The agony of victory: Girls cured of Hodgkin's face greater risk of breast cancer

December 13, 2001

Researchers have uncovered a tragic consequence associated with children who develop Hodgkin's disease: After successful treatment, girls, in particular, face a higher risk of getting a second malignancy than boys. And breast cancer appears to be a girl's greatest threat for a secondary cancer.

Louis S. Constine, M.D., of the James C. Wilmot Cancer Center of the University of Rochester Medical Center led the research. It was featured at last month's annual meeting of the American Society for Therapeutic Radiology and Oncology Inc.

Scientists are not yet able to explain why the increased risk exists -- although further studies will likely investigate radiation dosages and gender differences in the way children respond to cancer. The secondary cancer risk to girls seems to increase 10 years after the initial diagnosis and treatment of Hodgkin's disease.

Meanwhile, Constine believes physicians should be especially alert to cancer prevention and detection for this group of children. "It is critical that health care providers establish early surveillance programs for any young woman who survives Hodgkin's disease," Constine said. "Girls really require greater surveillance and should begin having mammograms 10 years after treatment."

Constine led a study of 928 children (57 percent males; 43 percent females) who were treated for Hodgkin's disease at five academic medical centers between 1960 and 1990. A form of lymphoma, Hodgkin's afflicts about 5 percent of people who develop childhood cancer. The disease is considered highly curable, with more than 80 percent of children treated successfully by a combination of radiation and chemotherapy. In patients where the cancer is caught early, 90 percent can expect to be cured.

However, the follow-up research showed that children had a 15-fold increased risk for a second malignancy. The risk to girls for breast cancer was a 45-fold increase. Moreover, the research showed that girls who had early stage (I or II) Hodgkin's disease were most likely to develop breast cancer, an outcome that cannot yet be explained.

"The agony of victory in successfully treating Hodgkin's disease is the occurrence of second malignant neoplasms," Constine said. "We know that children with Hodgkin's have a predisposition to other cancers, but that predisposition appears to be augmented by treatment."

Indeed, cancer treatment carries many difficult, long-term side effects. Chemotherapy and radiation can cause heart damage and can interfere with fertility. But the increased possibility of a second cancer has pushed oncologists to review treatment protocols for children.

Already, Constine said, clinicians are lowering radiation dosages -- while still maintaining an effective level of radiation to cure the Hodgkin's -- and doing whatever is possible to exclude breast tissue from radiation to the chest area of girls.
The other medical centers involved in the research were the radiation oncology units at Dana Farber Cancer Institute/Harvard University, Boston; St. Jude Children's Research Hospital, Memphis; The Johns Hopkins Hospital, Baltimore; University of Florida Medical Center, Gainesville.

University of Rochester Medical Center

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