title: Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence.
abstract: OBJECTIVE
  To determine the frequency of and risk factors for second malignant neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in children and adolescents.
  
  
  METHODS
  One hundred eighty-two consecutive, previously untreated patients with Hodgkin's disease who were younger than 20 years of age at diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo, NY) for treatment between January 1, 1960, and December 31, 1989, were studied. Sex-specific standardized incidence ratios (SIRs) were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to SMN incidence.
  
  
  RESULTS
  Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. The cumulative percentage of patients who developed an SMN was 26.27 +/- 6.75% at 30 years after diagnosis. The SIR was 9.39 (95% confidence interval [CI], 4.05 to 18.49) for male patients and 10.16 (95% CI, 5.56 to 17.05) for female patients. The most frequent SMNs were thyroid cancer, breast cancer, nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Multivariate analysis of sex, treatment with any alkylating agent, treatment with doxorubicin, splenectomy, and relapse (as a time-dependent covariate) with time to SMN onset gave nonsignificant results.
  
  
  CONCLUSIONS
  Successfully treated children and adolescents with Hodgkin's disease have a substantial risk for the occurrence of subsequent neoplasms. The most frequent SMNs (skin, thyroid, and breast) are readily detected by physical examination and available screening procedures.
authors.affiliation: Departments of Pediatrics, Cancer Prevention, Epidemiology and Biostatistics, Pathology, Radiation Medicine, and Psychology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA. daniel.green@roswellpark.org
authors.forename: D M
authors.initials: DM
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Hyland
authors.forename: M P
authors.initials: MP
authors.lastname: Barcos
authors.forename: J A
authors.initials: JA
authors.lastname: Reynolds
authors.forename: R J
authors.initials: RJ
authors.lastname: Lee
authors.forename: B C
authors.initials: BC
authors.lastname: Hall
authors.forename: M A
authors.initials: MA
authors.lastname: Zevon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment; D012737:Sex Factors