Radiation-Induced Breast Cancer after Treatment of Hodgkin's Disease: A Revealing Case of the Challenges of Long-Term Follow-Up

Introduction: Radiation-induced breast cancer is a rare but documented long-term complication of combined chemotherapy and radiotherapy for Hodgkin's disease, especially in young patients. Improved treatments have increased survival rates but also secondary cancer risks, particularly in women irradiated in the mediastinum before age 30, leading to unique diagnostic and therapeutic challenges. Methods: This case report describes a 45-year-old woman with a history of Hodgkin's disease treated at age 20 with chemotherapy and radiotherapy. Screening began at age 42 with mammography, followed by biennial assessments. After loss to follow-up, she presented with a right breast nodule. Diagnostic methods included clinical examination, echomammography, micro-biopsy, and multidisciplinary evaluation for neoadjuvant chemotherapy, mastectomy, hormone therapy, and targeted therapy. Results: Initial mammography showed ACR2 right and ACR1 left breasts, progressing to ACR4B right (with pleomorphic microcalcifications) and ACR3 left after two years. Re-presentation revealed a 70x50x34 mm irregular mass in the upper-outer right quadrant with axillary adenopathy (ACR5 right, ACR3 left). Biopsy confirmed infiltrating micropapillary carcinoma (SBR grade II, hormone receptor-positive, Ki67 50%, HER2 3+). Extension assessment was negative, leading to neoadjuvant treatment and planned surgery. Conclusions: This case underscores the need for early, annual screening (mammography/IRM) starting 8-10 years post-radiotherapy or at age 25 in high-risk patients to prevent delayed diagnosis and advanced presentation. Multidisciplinary surveillance is essential to mitigate risks and improve outcomes in survivors of Hodgkin's disease.