Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma

Princess Margaret Hospital, University Health Network, and the Department of Radiation Oncology, University of Toronto, Canada.
Journal of Clinical Oncology (Impact Factor: 18.43). 05/2007; 25(12):1489-97. DOI: 10.1200/JCO.2006.09.0936
Source: PubMed

ABSTRACT Hodgkin's lymphoma (HL) survivors are known to be at substantially increased risk of solid cancers (SC). However, no investigation has used multivariate modeling to estimate the relative risk (RR), excess absolute risk (EAR), and cumulative incidence for specific attained ages and ages at HL diagnosis.
We identified 18,862 5-year HL survivors from 13 population-based cancer registries in North America and Europe. Poisson regression was used to evaluate the effects of age at diagnosis, attained age, latency, sex, treatment, and year of diagnosis on the RR and EAR of SC.
Among 1,490 identified SC, 850 were estimated to be in excess. For most cancer sites, both RR and EAR decreased with age at HL diagnosis and showed strong dependencies on attained age. For a patient diagnosed at age 30 years and survived to > or = 40 years, modeled risks were significantly elevated for cancers of the breast (RR = 6.1), other supradiaphragmatic sites (RR = 6.0), and infradiaphragmatic sites (RR = 3.7); the largest RR (20-fold) was observed for malignant mesothelioma. Thirty-year cumulative risks of SC for men and women diagnosed at 30 years were 18% and 26%, respectively, compared with 7% and 9%, respectively, in the general population. For young HL patients, risks of breast and colorectal cancers were elevated 10 to 25 years before the age when routine screening would be recommended in the general population.
Multivariable modeling demonstrates for the first time temporal changes in SC risk not evident in unadjusted analyses, and can facilitate the development of individualized risk assessment and the creation of screening strategies for early detection.

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    • "Some authors studied the efficacy of dose escalation on secondary cancer induction(Manem et al, 2014b)(Schneider et al, 2007). It has also been noted that the latency period is typically between 10 to 20 years for solid tumors, and around 5 years for leukemia post irradiation (Zhang et al, 2012)(Wang et al, 2014)(Schneider et al, 2014)(van Leeuwen et al, 2003)(Yeoh and Mikhaeel, 2010)(Yahalom, 2009)(Hodgson et al, 2007a). As a result of increasing prevalence of secondary malignancies, it is clearly of great importance to investigate the risks associated with different treatment regimens as well as their possible variation with age (by incorporating age at exposure and time since exposure)(Hodgson et al, 2007b). "
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    • "In contrast, the risk (RR and EAR) for thyroid cancer after HL did not vary by attained age [20]. Because most cancer rates in the general population increase substantially with increasing age, even steady or declining RRs with increasing age can be associated with strikingly increasing EARs, such as the pattern described above for breast cancer after HL [20]. "
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    • "For patients treated with radiotherapy alone, the incidence of all SMNs was significantly higher than the expected rate in the general population and comparable to other studies of long term HL survivors (Hoppe, 1997; Foss Abrahamsen et al, 2002; Ng et al, 2002a,b; Bhatia et al, 2003; De Bruin et al, 2009). Specifically, rates of breast cancer, lung cancer and thyroid cancer were similar to those observed in a recent population-based study of 18 862 5-year HL survivors from 13 population-based cancer registries in North America and Europe (Hodgson et al, 2007). For patients who underwent CMT, there was not an increased risk of solid SMNs, and subsequent haematological malignancies were limited to patients who received MOPPlike regimens. "
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