Survivors of childhood Hodgkin’s lymphoma are 14 times more likely to develop a subsequent solid tumor than the general population, and this risk remains high for several decades post-diagnosis, a report shows.
The research also demonstrates that some female patients — those diagnosed between ages 10 and 16 — have a 32-fold higher risk for breast cancer than the general population.
The study, “Risk of solid subsequent malignant neoplasms after childhood Hodgkin lymphoma— identification of high‐risk populations to guide surveillance: A report from the Late Effects Study Group,” was published in Cancer.
It is known that Hodgkin’s lymphoma patients who are diagnosed and treated during childhood face a significantly higher risk for other cancers later, including solid cancers.
Unfortunately, this risk is not restricted to the first years, post-diagnosis, and seems to continue for several decades. Up until now, studies have not followed these patients for longer than 25 years.
To gauge the importance of this long-term risk, researchers at the University of Alabama at Birmingham reviewed records from 1,136 patients, diagnosed with Hodgkin’s lymphoma between 1955 and 1986 at 16 years of age or younger.
Median diagnosis was 11 years and patients were followed for a median period of 26.6 years. In that time, 162 patients developed a total of 196 subsequent cancers – including 54 breast cancers, 34 basal cell carcinomas (a kind of skin cancer), 30 thyroid cancers, 15 colorectal cancers, 11 lung cancers, and 40 cancers in other regions. There was no information available on 12 of the patients.
Overall, patients were found to be at a 14-fold increased risk for a subsequent cancer, compared to the general population. Also, among childhood survivors, women were nearly two times more likely of having another cancer than men, and those treated with radiation were nearly five times more likely of having another cancer, compared to those who did not.
The study also identified childhood lymphoma survivors were at a particularly higher risk for certain cancers. Female patients diagnosed between ages 10 and 16, who had been exposed to chest radiation had the highest risk for breast cancer. By age 50, 45.3% of these women had had breast cancer.
Males treated before age 10 with chest radiation had the highest risk for lung cancer, while patients treated with pelvic or abdominal radiation, and alkylating agents, had the highest risk for colorectal cancer. Finally, thyroid cancer risk was the highest for females, who received radiation in the neck before age 10.
For the highest risk patients, the cumulative incidence of lung, colorectal, and thyroid cancer was 4.2%, 9.5%, and 17.3% at 50.
“This large multi-institutional, international cohort of childhood Hodgkin lymphoma allowed us to determine the risk of new solid cancers such as breast cancer, colorectal, cancer and thyroid cancer,” study lead author, Smita Bhatia, MD, MPH, said in a press release.
Also, by having identified characteristics that make Hodgkin’s lymphoma survivors more prone to develop certain cancers, Bhatia believes this could lead to tailored approaches that prevent them from developing, or allow for early diagnosis.
“As a physician and a childhood Hodgkin lymphoma survivor who developed radiation-related breast cancer 34 years after treatment, I cannot emphasize enough the importance of these data for the long-term care of survivors, as they not only underscore the necessity of lifelong cancer screening in that population, but also provide a stratification of risk for specific malignancies within subgroups, allowing for a more targeted approach to screening,” said Allison Thompson-Graves, MD, who was not involved with the study.
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