Hodgkin Lymphoma Survivors at High Risk for Second Cancers

Patients who have survived Hodgkin lymphoma were at more than double the risk for diagnosis with a second cancer, according to the results of a recent study. This risk was increased among patients with a family history of certain cancer types, and remained high as long as 30 years after undergoing treatment for the disease.

“Our findings further substantiate the significant cancer risks associated with survivorship from Hodgkin lymphoma and that these are modified by a family history of cancer,” Amit Sud, MBChB, MRes, of the Institute of Cancer Research, United Kingdom, and colleagues wrote in a study published in the Journal of Clinical Oncology. “In addition, our findings are of importance in a primary healthcare setting where many surviving patients with Hodgkin lymphoma are treated (for other symptoms and diseases) after the first 5 years of follow-up.”

Sud and colleagues used data from the Swedish Family-Cancer Project Database. They identified 9,522 individuals diagnosed with Hodgkin lymphoma between 1965 and 2012. They compared the standardized incidence ratios and cumulative incidence of a second cancer in survivors and the standardized incidence ratios of lung, breast, colorectal, and all second cancers in survivors with and without a family history of cancer.

Among this group of survivors, the risk for a second cancer was increased 2.39-fold (95% CI, 2.29–2.53).

“In this study, Hodgkin lymphoma survivors with a family history of colorectal, lung, or breast cancer showed an increased risk of concordant second cancers when compared with Hodgkin lymphoma survivors without a family history,” the researchers wrote.

About 30% of Hodgkin lymphoma survivors in the study had one or more first-degree relatives with cancer. Those survivors with a family history of cancer were 2.8 times more likely to get a second cancer compared with a 2.2-fold increased risk in patients with no first-degree relatives with cancer.

Specifically, the study showed the risk for all second cancers was 1.3-fold high for survivors with a first-degree relative with cancer (P < .001). There was a 3.3-fold increased risk for lung cancer, 2.1-fold increased risk for colorectal cancer, and a 1.8-fold increased risk for breast cancer.

Finally, the researchers found that increased risk for a second cancer was associated with age at diagnosis for women. Among women diagnosed with Hodgkin lymphoma at an age younger than 35, the 30-year cumulative incidence of breast cancer was 13.8%. In comparison, women over 35 when diagnosed had a risk of only 3%.

“After patients are cured, they no longer encounter oncologists, so it’s important that other healthcare providers are aware of the increased risk to Hodgkin lymphoma survivors to improve early diagnosis of second cancers,” Sud said in a press release.