you learn the technique your skills improve.  Finally the best thing to do is to follow your oncologist's advice.  Your risk may be higher than a "normal woman's" but then, there are many circumstances where risk is increased, (like having a first degree relative with breast cancer).  All you can do is do what you can to detect it early.  That being said, you can have a complete risk assessment, and if your risk is high enough, some people might recommend bilateral mastectomy and breast reconstruction.  However, if the only increased risk is the Hodgkin's disease treatment, probably that wouldn't be recommended.
Lastly, the reason there may be a slightly worse prognosis in patients who have had Hodgkin's disease and then get breast cancer is partly due to the fact that the standard treatment is sometimes not possible in patients who have received a lot of radiation.  When you were treated, however, most doctors were using shields of breast tissue, and you probably aren't compromised much.  (in the really olden days, we used to radiate heavily, and the breast tissues got a lot of radiation; those were the patients who had a lot of problems).  
Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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