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Hodgkins Disease Survivors Face Greater Risk of
Stroke, Breast Cancer
Radiation used on chest is suspected cause
Oct. 13, 2005 - Patients surviving childhood
Hodgkins disease suffer strokes later in life at rates about four times
that of the general population, UT Southwestern Medical Center
researchers have found. They suspect the radiation used in treating this
cancer as a cause. Another recent study pointed to radiation causing
women survivors of HD to be at as much as 40 percent greater risk for
breast cancer.
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About Hodgkin's Disease |
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Hodgkin's disease is one
of a group of cancers called lymphomas. Lymphoma is a
general term for cancers that develop in the lymphatic system.
Hodgkin's disease, an uncommon lymphoma, accounts for less than
1 percent of all cases of cancer in this country. Other cancers
of the lymphatic system are called non-Hodgkin's lymphomas. At
this time, the cause or causes of Hodgkin's disease are not
known.
Hodgkin's disease occurs most often in
people between 15 and 34 and in people over the age of 55. It is
more common in men than in women. Brothers and sisters of those
with Hodgkin's disease have a higher-than-average chance of
developing this disease.
National Cancer Institute on Hodgkins Disease |
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Principal investigator Dr. Daniel Bowers, assistant
professor of pediatrics, and other UT Southwestern researchers
identified the link using patient information from a national database
of long-term childhood cancer survivors. The study, which appeared in
the Journal of Clinical Oncology, is available online.
"We were surprised. We knew there was increased
risk of a second cancer - usually breast cancer - and increased risk of
heart failure, but stroke was unexpected," said Dr. Bowers.
Although doctors cure about 70 percent of pediatric
outpatients with cancer, little research had linked strokes later in
life to cancer. Testing that hypothesis on all survivors of childhood
cancer was too impractical, so the UT Southwestern research team
narrowed the field to survivors of Hodgkin disease, a type of lymphoma
that's the second-most common form of childhood cancer.
"The goals are changing to more than just curing
the child of cancer," Dr. Bowers said. "They are to evaluate and reduce
the long-term side effects. It's been well-established that childhood
cancer survivors have several well-described long-term side effects,
including second cancers, learning problems, growth problems and heart
damage."
UT Southwestern is a member of the Childhood Cancer
Survivor Study, a national consortium tracking the long-term effects of
cancer survivors. Children's Medical Center Dallas is also a member and
contributed patients to the study. The National Institutes of
Health-sponsored study involves 27 institutes and the statistical
histories of some 20,000 childhood cancer survivors.
From that database, researchers identified 1,926
people who had survived Hodgkin disease more than five years after being
diagnosed between 1970 and 1986. Dr. Bowers and other researchers
identified 24 Hodgkin disease survivors who later reported a stroke and
compared that to the siblings of cancer survivors, where only nine of
more than 3,800 had suffered strokes. The incidence of strokes - 83.6
per 100,000 person-years for Hodgkin disease survivors and 8.0 per
100,000 person-years for the control group - demonstrated that Hodgkin
disease survivors were at significantly increased risk of suffering a
stroke.
"With the high visibility of stories like Lance
Armstrong, people think that if you're a cancer survivor you're cured,
and you have no further problems, and you can go ride in the Tour de
France," Dr. Bowers said. "And maybe that's true for some people. But we
are clearly recognizing that cancer survivors have unique and long-term
cancer-specific side effects. People are beginning to look at quality of
life."
The UT Southwestern research may support other
studies suggesting the need to reduce the amount of radiation used in
treatments for Hodgkin disease, he said.
"The next generation of studies will be able to
look at the question: Does a reduction in radiation dose cause a
decrease in the frequency of stroke?" Dr. Bowers said. "It certainly
would be a logical expectation, but we don't know that."
Other researchers involved in the study were senior
author Dr. Kevin Oeffinger, a former family practice professor at UT
Southwestern, now with the Memorial Sloan Kettering Cancer Center, and
researchers from UT M.D. Anderson Cancer Center in Houston, the Food and
Drug Administration, the University of Minnesota, St. Jude Children's
Research Hospital in Memphis, Tenn., Stanford University School of
Medicine, Children's National Medical Center in Washington, D.C., and
the Childhood Cancer Survivor Study.
The study was funded by the Department of Health
and Human Services and the Children's Cancer Research Fund.
Breast Cancer Study
The findings on the increased breast cancer risk
for female survivors of HD, which appear in the Journal of the National
Cancer Institute, are based on a study of 3,817 young women who survived
at least 1 year after being diagnosed with Hodgkin's disease between
1965 and 1994.
The risk of breast cancer increased as age at
diagnosis, radiation dose, and duration of follow-up increased. The
risks ranged from 0 percent for a patient diagnosed at 15 years of age,
treated with a limited dose of radiation, and followed for 10 years to
40 percent for someone diagnosed at 30 years of age, treated with a
large dose of radiation, and followed for 30 years.
"This study is the first, to our knowledge, to
estimate the cumulative absolute risk of breast cancer among women
treated for Hodgkin's disease at age 30 years or younger using detailed
information on radiation and chemotherapy," lead author Dr. Lois B.
Travis, from the National Cancer Institute in Bethesda, Maryland, told
Reuters Health.
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