Résumé :
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[BDSP. Notice produite par INIST-CNRS YR0x1sB0. Diffusion soumise à autorisation]. Context : Second cancer is the leading cause of death in long-term survivors of Hodgkin disease (HD), with exceptionally high risks of breast cancer among women treated at a young age. Quantitative associations between radiotherapy dose delivered to the breast and administered chemotherapy have not been reported to date in large series, nor has the influence of ovarian exposures on subsequent risk. Objective : To quantify the long-term risk of breast cancer associated with use of radiotherapy and chemotherapy to treat young women with HD. Design, Setting, and Subjects : Matched case-control study of breast cancer within a cohort of 3817 female 1-year survivors of HD diagnosed at age 30 years or younger, between January 1,1965, and December 31,1994, and within 6 population-based cancer registries. The study was conducted March 1,1996, through September 30,1998. Main Outcome Measures : Relative risk (RR) of breast cancer associated with radiation dose delivered to site of breast cancer or to ovaries and with cumulative dose of alkylating agents. Results : Breast cancer occurred in 105 patients with HD who were matched to 266 patients with HD but without breast cancer. A radiation dose of 4 Gy or more delivered to the breast was associated with a 3.2-fold (95% confidence interval [Cl], 1.4-8.2) increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 8-fold (95% Cl, 2.6-26.4) with a dose of more than 40 Gy (P<. for trend radiation risk did not vary appreciably by age at exposure or reproductive history. increased risks persisted more years following radiotherapy cl p="03" with dose treatment alkylating agents alone resulted in a reduced of breast cancer and combined risk. decreased increasing number agent cycles also was low among women who received gy delivered to ovaries compared those lower doses. conclusions : hormonal stimulation appears important the development radiation-induced as evidenced associated ovarian damage from radiation. high radiation-related which diminish highest doses longest follow-up however suggests need lifetime surveillance programs patient public awareness.>
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