SEX-DIFFERENCES IN RISK OF 2ND MALIGNANT-TUMORS AFTER HODGKINS-DISEASE IN CHILDHOOD

There have been reports of a high incidence of second malignant disord ers in survivors of Hodgkin's disease. We studied the cumulative incid ence of second tumours in 191 children, who were 16 years or younger a t diagnosis, with stage IA-IVB Hodgkin's disease, treated at the Joint Center for Radiation Therapy, Boston, between 1969 and 1988. The 10-y ear actuarial survival was 89 (SE 2)%. The median follow-up time was 1 1 (range 3-21) years from diagnosis. 109 children were initially treat ed with radiotherapy alone, 61 received chemotherapy and radiotherapy, and 21 received chemotherapy alone. Second tumours arose in 15 patien ts 6-20 years after the diagnosis of Hodgkin's disease. The estimated cumulative incidence of second malignant disorders at 1 5 years was 12 (4)% overall. 10 of the second tumours arose among 66 female patients , compared with 5 among 125 male patients (cumulative incidence 24 [9] vs 5 [3]%). The relative risk of a second tumour for female compared with male patients was 4.5 (95% CI 1.4-15.1; p=0.013). For male patien ts, the observed incidence of second tumours was 18 times that expecte d for the normal population (95% CI 6-42), whereas for female patients it was 57 times that expected (27-105). 13 of the second malignant di sorders were solid tumours, including 4 breast cancers. Thus, the risk of a child treated for Hodgkin's disease developing a second tumour i s higher for girls than for boys. The cumulative incidence of second c ancers increases from 10 years after treatment. These findings emphasi se the importance of continued surveillance in patients treated for Ho dgkin's disease.