title: High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin's disease: report from the Late Effects Study Group.
abstract: OBJECTIVE
  We present an update of a previously reported Late Effects Study Group cohort of 1,380 children with Hodgkin's disease (HD) diagnosed between 1955 and 1986 in patients aged 16 years or younger. We describe the pattern and incidence of subsequent neoplasms (SNs) occurring with extended follow-up.
  
  
  METHODS
  Median age at diagnosis of HD was 11.7 years (range, 0.3 to 16.9 years) and at last follow-up was 27.8 years. Median length of follow-up was 17.0 years.
  
  
  RESULTS
  An additional 103 SNs were ascertained (total SNs = 212). The cohort was at an 18.5-fold increased risk of developing SNs compared with the general population (standardized incidence ratio [SIR], 18.5, 95% CI, 15.6 to 21.7). The cumulative incidence of any second malignancy was 10.6% at 20 years, increasing to 26.3% at 30 years; and of solid malignancies was 7.3% at 20 years, increasing to 23.5% at 30 years. Breast cancer was the most common solid malignancy (SIR, 56.7). Other commonly occurring solid malignancies included thyroid cancer (SIR, 36.4), bone tumors (SIR, 37.1), and colorectal (SIR, 36.4), lung (SIR, 27.3), and gastric cancers (SIR, 63.9). Risk factors for solid tumors included young age at HD and radiation-based therapy. Thirty-two patients developed third neoplasms, with the cumulative incidence approaching 21% at 10 years from diagnosis of second malignancy.
  
  
  CONCLUSIONS
  Additional follow-up of this large cohort of HD survivors documents an increasing occurrence of known radiation-associated solid tumors, (breast and thyroid cancers), as well as emergence of epithelial neoplasms common in adults, (colon and lung cancers) at a younger age than expected in the general population, necessitating ongoing surveillance of this high risk population.
authors.affiliation: City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010-3000, USA. sbhatia@coh.org
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Jillian M
authors.initials: JM
authors.lastname: Birch
authors.forename: Monica K
authors.initials: MK
authors.lastname: Bogue
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
authors.forename: Cyndi
authors.initials: C
authors.lastname: DeLaat
authors.forename: Franca
authors.initials: F
authors.lastname: Fossati-Bellani
authors.forename: Elaine
authors.initials: E
authors.lastname: Morgan
authors.forename: Odile
authors.initials: O
authors.lastname: Oberlin
authors.forename: Gregory
authors.initials: G
authors.lastname: Reaman
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Ruymann
authors.forename: Jean
authors.initials: J
authors.lastname: Tersak
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States / Q000453:epidemiology