Abstract
The risks of second primary cancer were analysed in 2846 patients with Hodgkin's disease treated within the British National Lymphoma Investigation during 1970-87. The relative risk (RR) of leukaemia was significantly greater in women (RR = 30.1; 95% confidence limits (CL) 13.0-59.5) than in men (RR = 10.9; 95% CL 4.7-21.5), and showed a significant trend of greater risk with younger age at first treatment (P < 0.001). The relative risk of solid cancers was similar between the sexes, but again significantly greater at young than at older ages of first treatment (P < 0.01). Non-Hodgkin's lymphoma relative risks, although not related to sex or age, were significantly related to histology of the original Hodgkin's disease, and were greatest after lymphocyte predominant Hodgkin's disease (RR = 55.6; 95% CL 18.0-129.7). The relative risk of second cancers did not vary significantly according to whether or not splenectomy had been performed. Leukaemia risk was non-significantly greater after splenectomy than with no splenectomy, which accorded with previous evidence of a modest increased risk associated with this operation. If the greater relative risk of solid second cancers after treatment at young than at older ages persists with longer follow-up, the incidence rates of these second primaries in patients treated young for Hodgkin's disease will become very substantial as they age. This emphasises the need to maintain long-term follow-up surveillance of young Hodgkin's disease patients apparently cured of their disease, and to continue to develop new less carcinogenic treatment regimens.
Highlights
Seven were excluded from analysis because they died on the first day of treatment, and did not contribute any person-days at risk
One hundred and thirteen second primary cancers other than Hodgkin's disease occurred in the cohort during followup
8.4 overall relative risk of second cancer in the cohort, compared to expectations derived from general population rates, was 2.7 (95% confidence limits (CL) 2.3-3.3) (Table II)
Summary
The BNLI is a collaborative group of over 60 participating centres in the UK, which has collected detailed data on the diagnosis, therapy and follow-up of lymphoma patients treated at the centres since 1970. The present analyses relate to all BNLI patients with Hodgkin's disease aged 10 years and above first treated between 1 February 1970 and 31 December 1987. Data on all treatments for Hodgkin's disease, both at presentation and for relapses, were available in the BNLI files. Treatments and person-years at risk after incidence of a second primary cancer were excluded from the analyses. Person-years at risk by sex, age and calendar year were calculated to that date, or to death, loss to follow-up or incidence of second primary cancer if these occurred earlier. In analyses of risk in relation to duration since first treatment and in relation to combined modality treatment, person-years and any second cancer in an individual at each moment during follow-up were allocated to the category of the analysis variable that the individual had reached at that time. Absolute excess risks of second cancers were calculated by subtracting the expected from the observed number of cases, and dividing by person-years at risk
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