Two sisters had breast cancer at four years and I1 years after diagnosis of Hodgkin's disease. The affected breast tissues had received several hundred rads of scatter radiation during treatment of the lymphoma. Family history revealed breast cancer in a third sister and five other women in the paternal line. Cytogenetic and HLA studies showed no markers of susceptibility to neoplasia. Development of second primary neoplasms of the breast in the two sisters may have resulted from interactions between genetic factors and carcinogenic effects of radiation exposure. Cancer 47:200-202. 1981.
KENT STUDIES I N HUMANS suggest that genetic R factors can potentiate effects of environmental carcinogens.IJ This report examines host-environmental interactions in development of breast cancers in two sisters who previously had Hodgkin's disease treated with agents that possess carcinogenic properties.
Case Reports (Figure 1)
The proband developed right cervical adenopathy at 40 years of age in 1974. Biopsy revealed Hodgkin's disease. and laparotomy and other procedures revealed Stage IIA disease. Cobalt-60 radiotherapy was administered to the cervical, axillary, mediastinal, and retroperitoneal regions in doses between 3600 rads and 4400 rads to each area. The treatments produced transient erythema of the skin, mucositis, anorexia, and nausea. The patient has been in complete remission of Hodgkin's disease.
In February 1978, a 4 cm by 2 cm mass in the inferior subareolar region of the left breast developed in the patient. Histopathology examination of a biopsy specimen showed infiltrating ductal carcinoma. A modified radical mastectomy showed invasion of the lymphatics of the dermis of the nipple and metastatic carcinoma in two of nine axillary nodes. From available port films, the area of the left nipple had received between 200 rads and 600 rads during the therapy for Hodgkin's disease. Fibrocystic disease was also present in the breast tissue. She was treated with adjuvant chemotherapy and is in remission of breast cancer.