Individuals who have developed Hodgkin's disease have an 85 per cent to 90 per cent chance of being cured of their cancer. However, survivors of Hodgkin's disease have developed second cancers and heart disease earlier than expected. Breast cancer has been found to be the most frequent type of cancer among these women with a rate more than 4 times that observed in the general population. The group of survivors most likely to get breast cancer are those women who were treated with radiation to their chests before 35 years of age and who are more than five years from treatment. Little is known about the screening practices of these women who are now at high risk for breast cancer. Neither has the best screening practices for them been defined. Although mammography has been found to reduce death rates for women over 50, it is not clearly established to be of benefit at younger ages, when breast cancers have most often arisen after Hodgkin's disease treatment. Among women with gene mutations that are associated with increased risks for breast cancer, mammography is being recommended for women who are as young as 25 years of age.

Therefore, we have designed a study with three major aspects. It will: 1) examine the emotional impact of being notified of an increased risk of cancer; 2) examine whether risk notification leads more women to protective screening behaviors, and 3) assess whether mammograms contribute meaningfully to identifying early, curable tumors in younger women who have a risk for breast cancer that is above average.

Methodologically, the study has two components or phases. In the first phase, we will send questionnaires to female survivors of Hodgkin's disease to learn about their general well-being, about their knowledge of breast cancer, and about their breast cancer screening practices. Women who are not participating in breast cancer screening will be eligible for the study. Women who agree to participate in this study will be assigned by chance to either the intervention group or to a delayed intervention. Those assigned to the intervention group will receive telephone counseling by trained counselors and be encouraged to seek a breast check-up. Those assigned to the delayed intervention will receive telephone counseling six months later after collection of a second questionnaire including information regarding their breast cancer screening behavior.

The second phase of the study will include a study of the potential usefulness of mammography in these younger women. Participants will be offered a free baseline mammogram. Studies will be performed either at Stanford or in the local communities. The mammograms will be reviewed twice by two different radiologists who will not know whether the mammogram was considered normal or abnormal. The reviewers will look at the mammogram to determine whether the breast tissue is normal, and whether factors such as breast density impair valid interpretation of the study. If participating women have mammograms that are unlikely to be useful for screening, they will be advised that annual mammography will not be necessary. All mammography findings will be related to any abnormal findings on breast examination or biopsy. The participants will be contacted 12 months after their mammogram to determine whether breast cancer has been diagnosed after their mammogram. The efficacy of the mammography will then be determined. The sample for the proposed study will consist of 522 women who received radiation therapy to treat their Hodgkin's disease before the age of 35, are five years or more from treatment, and have had sufficiently recent contact with Stanford (within five years) to expect potential recruitment and participation. We anticipate that at least 400 women will agree to participate, i.e., 200 for each group in the study measuring the effects of counseling intervention.