BREAST-CANCER AND OTHER 2ND NEOPLASMS AFTER CHILDHOOD HODGKINS-DISEASE

Background. Patients who survive Hodgkin's disease are at increased ri sk for second neoplasms, As survival times increase, solid tumors are emerging as a serious long-term complication. Methods. The Late Effect s Study Group followed a cohort of 1380 children with Hodgkin's diseas e to deter mine the incidence of second neoplasms and the risk factors associated with them. Results. In this cohort, there were 88 second n eoplasms as compared with 4.4 expected in the general population (stan dardized incidence ratio, 18.1; 95 percent confidence interval, 14.3 t o 22.3), The estimated actuarial incidence of any second neoplasm 15 y ears after the diagnosis of Hodgkin's disease was 7.0 percent (95 perc ent confidence interval, 5.2 to 8.8 percent); the incidence of solid t umors was 3.9 percent (95 percent confidence interval, 2.3 to 5.5 perc ent), Breast cancer was the most common solid tumor (standardized inci dence ratio, 75.3; 95 percent confidence interval, 44.9 to 118.4), wit h an estimated actuarial incidence in women that approached 35 percent (95 percent confidence interval, 17.4 to 52.6 percent) by 40 years of age, Older age (10 to 16 vs, <10 years) at the time of radiation trea tment (relative risk, 1.9) and a higher dose (2000 to 4000 vs, <2000 c Gy) of radiation (relative risk, 5.9) were associated with significant ly increased risk of breast cancer, The estimated actuarial incidence of leukemia reached a plateau of 2.8 percent (95 percent confidence in terval, 0.8 to 4.8 percent) 14 years after diagnosis. Treatment with a lkylating agents, older age at the diagnosis of Hodgkin's disease, rec urrence of Hodgkin's disease, and a late stage of disease at diagnosis were risk factors for leukemia. Conclusions. The risk of solid tumors , especially breast cancer, is high among women who were treated with radiation for childhood Hodgkin's disease. Systematic screening for br east cancer could be important in the health care of such women. (C) 1 996, Massachusetts Medical Society.