Individualized Breast Surveillance in a Young Hodgkin Lymphoma Survivor With High-Risk Features

Survivors of pediatric Hodgkin lymphoma have an elevated lifetime risk of secondary breast malignancy, particularly those who received chest-directed radiation before age 30. This report describes a 19-year-old female patient, three years post-therapy for stage IIB Hodgkin lymphoma treated with 30 Gy mediastinal radiation, who presented within a structured survivorship program for evaluation of a self-detected, firm, mobile, non-tender left breast mass. Physical examination confirmed a 2 cm lesion in the upper outer quadrant without overlying skin changes, nipple inversion, or lymphadenopathy. Given her therapeutic radiation exposure and significant family history of early-onset breast and ovarian cancers, targeted breast ultrasound and bilateral magnetic resonance imaging (MRI) with contrast were performed for characterization. Imaging findings were consistent with a benign fibroadenoma, and short-interval follow-up was arranged in accordance with American College of Radiology (ACR) and National Comprehensive Cancer Network (NCCN) guidance for individualized surveillance of high-risk patients. The survivorship evaluation also identified an unaddressed need for germline testing, and subsequent genetic analysis confirmed a pathogenic BRCA1 mutation. This case illustrates the importance of risk-stratified, multidisciplinary assessment of new breast findings in adolescent and young adult (AYA) cancer survivors. Individualized, radiation-sparing imaging strategies coupled with comprehensive survivorship follow-up enable early detection, genetic risk identification, and longitudinal care coordination for patients at dual risk from prior therapy and hereditary predisposition.