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Late Effects

Second Malignant Neoplasm




Breast cancer screening:

Young women previously treated for Hodgkin lymphoma, especially those treated in adolescence have a high risk for the development of breast cancer and should have screening.

Mammography is the most widely accepted screening tool for breast cancer in the general population – but this may not be ideal by itself for RT induced breast cancers occurring in relatively young women with dense breasts.

The American Cancer Society recommends including adjunct screening with magnetic resonance imaging (MRI)14.

For women who received RT associated with significant scattered radiation to the  breast:

  • RT doses of 20 Gy or higher to the following fields:
    • Mantle
    • Mediastinal
    • Whole lung
    • Axillary fields


  • Monthly breast self-examination beginning at puberty
  • Annual clinical breast examinations beginning at puberty until age 25 years
  • Clinical breast examination every 6 months
  • Annual mammograms and MRIs beginning 8 years after RT or at age 25 years (whichever occurs later).


If thoracic RT given (20 Gy or more in childhood, adolescence or early adulthood):




Increased Breast cancer risk

Breast self examination


Breast examination by HCP

Annually until aged 25 and then 6 monthly thereafter

Breast MR

Annually starting at age 25 or 8 years after the RT was given


Annually starting at age 25 or 8 years after the RT was given

There is evidence to show that a significant number of women who are at risk for the development of breast cancer, do not have the necessary screening15


Screening for early-onset colorectal cancer:

Screening of survivors at risk for early-onset colorectal cancer is recommended:

Increased risk factors:

  • RT doses of 30 Gy or higher to the abdomen, pelvis, or spine

Colonoscopy should be performed beginning at age 35 years or 10 years following radiation (whichever occurs last).


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