Originally published as JCO Early Release 10.1200/JCO.2006.09.0936 on March 19 2007

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Long-Term Solid Cancer Risk Among 5-Year Survivors of Hodgkin's Lymphoma

David C. Hodgson, Ethel S. Gilbert, Graça M. Dores, Sara J. Schonfeld, Charles F. Lynch, Hans Storm, Per Hall, Froydis Langmark, Eero Pukkala, Michael Andersson, Magnus Kaijser, Heikki Joensuu, Sophie D. Fosså, Lois B. Travis

From the Princess Margaret Hospital, University Health Network, and the Department of Radiation Oncology, University of Toronto, Canada; Division of Cancer Epidemiology and Genetics and the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD; The University of Iowa, Iowa City, IA; Danish Cancer Society, Copenhagen, Denmark; Karolinska Institute, Stockholm, Sweden; The Norwegian Cancer Registry; Norwegian Radium Hospital, Oslo, Norway; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research; and the Helsinki University Central Hospital, Helsinki, Finland

Address reprint requests to David Hodgson MD, MPH, FRCPC, Department of Radiation Oncology, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9; e-mail: David.Hodgson{at}rmp.uhn.on.ca

Purpose: 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.

Patients and Methods: 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.

Results: 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 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.

Conclusion: 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.

published online ahead of print at www.jco.org on March 19, 2007.

Supported by the Intramural Research Program of the National Institutes of Health, the National Cancer Institute, Division of Cancer Epidemiology and Genetics, and by a career development award from the Ministry of Health and Long Term Care of Ontario, Canada (D.C.H.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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