Second Malignant Neoplasms Among Long-Term Survivors of Hodgkin’s Disease: A Population-Based Evaluation Over 25 Years

Abstract

Significantly increased risks of second cancers were observed in all HD age groups. Although significantly elevated risks of stomach, female breast, and uterine cervix cancers persisted for 25 years, an apparent decrease in relative risk and AER of solid tumors at other sites is suggested.

Comparison of primary and secondary breast cancers in adolescents and young adults

“…2,4 Some of these females have received radiation and/or chemotherapy for a prior malignancy during childhood and are known to have an increased risk of developing a subsequent breast cancer. [5][6][7][8] These childhood cancer survivors are recommended to have regular breast cancer screening, with the frequency and modality of screening dependent on level of risk for the development of a subsequent cancer. 9 For female Hodgkin's lymphoma survivors, the cumulative risk of developing a breast cancer before age 50 is similar to that of BRCA mutation carriers, irrespective of the radiation dose received.…”

“…10 Similar to breast cancer in premenopausal women, these secondary malignancies (SMNs) have lower rates of hormone receptor positivity in age-matched controls. 2,5,[11][12][13] In addition to exhibiting different tumor biology, premenopausal patients and those with SMNs at any age are reported to receive different surgical treatments and adjuvant therapy regimens than their older or primary malignancy counterparts. Both groups are individually more likely to have a total mastectomy and less likely to receive adjuvant therapy.…”

Second primary breast cancer after Hodgkin's disease

“…Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.…”

“…In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy.…”

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

“…Female HL survivors are at high risk of radiation induced breast cancer, particularly those treated at a young age 7 , 8 . Lung cancer is one of the principal causes of death from second cancer following HL 9 , 10 . Moreover, irradiation can be also related to late pulmonary toxicity 11 , 12 .…”