Hodgkin Lymphoma Survivors at Risk for Second Cancers

A recent analysis of the Swedish Family-Cancer Project Database provides evidence that Hodgkin Lymphoma (HL) survivors may be at a risk for developing second cancer even after 30 years, according to an article published in the Journal of Clinical Oncology. Survivors with a family history of colorectal, breast, and lung cancer were at a significantly higher risk of similar second cancers.¹

Between 1965 and 2013, 1215 second cancers were reported in approximately 12% of patients with a primary diagnosis of HL. This represents a standardized incidence ratio (SIR) of 2.39.

HL survivors were at the greatest risk for Non-Hodgkin lymphoma, lung cancer, breast cancer, non-melanoma skin cancers, leukemia, and colorectal cancers. With the longest follow up being 48 years (median: 12.6 years), the SIRs for all second cancers remained high even after 30 years.

An analysis of cases over different time periods (1965-1977, 1078-1988, and 1989-2000) showed that SIRs for overall second cancers were not significantly different across the time periods analyzed, indicating that even with the advent of less toxic treatments, risk for second cancers in HL survivors remains.

When the study investigators evaluated whether patients’ family history of cancer was a factor, it was found that HL survivors were at increased risk of concordant second cancers. SIR for breast cancer was 4.36 in HL survivors with a family history of breast cancer (vs SIR of 2.36 in survivors with no family history of breast cancer). Risks were highest for lung and colorectal cancers in HL survivors with a family history of lung cancer and colorectal cancer, respectively.

The investigators indicated that these data are of importance in primary health care settings where many HL survivors are treated after the first 5 years follow up. The study underscores the importance of long-term follow up.

“Obtaining family history information has a place in informing the long-term follow-up screening of all patients with HL,” the authors concluded.

References

1. Sud A, Thomsen H, Sundquist K, Houlston RS, Hemminki K. Risk of second cancer in Hodgkin Lymphoma survivors and influence of family history. J Clin Oncol. doi: 10.1200/JCO.2016.70.9709 [Epub ahead of print].