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Hodgkin Lymphoma Kids Face Greater Risk of Future Problems

Breast cancer leading cause of death for female survivors; cardiovascular events for males

SATURDAY, May 31 (HealthDay News) -- People who survived Hodgkin lymphoma as children have an increased risk of developing and dying from another cancer or cardiovascular disease as adults, according to a new report.

The treatment for Hodgkin -- chemotherapy and radiation -- may help drive these increased risks, according to the researchers.

"The bottom-line message is that a portion of those who survive Hodgkin lymphoma continue to have significant health needs beyond their five-year 'cure' mark," Dr. Sharon Castellino, an assistant professor of pediatrics at Brenner Children's Hospital, part of Wake Forest Baptist Medical Center, said in a prepared statement. "Survivors and their doctors need to be aware of continued risks in adulthood from treatment received more than 20 years ago."

The study, primarily by Wake Forest researchers, was scheduled to be presented May 31 at the annual meeting of the American Society of Clinical Oncology, in Chicago.

Hodgkin lymphoma follows the growth of malignant cells in the lymph system, which is part of the immune system. The disease is considered one of the more curable types of cancer, with 90 percent of patients surviving in the first five years of treatment.

The study followed 1,927 of these five-year Hodgkin survivors who were diagnosed between 1970 and 1986 at a median age of 14 years. Of that group, 320 people died: 30 percent from a recurrence of Hodgkin, 26 percent from a different cancer, and 19 percent from a cardiovascular event such as a heart attack or stroke.

The findings linked an increased risk of premature death in the male survivors to higher doses of chemotherapy, including anthracycline drugs. Among females, radiation therapy -- regardless of dosage -- was associated with the higher death rate.

"It hadn't been clarified until this study that there was a different pattern of risks in men and women," Castellino, a pediatric oncologist, said. "Other than a recurrence of the original cancer, the leading cause of death in women is breast cancer, and for men it is cardiovascular events."

New prevention recommendations, such as earlier health screenings, could result from the findings. "Currently, women who received treatment for the disease are advised to have mammograms as early as 25 years old," she said. "But, currently there are no specific guidelines for heart disease prevention over those for the general population."

Although radiation therapy doses given to children with Hodgkin's have been lowered since the 1980s and techniques have been refined, Castellino said the heart and other critical structures are often exposed to radiation. Hodgkin's often attacks the lymph system in the chest, so radiation usually targets the neck and upper chest area.

More information

The American Cancer Society has more about Hodgkin lymphoma.

-- Kevin McKeever

SOURCE: Wake Forest University Baptist Medical Center, news release, May 31, 2008

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