Re: Roles of Radiation Dose, Chemotherapy, and Hormonal Factors in Breast Cancer Following Hodgkin's Disease

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Abstract
The recent study by van Leeuwen et al. ( 1) quantified the carcinogenic effect of therapeutic radiation on the breast in young women with Hodkgin’s disease. We believe that the results of this important study have implications beyond the treatment of women with Hodgkin’s disease. The study has caused us to rethink the possible hazardous effect of mammography in young women, in particular in those with BRCA1 mutations. The carcinogenic effect of radiation on the breast is highly dependent on the age of exposure, and young women are particularly sensitive. It is striking that early menopause mitigated the effect of the radiation in van Leeuwen’s study, given that surgical menopause is also highly effective in preventing the development of BRCA1-related breast cancers ( 2). To date, the established cofactors for BRCA1-associated breast cancers appear to be hormonally based ( 3).