Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma.
OBJECTIVE
Hodgkin's lymphoma (HL) survivors are known to be at substantially increased risk of solid cancers (SC). However, no investigation has used multivariate modeling to estimate the relative risk (RR), excess absolute risk (EAR), and cumulative incidence for specific attained ages and ages at HL diagnosis.


METHODS
We identified 18,862 5-year HL survivors from 13 population-based cancer registries in North America and Europe. Poisson regression was used to evaluate the effects of age at diagnosis, attained age, latency, sex, treatment, and year of diagnosis on the RR and EAR of SC.


RESULTS
Among 1,490 identified SC, 850 were estimated to be in excess. For most cancer sites, both RR and EAR decreased with age at HL diagnosis and showed strong dependencies on attained age. For a patient diagnosed at age 30 years and survived to > or = 40 years, modeled risks were significantly elevated for cancers of the breast (RR = 6.1), other supradiaphragmatic sites (RR = 6.0), and infradiaphragmatic sites (RR = 3.7); the largest RR (20-fold) was observed for malignant mesothelioma. Thirty-year cumulative risks of SC for men and women diagnosed at 30 years were 18% and 26%, respectively, compared with 7% and 9%, respectively, in the general population. For young HL patients, risks of breast and colorectal cancers were elevated 10 to 25 years before the age when routine screening would be recommended in the general population.


CONCLUSIONS
Multivariable modeling demonstrates for the first time temporal changes in SC risk not evident in unadjusted analyses, and can facilitate the development of individualized risk assessment and the creation of screening strategies for early detection.
Hodgson
David C
DC
Princess Margaret Hospital, University Health Network, and the Department of Radiation Oncology, University of Toronto, Canada. David.Hodgson@rmp.uhn.on.ca
Gilbert
Ethel S
ES
Dores
Graça M
GM
Schonfeld
Sara J
SJ
Lynch
Charles F
CF
Storm
Hans
H
Hall
Per
P
Langmark
Froydis
F
Pukkala
Eero
E
Andersson
Michael
M
Kaijser
Magnus
M
Joensuu
Heikki
H
Fosså
Sophie D
SD
Travis
Lois B
LB
D000328:Adult; D017677:Age Distribution; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology*; D016012:Poisson Distribution; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors