Risk of Second Cancer in Hodgkin Lymphoma Survivors


Key Points

  • Survivors of Hodgkin lymphoma are at substantially increased risk of a second cancer.
  • Risk is further augmented in Hodgkin lymphoma survivors with first-degree relatives with cancer.

In a study in the Swedish population reported in the Journal of Clinical Oncology, Sud et al found an increased risk of second cancers in survivors of Hodgkin lymphoma. Risk was further augmented in those with first-degree relatives with a cancer diagnosis.

Study Details

The study used data from the Swedish Family-Cancer Project Database on 9,522 individuals with primary Hodgkin lymphoma diagnosed between 1965 and 2012. Second cancers diagnosed in the first year after a Hodgkin lymphoma diagnosis were not included in the analysis.

Increased Risk

Compared with the general population, the standardized incidence ratio for a second cancer in Hodgkin lymphoma survivors was 2.39; the greatest contributors to excess risk were non-Hodgkin lymphoma (16.2% of excess risk), lung cancer (14.5%), and breast cancer (12.9%). The standardized incidence ratio for all second cancers remained high at > 30 years after treatment of Hodgkin lymphoma, with patterns of excess risk at different intervals varying according to the site of the second cancer.

For both men (standardized incidence ratios = 4.26 vs 2.08) and women (standardized incidence ratios = 4.61 vs 1.73), increased risk of a second cancer was higher among those diagnosed with Hodgkin lymphoma at age < 35 vs ≥ 35 years. The 30-year cumulative incidence of breast cancer in women diagnosed with Hodgkin lymphoma at age < 35 years was 13.8%. No significant differences in second cancer risk were observed across time periods of diagnosis of 1965–1977, 1978–1988, and 1989–2000.

Effect of Family History

The standardized incidence ratio for a second cancer was higher in Hodgkin lymphoma survivors with a first-degree relative with cancer vs those without (2.83 vs 2.16, P < .001), with 3.3-, 2.1-, and 1.8-fold greater risks found for lung, colorectal, and breast cancers, respectively. Increased risk of a second cancer was correlated with the number of first-degree relatives with a cancer diagnosis, with standardized incidence ratios of 2.67 for those with 1 relative and 3.40 for those with more than 1 relative. Risks for site-specific second cancers were higher in survivors with relatives with vs without the same cancer, including standardized incidence ratios of 11.24 vs 3.39 for lung cancer, 3.71 vs 1.76 for colorectal cancer, and 4.36 vs 2.36 for breast cancer.

The investigators concluded: “[Hodgkin lymphoma] survivorship is associated with a substantive risk of a second cancer. Notably, the risk is higher in individuals with a family history of cancer. This information should be used to inform risk-adapted therapy and to assist in screening to reduce long-term morbidity and mortality in patients with [Hodgkin lymphoma].”

The study was supported by German Cancer Aid, Swedish Research Council, FORTE, an ALF grant from Region Skåne/Lund University, and a clinical fellowship from Cancer Research UK.

Amit Sud, MBChB, MRes, of The Institute of Cancer Research, London, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.