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Abstract

Title: Second cancer risk following Hodgkin's disease: an analysis of 15,465 patients reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program.
Author: Dores G, Curtis RE, Travis LB
Journal: Proc Am Soc Clin Oncol 20:1125
Year: 2001
Month: None

Abstract: Improved therapy for HD over the past 3 decades has been accompanied by significantly increased risks for second cancers, however, there are few population-based data which either address patterns by age or quantify site-specific risks among large numbers of long-term survivors. Moreover, few studies provide results in terms of absolute risk [AR] (number of excess cancers/10,000 persons/year). We evaluated the risk of second cancers among 15,465 HD patients (119,247 person-years) reported to the SEER Program (1973-1997), of whom 5,110 and 995 survived at least 10 and >20 years, respectively. Mean age at HD diagnosis was 37.7 years and average follow-up 7.9 years. Overall 1,038 second cancers (observed/expected [O/E]:2.2;p<0.05;AR:47.8) and 783 solid tumors ([O/E]:1.9;p<0.05;AR:30.8) were identified. The largest AR for solid tumors were observed for female breast (AR:15.1), lung (AR:10.2), digestive sites (AR:4.0) and buccal cancers (AR:2.4). Significantly increased 2 to 10-fold O/E ratios, based on smaller numbers, were also observed for Kaposi's sarcoma and cancers of liver, ureter and salivary gland. AR of second cancers were significantly elevated among patients age <20 (AR:34.7), 20-39 (AR:34.1), 40-59 (AR:114.8) and 60+ (AR:37.1) years at HD diagnosis. The O/E ratio of all solid tumors at 2 months-<1 year, 1-4, 5-9, 10-14, 15-19, and 20+ years after HD diagnosis was 1.1, 1.3, 1.8, 2.4, 3.4, and 3.6, respectively (Ptrend<0.001), with corresponding AR of 4.3, 10.3, 27.7, 54.3, 106.1 and 135.8. For 8,297 patients who initially received radiotherapy, solid tumor risks (O/E) at 10-14, 15-19 and 20+ years were 2.9, 4.4 and 4.6, respectively; among 20-year survivors, 5 to 47-fold O/E ratios were reported for cancers of the stomach, lung, female breast and thyroid. Our results suggest a persistent, longterm increase in relative and absolute risks of solid tumors following HD, with excesses observed among all age groups.