Breast Cancer and Other Second Neoplasms after Childhood Hodgkin's Disease
Smita Bhatia, M.D., M.P.H., Leslie L. Robison, Ph.D., Odile Oberlin, M.D., Mark Greenberg, M.B., Ch.B., Greta Bunin, Ph.D., Franca Fossati-Bellani, M.D., and Anna T. Meadows, M.D.
Background Patients who survive Hodgkin's disease are at increasedrisk for second neoplasms. As survival times increase, solidtumors are emerging as a serious long-term complication.
Methods The Late Effects Study Group followed a cohort of 1380children with Hodgkin's disease to determine the incidence ofsecond neoplasms and the risk factors associated with them.
Results In this cohort, there were 88 second neoplasms as comparedwith 4.4 expected in the general population (standardized incidenceratio, 18.1; 95 percent confidence interval, 14.3 to 22.3).The estimated actuarial incidence of any second neoplasm 15years after the diagnosis of Hodgkin's disease was 7.0 percent(95 percent confidence interval, 5.2 to 8.8 percent); the incidenceof solid tumors was 3.9 percent (95 percent confidence interval,2.3 to 5.5 percent). Breast cancer was the most common solidtumor (standardized incidence ratio, 75.3; 95 percent confidenceinterval, 44.9 to 118.4), with an estimated actuarial incidencein women that approached 35 percent (95 percent confidence interval,17.4 to 52.6 percent) by 40 years of age. Older age (10 to 16vs. <10 years) at the time of radiation treatment (relativerisk, 1.9) and a higher dose (2000 to 4000 vs. <2000 cGy)of radiation (relative risk, 5.9) were associated with significantlyincreased risk of breast cancer. The estimated actuarial incidenceof leukemia reached a plateau of 2.8 percent (95 percent confidenceinterval, 0.8 to 4.8 percent) 14 years after diagnosis. Treatmentwith alkylating agents, older age at the diagnosis of Hodgkin'sdisease, recurrence of Hodgkin's disease, and a late stage ofdisease at diagnosis were risk factors for leukemia.
Conclusions The risk of solid tumors, especially breast cancer,is high among women who were treated with radiation for childhoodHodgkin's disease. Systematic screening for breast cancer couldbe important in the health care of such women.
Source Information
From the Department of Pediatrics, University of Minnesota, Minneapolis (S.B., L.L.R.); the Institut Gustave-Roussy, Villejuif, France (O.O.); the Hospital for Sick Children, Toronto (M.G.); the Children's Hospital of Philadelphia, Philadelphia (G.B., A.T.M.); and the National Tumor Institute, Milan, Italy (F.F.-B.).
Address reprint requests to Dr. Robison at the Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Box 422 UMHC, Minneapolis, MN 55455.
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