Correspondence (letter to the editor): Consider Family History

The authors (1) point out that the risk of developing cancer in young women after treatment for Hodgkin's disease in childhood or adolescence corresponds, up to age 50, with the high risk in the case of hereditary disposition in the high risk genes BRCA1/2. We provided genetic counseling for a 36-year-old woman who developed bilateral breast cancer at the ages of 26 and 35, after having been treated for Hodgkin's lymphoma and receiving radiotherapy at age 17. In her family history, we noticed an accumulation of cancers, among them breast cancer and prostate cancer. The patient opted for genetic testing, which identified the pathogenic mutation c.767_768delCA; p.(Thr256LysfsTer19) in the tumor suppressor gene BRCA2. To our knowledge, the current literature provides no evidence that women with Hodgkin's disease and subsequent breast cancer are at higher risk for having a BRCA1/2 or other risk gene mutation. Individual cases have been reported (2), but no results from prospective clinical trials are available. It is therefore unclear to what extent these or other genetic factors influence the risk for radiotherapy-induced breast cancer subsequent to Hodgkin's disease. For our patient, knowing that she carries a BRCA2 mutation implies a higher risk for other BRCA2 gene-associated cancers, especially ovarian cancer. According to the German breast cancer S3 guideline, prophylactic removal of the ovaries and Fallopian tubes (salpingo-oophorectomy) should be recommended to BRCA1/2 mutation carriers at the age of about 40, once they have had children if so desired. This procedure not only drastically reduces the risk of developing ovarian cancer but is also associated with improved overall survival. For this reason, we wish to point out the importance of considering the family history in women with breast cancer subsequent to radiotherapy for Hodgkin's disease.