Background Although female survivors of Hodgkin lymphoma (HL) have an increased risk of breast cancer (BC), no BC risk prediction model is available. We developed such models incorporating mean radiation dose to the breast or breast quadrant-specific radiation doses. Methods Relative risks and age-specific incidence for BC and competing events (mortality or other subsequent cancer) were estimated from 1194 Dutch 5-year HL survivors, treated at ages 11-40 during 1965-2000. Predictors were doses to 10 breast segments or mean breast radiation dose, BC family history, year of and age at HL diagnosis, and ages at menopause and first live birth. Models were independently validated using US Childhood Cancer Survivor Study cohort participants. Results Predicted absolute BC risks 25 years after HL diagnosis ranged from 1.0% for survivors diagnosed at ages 20-24 with less than 10 Gy mean breast radiation dose and who were menopausal 5 years after HL diagnosis, to 22.0% for survivors 25-29 years at diagnosis, with at least 25 Gy mean breast dose and no menopause within 5 years. In external validation, the observed/expected BC case ratio was 1.19 (95% confidence interval 0.97 to 1.47) for the breast segment-specific dose model, and 1.29 (1.05 to 1.60) for the mean breast dose model. The areas under the receiver operating characteristic curve were 0.68 (0.63 to 0.74) and 0.68 (0.62 to 0.73), respectively. Conclusion Breast segment-specific or mean breast radiation dose with personal and clinical characteristics predicted absolute BC risk in HL survivors with moderate discrimination but good calibration, rendering the models useful for clinical decision-making.

中文翻译：

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预测患有霍奇金淋巴瘤的青少年和年轻成人患乳腺癌的风险


背景 尽管霍奇金淋巴瘤 （HL） 的女性幸存者患乳腺癌 （BC） 的风险增加，但没有可用的 BC 风险预测模型。我们开发了此类模型，将平均辐射剂量纳入乳房或乳房象限特异性辐射剂量。方法 从 1194 名荷兰 5 年 HL 幸存者中估计 BC 和竞争事件 （死亡率或其他后续癌症） 的相对风险和年龄特异性发病率，这些幸存者在 1965-2000 年期间接受了 11-40 岁的治疗。预测因素是 10 个乳房节段的剂量或平均乳房放疗剂量、BC 家族史、HL 诊断的年份和年龄，以及绝经和首次活产的年龄。使用美国儿童癌症幸存者研究队列参与者对模型进行独立验证。结果 预测 HL 诊断后 25 年的绝对 BC 风险范围从 20-24 岁平均乳腺放疗剂量低于 10 Gy 且在 HL 诊断后 5 年绝经的幸存者为 1.0% 到诊断时 25-29 岁幸存者的 22.0%，平均乳房剂量至少为 25 Gy 且 5 年内无绝经。在外部验证中，乳腺节段特异性剂量模型的观察/预期 BC 病例比为 1.19 （95% 置信区间 0.97 至 1.47），平均乳腺剂量模型的 1.29 （1.05 至 1.60）。受试者工作特征曲线下面积分别为 0.68 （0.63 至 0.74） 和 0.68 （0.62 至 0.73）。结论 具有个人和临床特征的乳腺节段特异性或平均乳腺放疗剂量可预测 HL 幸存者的绝对 BC 风险，具有中等鉴别力但校准良好，使模型可用于临床决策。