Survivors of Hodgkin lymphoma have increased risk for second cancer

Survivors of Hodgkin lymphoma — particularly those with a family history of cancer — faced an increased risk for developing a second cancer, according to findings published in Journal of Clinical Oncology.

“Advances in the management of Hodgkin lymphoma over the past 40 years have led to improved disease-free survival in patients,” Amit Sud, MBChB, MRes, clinical research fellow of the division of genetics and epidemiology at the Institute of Cancer Research, London, and colleagues wrote. “However, this comes at the cost of an increased risk [for] second cancers, cardiovascular disease and other treatment-related complications. A family history of breast cancer was first suggested to be a risk factor for second cancer in Hodgkin lymphoma 20 years ago, and it has long been postulated that a subset of patients with cancer display a high sensitivity to mutational agents because of a genetic predisposition.”

The researchers used the Swedish Family-Cancer Project Database to identify 9,522 patients with primary Hodgkin lymphoma diagnosed between 1965 and 2012, and 28,277 relatives of patients. Sud and colleagues calculated incidence ratios and cumulative incidence of second cancer in patients who survived Hodgkin lymphoma. Researchers also compared the standardized ratios of breast, colorectal, lung and all second cancers in Hodgkin lymphoma survivors with and without a family history of cancer.

Overall, Hodgkin lymphoma survivors experienced a 2.39-fold increased risk for developing a second cancer (95% CI, 2.29-2.53). Women diagnosed with Hodgkin lymphoma at age younger than 35 years had a 13.8% 30-year cumulative incidence of breast cancer. Researchers reported no significant change in cancer risk over successive time periods. Survivors who had a first-degree relative with cancer demonstrated a 1.3-fold higher risk for developing a second cancer, with a 3.3-fold increase for lung cancer, 2.1-fold increase for colorectal cancer and 1.8-fold increase for breast cancers. The researchers reported “a greater than additive interaction” between a family history of lung cancer and Hodgkin lymphoma treatment (P = .03).

“Our research has shown that these patients are cured with a combination of chemotherapy and radiotherapy,” Sud said in a press release accompanying the study. “Younger women who have been treated with radiotherapy to the chest for Hodgkin lymphoma are already screened for breast cancer, but our study suggests that we should be looking at ways of monitoring survivors for other forms of cancer, too, and potentially offering preventative interventions. After patients are cured, they no longer encounter oncologists, so it’s important that other health care providers are aware of the increased risk to Hodgkin lymphoma survivors to improve early diagnosis of second cancers.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.