Lung cancer after Hodgkin's disease: a nested case-control study of the relation to treatment.
OBJECTIVE
To investigate the causes of the raised risk of lung cancer in patients who have had Hodgkin's disease, and in particular the relationship to treatment.


METHODS
A nested case-control study was conducted within a cohort of 5,519 patients with Hodgkin's disease treated in Britain during 1963 through 1993. For 88 cases of lung cancer and 176 matched control subjects, information on treatment and other risk factors was extracted from hospital case-notes, and odds ratios for lung cancer in relation to these factors were calculated.


RESULTS
Risk of lung cancer was borderline significantly greater in patients treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy than those who did not receive this treatment (relative risk [RR] = 1.66; 95% confidence interval [CI], 0.99 to 2.82), and increased with number of cycles of MOPP (P =.07). Exclusion of lung cancers for which histologic confirmation was not available strengthened these associations (RR = 2.41; 95% CI, 1.33 to 4.51; P =.004 for any MOPP and P =.007 for trend with number of cycles of MOPP). Risks were not raised, however, after chlorambucil, vinblastine, procarbazine, and prednisone treatment. There was evidence that the raised risk of lung cancer occurring in relation to radiotherapy was restricted to histologies other than adenocarcinoma.


CONCLUSIONS
The results suggest that MOPP chemotherapy may lead to elevated risk of lung cancer, at least in certain subgroups of patients. The role of chemotherapy in the etiology of lung cancer after Hodgkin's disease deserves further investigation.
Section of Epidemiology, Academic Unit of Radiotherapy and Oncology, Royal Marsden Hospital, and Royal Marsden National Health Service Trust, Sutton, Surrey, United Kingdom.
A J
AJ
Swerdlow
M J
MJ
Schoemaker
R
R
Allerton
A
A
Horwich
J A
JA
Barber
D
D
Cunningham
T A
TA
Lister
A Z
AZ
Rohatiner
G
G
Vaughan Hudson
M V
MV
Williams
D C
DC
Linch
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008466:Mechlorethamine / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D016609:Neoplasms, Second Primary; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D011344:Procarbazine / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D014750:Vincristine / Q000009:adverse effects* / Q000627:therapeutic use
D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D011241:Prednisone