title: Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years.
abstract: OBJECTIVE
  To quantify the relative and absolute excess risks (AER) of site-specific second cancers, in particular solid tumors, among long-term survivors of Hodgkin's disease (HD) and to assess risks according to age at HD diagnosis, attained age, and time since initial treatment.
  
  
  METHODS
  Data from 32,591 HD patients (1,111 25-year survivors) reported to 16 population-based cancer registries in North America and Europe (1935 to 1994) were analyzed.
  
  
  RESULTS
  Two thousand one hundred fifty-three second cancers (observed-to-expected ratio [O/E] = 2.3; 95% confidence interval [CI] = 2.2 to 2.4), including 1,726 solid tumors (O/E = 2.0; 95% CI, 1.9 to 2.0) were reported. Cancers of the lung (observed [Obs] = 377; O/E = 2.9), digestive tract (Obs = 376; O/E = 1.7), and female breast (Obs = 234; O/E = 2.0) accounted for the largest number of subsequent malignancies. Twenty-five years after HD diagnosis, the actuarial risk of developing a solid tumor was 21.9%. The relative risk of solid neoplasms decreased with increasing age at HD diagnosis, however, patients aged 51 to 60 years at HD diagnosis sustained the highest cancer burden (AER = 79.2/10,000 patients/year). After a progressive rise in relative risk and AER of all solid tumors over time, there was an apparent downturn in risk at 25 years. Temporal trends and treatment group distribution for cancers of the esophagus, stomach, rectum, female breast, bladder, thyroid, and bone/connective tissue were suggestive of a radiogenic effect.
  
  
  CONCLUSIONS
  Significantly increased risks of second cancers were observed in all HD age groups. Although significantly elevated risks of stomach, female breast, and uterine cervix cancers persisted for 25 years, an apparent decrease in relative risk and AER of solid tumors at other sites is suggested.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Executive Plaza South, Suite 7039, Bethesda, MD 20892, USA. doresg@mail.nih.gov
authors.forename: Graça M
authors.initials: GM
authors.lastname: Dores
authors.forename: Catherine
authors.initials: C
authors.lastname: Metayer
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Curtis
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: E Aileen
authors.initials: EA
authors.lastname: Clarke
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Hans
authors.initials: H
authors.lastname: Storm
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Holowaty
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
authors.forename: Tom
authors.initials: T
authors.lastname: Wiklund
authors.forename: Timo
authors.initials: T
authors.lastname: Joensuu
authors.forename: Mars B
authors.initials: MB
authors.lastname: van't Veer
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Mary
authors.initials: M
authors.lastname: Gospodarowicz
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D017677:Age Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D012306:Risk; D013997:Time Factors