A pilot investigation on impact of participation in a long-term
follow-up clinic (LTFU) on breast cancer and cardiovascular screening
among women who received chest radiation for Hodgkin lymphoma
B. A. Peterson
R. I. Vogel
A. H. Blaes
Received: 14 August 2017 / Accepted: 22 January 2018 / Published online: 7 February 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Women treated with chest radiation for Hodgkin lymphoma (HL) are at significantly increased risk of breast cancer
and cardiovascular disease. HL survivors are recommended to have annual dual screening with mammogram (MMG) and breast
magnetic resonance imaging (MRI). They are also recommended to undergo echocardiogram (echo) 5 years after completion of
radiation. We performed a pilot study to characterize the women who are and are not receiving proper dual screening for breast
cancer and baseline echo, and to examine the impact of a LTFU clinic consultation on screening.
Methods A retrospective chart review of 114 women treated for HL at University of Minnesota (UMN) between 1993 and 2009
was performed. Demographics, disease and treatment history (age at diagnosis, stage, radiation dose and field, chemotherapy,
recurrence) were assessed, as well as screening practices (MMG, MRI, both and echo), participation in LTFU clinic, and
recommendations from providers. Data was summated in yes/no (y/n) format; statistical analysis was performed using chi-
squared and Fisher’s exact tests. Breast cancer and cardiovascular screening outcomes were compared by participation in the
LTFU clinic (y/n) using Fisher’s exact tests. P values < 0.05 were considered statistically significant.
Results Forty-one of 114 women met inclusion criteria and had follow-up data for analysis. Median age at diagnosis was 29 years;
67.6% were diagnosed at stage IIa. Median dose of radiation was 3570 cGy. 56.1% participated in the LTFU clinic at the UMN.
36.6% had dual screening with both MMG and MRI, 41.5% had screening with only MMG, and 19.5% had no screening
performed. Women were more likely to have dual screening if they were seen in LTFU clinic vs not seen in LTFU clinic (52.2 vs
16.7%, p = 0.02). 67.5% of women were screened with echo; women were also more likely to have screening with echo if seen in
LTFU clinic vs not seen (86.4 vs 44.4%, p =0.007).
Conclusion Many women are not getting the proper dual screening for breast cancer despite their increased risk, with only 36.6%
of our study sample getting dual screening. Having a consultation in a LTFU clinic increases dual screening for breast cancer and
echo screening for cardiovascular disease. Proper screening allows for detection of secondary breast cancer at earlier stages where
treatment can be local therapy. Diagnosing CV disease early could allow for proper preventative treatment or intervention.
Hodgkin lymphoma (HL) is a disease that typically affects
approximately 10,000 young adults and children annually, with
cure rates exceeding 80% . Improved treatment modalities
with chemotherapy and radiation have resulted in larger cohorts
of patients living without cancer yet with long-term and late
effects of their cancer and cancer treatment. Many of these
survivors suffer from late effects of their treatment including
second cancers, cardiovascular disease, pulmonary disease, hy-
pothyroidism, and gonadal dysfunction .
Second cancers are a leading cause of morbidity and death
in Hodgkin lymphoma survivors. The incidence of developing
second cancers is 9–13% at 15–20 years and 18–26% at
30 years after completing therapy [3, 4]. The increased risk
begins as soon as 8 years after chest radiation with the
* K. Baxstrom
University of Minnesota Health, Minneapolis, MN, USA
Supportive Care in Cancer (2018) 26:2361–2368